1
L2
HIV/AIDS
D. Haider
HIV
There are two types of HIV virus HIV 1 and HIV 2 ,most cases are caused by type 1 ,the
2 types are indistinguishable clinically BUT HIV2 appeared to be less easily transmitted
than HIV1 and slower to progress to AIDS.
Most cases are due to type1.
Modes of transmission
1. Sexual.
2. Perinatal.
3. Parenteral (occupational and intravenous drug injection).
4. Blood transfusion.
5. Organ donation.
Pathophysiology
HIV can infect numerous cell types, most significantly CD4 T-helper lymphocytes. HIV
integrates into the host cell genome, and long-lived cells can serve as a reservoir of virus, which
contributes to the challenge of developing a cure for HIV infection.
Replication of HIV contributes to early death of T cells, depletion of CD4 cells, and
immunocompromised, resulting in increased risk for opportunistic infections and development
of AIDS.
Natural History: Acute HIV
Most persons who develop HIV infection experience an acute symptomatic illness, referred to
as acute retroviral syndrome, within a few weeks of acquiring the infection.
Severity varies, but presentation is most often consistent with an infectious mononucleosis
syndrome.
Differential diagnosis
Includes acute infection with Epstein-Barr virus, cytomegalovirus, influenza, and a hepatitis
virus and syphilis.
Patients with acute infection may not yet be producing antibodies against HIV antigen (the
“window period”), which results in negative results on traditional HIV serologic testing.
Therefore, diagnosis of acute HIV infection during this time period relies on detecting the virus
by RNA polymerase chain reaction or p24 antigen testing.
Because levels of virus are usually very high in patients with acute infection, treatment is
recommended to reduce the rate of transmission and possibly to reduce the progression of
disease.
2
SYMPTOMATOLOGY OF ACUTE HIV:
Fever.
Lymphadenopathy.
Pharyngitis.
Rash.
Myalgia/arthralgia.
Diarrhea.
Headache.
Nausea/vomiting.
Hepatosplenomegaly.
Oral thrush.
Weight loss.
Neurological symptoms.
Whether patients with acute HIV infection are treated or not, signs and symptoms of infection
resolve and the disease enters a chronic stage. Although patients may be asymptomatic for
years, active viral replication and destruction of CD4 T-helper lymphocytes continue
Symptomatology of chronic HIV:
1. Lymphadenopathy.
2. Fatigue.
3. Fever/Night Sweats.
4. Weight Loss.
5. Chronic Diarrhea.
6. Oral Aphthous/Periodontitis'//Gingivitis/Oral Hairy Leukoplakia.
7. Peripheral Neuropathy.
8. Leucopenia, Anemia, Thrombocytopenia.
9. Nephropathy.
10. Onychomycosis/Psoriasis/Tinea/Seborrheic Dermatitis.
AIDS definition
AIDS is diagnosed when certain indicator opportunistic infections or malignancies develop or
when the CD4 Cell count falls below 200/μL. Even before reaching this cell count level,
however, patients may develop recurrent or refractory infections, such as vaginal candidiasis,
oral or genital herpes simplex virus infection, Pneumococcal pneumonia and herpes zoster.
Laboratory tests to diagnose HIV:
1) ELISA.
2) P24 antigen test.
3) PCR.
4) HIV culture.
3
Initial evaluation of patient with HIV:
1. Repeat HIV tests if no documentation.
2. HIV resistance tests at baseline and after treatment failure.
3. Quantitative HIV RNA test (viral load).
4. T cells subsets (CD4 COUNT).
5. Complete blood count with differential.
6. Chemistries: liver function, renal function, fasting glucose.
7. Fasting lipid profile.
8. Urinalysis.
9. Serology for hepatitis A,B and C.
10. SEROLOGY for toxoplasmosis.
11. Tuberculin skin test, interferon gamma release assay.
12. Pap smear.
13. Tests of syphilis, other sexually transmitted diseases.
Mubark A. Wilkins