CD4 count and OIs

1. WHO STAGING (CLINICAL & CD4+ )DR.ALAP MEHTA(SENIOR MEDICAL OFFICER)ART CENTRE ,NEW CIVIL HOSPITAL,SURAT.

2. CD4 count and OIs

3. STAGES OF HIV INFECTION Viral transmission 2-3 wks. Acute Retroviral syndrome 2-3 wks. Recovery + Sero-conversion 2-4 wks. Asymptomatic chronic HIV infection Avg. 8 yrs Symptomatic HIV infection / AIDS Avg. 1.3 yrs

4. WHO STAGE-1 • Asymptomatic OR Generalized Lymphadenopathy OR Acute Retroviral syndrome • Duration is almost 3-5 Years after infection • The symptoms of acute HIV infection usually develop within days to weeks after exposure and usually last less than 14 days. • A quantitative plasma HIV-1 RNA viral load of greater than 50,000 copies per mL in the absence of HIV antibodies establishes the diagnosis of acute HIV syndrome.

5. Acute Retroviral Syndrome • Fever > 80 to 90% • Fatigue > 70 to 90% • Rash > 40 to 80% • diarrhea > 30 to 60% • Lymphadenopathy > 40 to 70% • Pharyngitis > 50 to 70% • Myalgia or arthralgia > 50 to 70% • STDS > 20 to 25%

6. WHO STAGE II • Duration is 2-3 Years • Most common presentations are URTI, Oral Ulcers, Skin manifestations, Weight loss ( <10% of Body Weight) • Usually CD4+ count of the patient is > 350

7.  CLINICAL FINDINGS • Unexplained moderate weight loss (<10% of presumed or measured body weight) • Recurrent respiratory tract infections (sinusitis, tonsillitis, otitis media, pharyngitis) • Herpes zoster • Angular cheilitis • Recurrent oral ulceration • Papular pruritic eruptions • Seborrhoeic dermatitis • Fungal nail infections

8. WHO STAGE III • Most common stage of presentation of the patient to clinician • Usually CD4+ of the patient is between 100 to 350 • Most common presenting complains are 1. Chronic Diarrhea ( > 1 Month & do not responding to conventional Anti - Diarrheal therapy ) , 2. Chronic Fever ( > 1 Month ) , 3. Weight Loss ( > 10 % of the Body weight )

9. CLINICAL CONDITIONS • Unexplained severe weight loss (>10% of presumed or measured body weight) • Unexplained chronic diarrhoea for longer than one month • Unexplained persistent fever (above 37.5oC intermittent or constant for longer than one month) • Persistent oral candidiasis • Oral hairy leukoplakia • Pulmonary tuberculosis • Severe bacterial infections (e.g. pneumonia, empyema, pyomyositis, bone or joint infection, meningitis, • bacteraemia) • Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis

10. WHO STAGE IV • Terminal Stage of the Disease • CD 4+ < 100 • Multi Organ involvement • CNS Manifestations are occurs in this stage

11. CLINICAL FINDINGS GENERALISED CONDITIONS • HIV wasting syndrome GASTROINTESTINAL • Oesophageal candidiasis • Chronic cryptosporidiosis • Chronic isosporiasis • Abdominal Koch’s RESIRATORY TRACT • Pneumocystis pneumonia • Recurrent severe bacterial pneumonia • Candidiasis of trachea, bronchi or lungs • Histoplasmosis ( Continue)

12. CENTRAL NERVOUS SYSTEM • Central nervous system toxoplasmosis • HIV encephalopathy • Cryptococcosis meningitis • Progressive multifocal leukoencephalopathy • TB meningitis OTHERS • Symptomatic HIV-associated nephropathy • Symptomatic HIV-associated cardiomyopathy • Lymphoma (cerebral or B cell non-Hodgkin) • Invasive cervical carcinoma • Kaposi sarcoma

13. SPECIAL COSIDERATION Following diseases can present irrespective of CD4+ cell count level • Tuberculosis • Candidiasis • Herpes Zoster • STDs

14.  WHEN TO START ART

15. STOP AIDS. KEEP THE PROMISE.  THANK YOU