| ID | 217 |
|---|---|
| Name | HIV INFECTION & AIDS |
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| Signs Symptoms | |
| Diagnosis | Diagnosis: 1. ELIS A test (for screening purpose)- diagnosis is confirmed by detection of antibodies to HIV by ELISA test. Blood specimen should be handled carefully. It becomes positive with 5 months of infection. 2. Western blot test- for confirmation. 2. Detection of virus- by circulating viral protein assays. 3. Complete Blood count (CBC)- usually anemia, neutropenia and thrombocytopenia are found in advanced HFV infection, 4. Absolute CD4 lymphocyte count and percentage- a person with a positive HIV serology and a CD4 lymphocyte count below 200 cells/ul or a CD4 lymphocyte percentage below 14% is to be considered as a patient of AIDS |
| Investigations | |
| Management | Management: The mortality rate of AIDS is over 50% and the underlying condition appears to be incurable. There is no specific therapy for HIV infection although certain antiviral drugs (such as zidovudine) are available now-a-day, which can only suppress the viruses. The managemntt of AIDS therefore divided into four phases- i. symptomatic treatment, ii. prophylaxis & treatment for secondary opportunistic infections & diseases including malignancies, iii. treatment with hemoatopoietic factors & iv. antiretroviral treatment. Antiretroviral treatment- The antiretroviral agents that are in clinical use now a day, play their role by suppression of HIV replication. A considerable suppression of HIV replication may cause partial immunologic reconstitution & improvement of immunosuppression. As a result, the patients get stabilization and improvement of clinical course of the disease. Initiation of antiretroviral therapy depends on different clinical situations. Such as, an adult patient should be initiated therapy only when any of the following indications is present- - symptomatic HIV disease - CD4 counts < 350 cells/ul - very rapidly falling CD4 count - high viral load (> log 4)3 There are several guidelines and treatment frameworks developed (e.g PACT framework, BHIVA guidelines) for retroviral therapy. The starting drug regimen and whether mono- or combination therapy is to be given must be individualized depending on the clinical condition of the particular patient.3 The antiretroviral drugs available now-a-day, are classified into three main categories 1- 1. Nucleoside & nucleotide reverse transcriptase inhibitors-a. Zidovdine b. Didanosine c. Zalcitabine d. Stavudine e. Lamivudine f. Abacavir g. Adefovir 2. Nonnucleoside reverse transcriptase inhibitors-a. Nevirapine & b. Delavirdine 3. Protease inhibitors-a. Indinavir b. Nelfinavir c. Ritonavir d. Saquinavir Note: The detailed management and treatment approaches of AIDS are no more discussed here. Our respected readers are requested to consult any of the dependable text book of medicine. Prevention: No vaccine is yet available. 1. Education and behavior modification are the corner stones of prevention. 2. Ethical sexual practice is essential. Sexual promiscuity & anal intercourse must be prevented successfully. 3. The counselling of persons found to be antibody positive. 4. Universal precaution should be taken during handling of blood, blood products & body fluid etc. 5. Screening of donated blood & blood products for HIV antibody. 6. Intravenous drug users, their heterosexual partners, their children will require intensive efforts aimed to treatment of drug abuse together with behavioral modification. |
| Introduction | The Acquird Immunodeficiency Syndrome (or AIDS) was first recognised in 1981 in USA, and the association of human immunodeficiency virus (HTV) as the cause of development of AIDS was established later on in 1984. Initially, some cases of severe opportunistic infections e.g pneumocystis carinii pnejftnonia and unusual neoplasms, such as Kaposi’s sarcoma, which can only be seen in severely immunocompromised patients i.e in defective cell-mediated immunity- were found in some previously healthy homosexual individuals in the absence of any known cause of underlying immune defects (such as iatrogenic immunosupression e.g chemotherapy patients, or malignant neoplasm, or severe malnutrition), this condition was then eventually recognised as the ‘acquird immunodeficiency syndrome1 or AIDS. After finding of HIV infection as the cause of AIDS, different stages of the disease have been described later on, such as a healthy individual with seropositive HIV infection at one end of the disease spectrum & severe opportunistic infection or unusual neoplasm like Kaposi’s sarcoma at the other end. In 1987, a definition of AIDS was described, which included 23 opportunistic infections (such as pneumocystis pneumonia) and unusual neoplasms (like Kaposi’s sarcoma), with loss of weight, diarrhea, dementia and a positive HIV infection. In 1993 CDC (Center for Disease Control and Prevention) expanded the AIDS definition, and added that, a person with a positive HIV serology and who have ever had a CD4 lymphocyte count below 200 cells/ul or a CD4 lymphocyte percentage below 14% is to be considered as a patient of AIDS.1 The term” AIDS-related complex” (ARC) had been used in the early period to indicate the HIV-infected patients who were symptomatic but did not justify the CDC definition of AIDS, and were heterogeneous, with variable clinical problems and prognoses- so this term is now avoided |
| History | |
| Etiology | Etiology: AIDS is caused by infection with human retroviruses known as ‘human immunodeficiency vims’ (or HIV or HIV-1). Besides classic AIDS virus, a group of related viruses designated as HTV-2 - found in some West African patients having same genetic organization as HIV-1, but significantly different glycoprotein contents, manifested AIDS-like illnesses in some patients, but most cases found asymptomatic. Mode of transmission: 1. Sexual contact is the major mode of transmission of HTV. About 60% are homosexual or bisexual. 2. Intravenous route- about 20% of patients are heterosexual men and women intravenous drug users, and is related to the sharing of needles. About 7% are homosexual or bisexual men, who are also using intravenous drugs. Transfusion of contaminated blood & blood products, if not screened or treated, may be a significant way of AIDS transmission. 3. Infected mothers are efficiently (30-40%) transmit the virus to their infants perinatally during the first and second trimester. Virus can also be transmitted from mother to infant via breast feeding. Incubation period:3 Incubation period is about 2-4 weeks following infection. |
| Clinical Features | Clinical manifestations: The majority of individuals experience no recognizable symptoms or signs at the time of initial infection by human immunodeficiency virus (HTV) but some patients develop an acute illnes, characterised by fever, rigor, night sweats, arthralgia, myalgia, urticaria, abdominal cramps, diarrhoea and aseptic meningitis. The syndrome lasts 2-3 weeks and resolves spontaneously. Certain patients develop persistent generalised lymphadeno-pathy, otherwise asymptomatic. Some patients present with fever, weight loss, fatigue, persistent skin rash, herpes simplex, oral thrush (constitutional disease) etc. 40-60% of patients with AIDS manifest neurologic disfunction like cryptococcal meningitis, CNS toxoplasmosis, cytomegalovirus infection, CNS Most common clinical manifestations of AIDS are opportunistic infection, in which pneumocystic carinii pneumonia is the most common (80%) one. But tuberculosis, viral infections (cytomegalo, herpes simplex, herpes zoster) and toxoplasmosis may also occur. There is a greatly increased risk of Kaposi’s sarcoma of the skin & viscera. |
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