Summary for Alan & Bill =)

AIDS VS HIV
AIDS
Official criteria- HIV-infected people who have fewer than 200 CD4 T cells.
HIV infection
Case definition- Adults, adolescents, or children aged ≥ 18 months, Children aged ≤ 18 months
Notifiable diseases
These are some of the notifiable diseases: AIDS, HIV infection, Cholera, Malaria, Measles, severe acute respiratory syndrome
Incidence and Prevalence
The number of cases reported in the world increases by year. In Malaysia, majority of the cases reported are male. (more will be shown during presentation)
Etiology
There are 3 major routes of transmission of the HIV(Sexual Transmission, Transmission via blood or blood products, Mother to Child Transmission)
The risk of transmission via tears, urine and saliva is considered to be negligible
Pathophysiology
• Entry to host cells (CD4+ lymphocytes, macrophages and monocytes) using gp120 with the help of chemokine co-receptors.
• Life cycle of HIV (8 stages):
1. Viral binding
2. Entry and Uncoating
3. Reverse transcription
4. Integration into host chromosomal DNA
5. Synthesis of viral DNA
6. Translation and production of Viral proteins
7. Assembly of virus and budding from the host cell
8. Maturation
• Then the virus is ready for infection
Investigation and Diagnosis
• HIV Antibody Testing :
-Detects HIV antibodies in blood or other body fluids
weeks after exposure or an HIV RNA test (viral load)
>detects the presence of the virus
• ELISA - (Enzyme-linked Immunosorbent Assay Test)
-A common serological test for the presence of particular antigens or antibodies (Serum)
-Direct and indirect
• Western Blot Test
• Home Collection Kit
• HIV Viral Load
• p24 Antigen Count Test
• CD4 Count
-measurement of how many functional CD4 T-cells are circulating in the blood.
Modes of transmission
• Having vaginal or anal sex without a condom with someone who is infected.
• Having contact with the blood of someone who has HIV. This could be having a blood transfusion from someone who is infected with HIV
• From a mother who has HIV to her baby: HIV can pass to the baby during pregnancy, during the birth of the baby, or through breast-feeding. Only about one in three babies born to HIV-positive mothers get HIV.
• Receiving an injection from an unsterilized needle that was previously used by someone with HIV.
• Heterosexual transmission is the route by which most people with AIDS have become infected with HIV worldwide
This category of AIDS cases is also among the most rapidly increasing.
Signs and Symptoms of HIV infection
Symptoms Early After Infection - Acute HIV : fever, headache, muscle and joint pain, sore throat, rash, diarrhea.
Later Symptoms Of HIV Infection
it takes about eight to nine years between the time of infection and the appearance of later symptoms, although this varies from person to person.
These symptoms signal that immune system function is deteriorating, due to declining numbers of CD4+ T cells
Symptoms of the Immune System: Swollen lymph nodes in the neck, axilla, or groin (lymphadenopathy), fever / night sweats
Symptoms of the GI Tract : Rapid weight loss, Diarrhea, Poor appetite, Profound fatigue
Respiratory Symptoms
usually occur later in course of the disease
Any cough or shortness of breath could be a sign of bacterial pneumonia or pneumocystis (carinii) jiroveci pneumonia (PCP).
Shortness of breath
Dry cough / productive cough
Symptoms of the Skin and Mucous Membranes
result of infection by other viruses, fungi or bacteria. Often, these infections involve the skin or mucous membranes (for example, inside the mouth).
HIV Effects on Dental Health
Skin rash
Genital sores (sores around the penis or vagina)
Red, brown, pink or purple lesion on the skin - suggestive of Kaposi's sarcoma
White patches on the tongue, inside of the mouth, or gums - could be signs of thrush, candida, or hairy oral leukoplakia
Canker sores / apthous ulcers
Neurological / Emotional Symptoms
Depression
Numbness, tingling, or burning in the feet, hands, or face. (peripheral neuropathy)
Confusion, weakness, or changes in level of consciousness
memory loss
Blurred vision
Complications
Bacterial
- Pneumonia
- Mycobacterium avium complex
- Tuberculosis
- Salmonellosis
Viral
- Cytomegalovirus
- Viral hepatitis
- Herpes simplex virus
- Human papillomavirus
Fungal infections
- Candidiasis
- Cryptococcal meningitis
Parasitic
- Pneumocystis carinii pneumonia
- Toxoplasmosis
- Cryptosporidiosis
Cancers
- Kaposi’s sarcoma
- Non-Hodgkin’s lymphoma
Neurological complications
Management and Treatment
Counsellingproper counselling before and after testing with informed consent especially patients tested positive to address issues such as stigma and the fear of disclosure of one's HIV status
Support Groups
Initiation of Antiretroviral Therapy (Antiretroviral drug treatment)
Combination Therapy (combination of 2 or more drugs)
Home based care (patient staying at homeable to work and do daily chores)
Traditional/Alternative Medicine
Prevention
Effective HIV prevention interventions include
• Condom use, Male circumcision, Provision of clean injecting equipment, Opioid substitution therapy, treatment of sexually transmitted infections, HIV testing and counselling, A set of interventions to prevent mother-to-child transmission of HIV, Sex education
In health care settings, transmission of HIV can be prevented through
• primary prevention measures
• secondary prevention measures
In addition, there is increasing evidence indicating that
• antiretroviral therapy programmes
• Current research on new prevention technologies such as microbicides, topical and oral antiretroviral pre-exposure prophylaxis
HIV prevention - combination behavioural change approach has been
• Abstinence, including delay of sexual initiation or debut
• Being safer by being faithful to one’s partner or reducing the number of sexual partners, and
• correct and consistent Condom use.
Legal and Ethical Issues
o Consent for medical examination and treatment
o Prenatal HIV Testing
 Recommended by Institute of Medicine Panel:
o Confidentiality
 Exception
o The Doctor & The Law Courts
o Release of Information to a third party