ACQUIRED IMMUNODEFICIENCY pdf - د. ناديا

ACQUIRED IMMUNODEFICIENCY

SYNDROME ICD-10 B20-B24

(HIV infection, AIDS)

Dr. Nadia Aziz

C.A.B.C.M.

Community medicine department

Baghdad medical college

Objective

1- Define the acquired immunodeficiency
syndrome

2- Identify the causative agent

3- Identify the mode of transmission & the high
risk group

4- Identify the ways of prevention & management

Introduction

Acquired Immunodeficiency syndrome (AIDS) is
a term first used in 1981 by epidemiologists
concerned about the emergence of a cluster of
diseases associated with

loss of cellular

immunity in adults

who had no obvious reason

for presenting such immune deficiencies.

Introduction

AIDS

is the late clinical stage of infection with the

human immunodeficiency virus (

HIV

). Within weeks to

months after infection with HIV, many persons develop
an

acute self-limited mononucleosis-like

illness lasting

for a week or two.
They may then be free of clinical signs or symptoms for
months or years before other clinical manifestations
develop.

Introduction

More than a dozen

opportunistic infections

and

several

cancers

were considered to be

sufficiently

specific

indicators of the underlying

AIDS.

Other Presentations

Includes:

Tuberculosis

pneumococcal disease

and non-

typhoid

salmonellosis

, which are not

diseases of high virulence.

Bacterial pneumonia

is one of the commonest

presentations.

Diagnosis

All HIV-infected persons are regarded as AIDS
cases if:
1- CD4 cell count of

under

200/mm3

2- CD4 T-lymphocyte percentage of total
lymphocytes

under 14%,

regardless of clinical

status.

Diagnosis

The most commonly used screening test:
1-

EIA or ELISA

is highly sensitive and specific.

Western blot test

detectable

antibodies

within 1–3 months after

infection
3-

HIV antigen

PCR

tests to detect viral nucleic acid sequences..

Diagnosis

Passively

transferred maternal anti-HIV

antibodies often cause

falsely positive

anti-HIV

EIA tests in these children even up to the

age of 15 months.

Case-fatality

In the absence of effective anti-HIV treatment,
the AIDS case-fatality rate is

high

Survival time in many developing country
studies is often under

year,

In industrialized countries 80%–90% of
untreated patients used to die within

3–5

years

after diagnosis.

Infectious agent

Human immunodeficiency virus (HIV), a

retrovirus

Two serologically and geographically distinct types
with similar epidemiological characteristics,

HIV-1 and HIV-2.

The pathogenicity of HIV-2 may be

lower

than that

of HIV-1

Occurrence

AIDS was first recognized as a distinct clinical
entity in 1981.
Of the estimated 40 million persons (34–46
million) living with HIV infection or AIDS
worldwide.
The largest elements were estimated at 25–28.2
million in

sub-Saharan Africa.

sub-Saharan

Africa, AIDS is called "

slim disease

Occurrence

Globally, AIDS caused an estimated

3.1 million deaths in 2003 (2.5–3.5 million)

Reservoir

Humans HIV is thought to have recently
evolved from chimpanzee viruses.

Mode of transmission

Person to person

transmission through

1- Unprotected (heterosexual or homosexual)

intercourse

2- Contact of

abraded skin

or mucosa with body

secretions such as blood, CSF or semen.
3- The use of HIV-

contaminated needles

4- Transfusion of

infected blood

or its components

5- The

transplantation

of HIV-infected tissues or organs.

Mode of transmission

the presence of a concurrent sexually
transmitted disease, (ulcerative) can

facilitate

HIV transmission.

Mode of transmission

6- HIV transmitted from mother to child (MTCT or

vertical transmission

From 15% to 35% of infants born to HIV-positive
mothers are infected through

placental processes

birth.

HIV-infected women can transmit infection to their
infants through

breast-feeding

and this can account for

up to half of mother-to-child HIV transmission.

Incubation period

Variable.
The time from infection to the development of
detectable antibodies is generally

1–3 months

The time from HIV infection to diagnosis of
AIDS range from

less than 1 year to 15 years or

longer.

HIV infection, AIDS

The

only factor

that has been shown to affect

progression

from HIV infection to the

development of AIDS

age

at initial infection

adolescent and adults (males and females) who
acquire HIV infection at an

early age

progress

to AIDS

more slowly

than those infected at an

older age.

