DR Anil Sabharwal MD
DR Anil Sabharwal MD
Dr Anil Sabharwal MD
• AIDS was first recognized in the United States in the summer
of 1981,
• Unexplained occurrence of Pneumocystis carinii pneumonia
in five previously healthy homosexual men in Los Angeles
• Kaposi's sarcoma (KS) in 26 previously healthy homosexual
men in New York and Los Angeles.
• Within months, the disease became recognized in male and
female injection drug users (IDUs) and soon thereafter in
recipients of blood transfusions and in hemophiliacs.
• It became clear that a microbe transmissible by sexual
(homosexual and heterosexual) contact and blood or blood
products was the most likely etiologic agent of the epidemic
• In 1983, HIV was isolated from a patient with
lymphadenopathy
• 1984 it was demonstrated clearly to be the causative
agent of AIDS.
• In 1985, a sensitive enzyme-linked immunosorbent assay
(ELISA) was developed,
AIDS
• 1st recognized in US 1981
• In 1983, HIV was isolated from a patient
with lymphadenopathy,
• In 1984 it was demonstrated clearly to be
the causative agent of AIDS.
• In 1985, a sensitive enzyme-linked
immunosorbent assay (ELISA) was
developed
HIV I & II
• HIV, which belongs to the family of human retroviruses –RNA
virus-HIV-1 (subtypes A,B,C,D,AE )and HIV-2,
HIV2 –differs from HIV 1-
• patient has lower viral load
• Slower CD-4 decline,
• Lower rate of viral transmission
• Slower progress to AIDS
TRANSMISSION:
• Major route heterosexual(>75%)
• HIV is transmitted by homosexual & heterosexual contact
• Blood and blood products-lab workers;
• Infected mothers to infants either intra partum,
perinatally, or via breast milk.
• There is no evidence that HIV is transmitted by casual
contact or that the virus can be spread by insects, such as
by a mosquito bite.
• World wide there are 40 million persons infected with
HIV
CD4 & CD8 cells
• After entry HIV is transported to LN via CD4
cells
• CD4 cells (helper inducer) are responsible for cell
mediated immunity
• Any ↓ in CD4 count→ opportunistic infection &
onchogenic virus related tumors
• ↓CD4 cells is correlated with virus load
• CD8 cytotoxic T cells bind & Lyse infected CD4
cells
• B lymphocyte ¯ophages are also
infected→↓ humoral immunity
• CD4 count provides important prognostic
information
Clinical features of primary infection
• Many patients with HIV infection remain
asymptomatic with a mean time of 10 years
between exposure development of AIDS
• However hairy lucoplakia & oral thrush should
raise suspicion of HIV
• Fever with rash
• Pharyngitis with cervical lymphadenopathy
• Myalgia/arthalgia
• Headache
• Mucosal ulceration
• Fever, night sweats, weight lost
Pneumocystitis pneumonia is most
common opportunistic infection associated
with AIDS & is difficult to diagnose
because symptoms –fever, cough &
dyspnea are nonspecific
• Diagnosis-chest X-ray-diffuse or perihilar
infiltrates
CNS
• Toxoplasmosis-most common
• AIDS dementia complex
• Cryptococcus meningitis
• HIV myelopathy
• progressive multifocal leucoencephalopathy
Others
• Myopathy
• Retinitis
• Oral lesion-candidiasis or hairy leucoplakia
• GIT-candidal esohagitis,hepatic dis
• Endocrinal-hypogonadism
• Skin-Herpes simplex,, herpes zoster,
mmolluscum contagiosum
HIV related malignancies
• Kaposi sarcoma
• Non-Hodgkin’s lymphoma
• Primary lymphoma of brain
• Non-invasive cervical carcinoma
Lab investigations
• HIV-ELISA-screening test,15% +ve in 3 weeks, 95%
in 6wks
• Western blot-confirmatory test,
• HIV rapid antibody test-screening test
• CBC-anemia, neutropenia, thrombocytopenia
• Absolute CD4 count risk of opportunistic infection or
malignancy ↑ when CD4<200cells/mcl
• CD4 lymphocyte percentage-risk↑ if %<20 %
• HIV viral load tests-measure amouunt of actively
replicating virus
Prevention-Primary
• No vaccine
• Education
• Effective precautions regarding sexual practices
• Injection use
• Screening of blood products
• Perinatal HIV prophylaxis practice
• Precautions for lab technicians & blood handlers
Secondary prevention
• AIDS develops in 10 years in 50 % of sero
positive persons in untreated patients
• ↓in incidence of A IDS reflecting successful
treatment of HIV & successful HIV
prevention is reported in USA & Europe
• Prophylactic regimen can prevent
opportunistic infection & improve survival
HIV risk for health care professional