Period of communicability

Begins

early

after HIV infection and extends

throughout life

Infectivity increases:
1- During the

first months

2- With

viral load

3- With

worsening clinical status

4- With the presence of

other STIs

Susceptibility

Factors increase susceptibility

1- Presence of

other STIs

(ulcerative)

Not being circumcised

for males, a factor

possibly related to the general level of penile
hygiene.

Interaction with other infections

1-The major interaction is with

Mycobacterium

tuberculosis infection

Persons with latent tuberculous infection who

are infected with HIV develop clinical
tuberculosis at an increased rate.

Lifetime risk of developing tuberculosis is

multiplied by a factor of 6–8

Interaction with other infections

2- Other adverse interactions with HIV infection

include

pneumococcal

infection, non-Typhiod

salmonellosis

, falciparum

malaria

and

visceral

leishmaniasis

Methods of control

A- Preventive measures

Public and school health education

must stress

that having multiple and especially concurrent
and/or overlapping sexual partners or sharing
drug both increase the risk of HIV infection.

Programs for school-age youth

should address the

needs and developmental levels of both

students and those who do not attend school.

Preventive measures

2) The only absolutely sure way to avoid
infection through sex to

abstain

from sexual

intercourse or to engage in mutually

monogamous sexual

intercourse only

In other situations,

latex condoms

must be

used correctly

Preventive measures

3) Expansion of facilities for

treating drug users

reduces HIV transmission.

Preventive measures

4) HIV

testing and counselling

for:

a) persons who are ill or involved in

high-risk

behaviors

b) attenders at antenatal clinics, to diagnose

maternal

infection

c) couple counselling (

marital or premarital

)

d) confidential HIV counselling and testing for the
“

worried well

”.

Preventive measures

5) All donated units of blood must be tested for
HIV antibody, only donations testing negative can
be used.
People who have engaged in behaviors that place
them at

increased risk of HIV infection should not

donate

plasma, blood, organs for transplantation,

tissue or cells (including semen for artificial
insemination).

Preventive measures

6) Care must be taken in handling, using and

disposing of needles or other sharp instruments

Health care workers should wear latex gloves,
eye protection and other personal

protective equipment in order to avoid contact
with blood or with fluids.

Preventive measures

7) WHO recommends

immunization of

asymptomatic HIV infected children

with the

EPI vaccines.

Those who are symptomatic

should not

receive

BCG vaccine.

B. Control of patient, contacts and the

immediate environment:

Report

to local health authority: Class 2

2) Isolation: Isolation of the HIV-positive
person is

unnecessary

, ineffective and

unjustified.

B. Control of patient, contacts and the

immediate environment:

3) Notification of contacts and source of

infection: The infected patient should

ensure

notification of sexual and needle sharing

partners whenever possible

Notification by the health care provider is

justified only when the patient, after

counselling, still refuses to notify his/her

partner(s), and this will not harm the index

case.

B. Control of patient, contacts and the

immediate environment:

Prior to the development of relatively effective
antiretroviral treatment
1-

Prophylactic

use of oral trimethoprim-

sulfamethoxazole, with aerosolized pentamidine is
recommended to prevent P. carinii pneumonia.
2-

All HIV

infected persons should do

tuberculin

skin tests

and be evaluated for active TB.

B. Control of patient, contacts and the

immediate environment:

3- If active TB is found,

anti tuberculosis

treatment

should be given.

If no active TB is found, patients who are

tuberculin-positive

or were

recently exposed

should be offered

preventive treatment

with

isoniazid for 12 months

Treatment

AIDS must be managed as a chronic disease,

antiretroviral treatment is complex

involving a

combination of drugs

resistance

will rapidly appear if a single drug is

used.

The drugs are toxic

and

treatment must be lifelong

Treatment

A successful treatment is not a cure

, although it

results in suppression of viral replication.

In general, a

protease inhibitor

and

two

non-nucleoside reverse transcriptase inhibitors

should be used initially.

Post Exposure Prophylaxis

The factors to consider before recommending post
exposure prophylaxis (PEP) includes:

1- The

nature

of the exposure

2- Whether the exposed worker might be

pregnant

3- The local occurrence of

drug resistant

HIV strains.

Post Exposure Prophylaxis

Include a basic

4-week regimen

of two drugs

(zidovudine and lamivudine) for most HIV
exposures
An expanded regimen that includes the
addition of a protease inhibitor (indinavir or
nelfinavir)

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