HIV / AIDS HUMAN IMMUNODEFICIENCY Virus (HIV) ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

HISTORICAL ASPECTS AIDS was first recognized in mid 1981 ( in homosexual men with K.S ,P.C.P, in U.S) 1983 : Cytopathic retrovirus was isolated from persons with AIDS By 1985 : Serologic tests to detect evidence of infection with HIV had been developed and licensed

Cause of distribution Involvement of immune system (CD4 positive lymphocyte) Asymptomatic patient

CLINICAL MANIFESTATIONS OF HIV / AIDS CLINICAL CATEGORIES : Group A : Asymptomatic ; Acute infection (acute mononucleosis-like illness) ;PGL Group B : Symptomatic HIV disease Group C : AIDS Indicator conditions

CLINICAL MANIFESTATIONS OF HIV / AIDS The CD4+ levels : 1) CD4+ > 500 2) CD4+ : 200-499 3) CD4+ < 200/mm

Type of clinical manifestation Acute Retroviral Syndrome Immunological response to chronic infection : LAP , PLT , AIDS Dementia Opportunistic diseases

Acute Retroviral Syndrome 20 – 60% of infected persons 1 – 6 weeks ( 3 w ) Mononucleose like syn. Fever sweat myalgia anorexia nausea diarrhea non exudative pharyngitis

Acute Retroviral Syndrome Exanthem (maculopapular)

Acute Retroviral Syndrome Lymphadenopathy

Acute Retroviral Syndrome Rash Lymphadenopathy Aseptic meningitis Encephalitis Peripheral neuropathy

Acute Retroviral Syndrome Viral load  Total Lymphocyte count  CD4+  CD8+  P24 Ag 75% pos. Ab (ELISA) neg.

Acute Retroviral Syndrome Differential Diagnosis Infectious mononucleosis Syphilis Measles Rubella HSV Viral Hepatitis

Persistent Generalized Lymphadenopathy 2 extra inguinal lymphadenopathy 3 – 6 months In 75% HIV/AIDS Follicular hyperplasia

Constitutional & Wasting Befor AIDS phase Fatigue , night sweat Fever (low grade) Diarrhea Wasting >10% weight loss

Oral Lesion Oral Aphthous

Oral Lesion Hairy Leukoplakia

Oral Lesion Necrotizing Ulcerative periodentitis

Cutaneous Manifestation Staphilococal Folliculitis

Cutaneous Manifestation Herprs Zoster

Cutaneous Manifestation Kaposi’s Sarcoma

Renal manifestation HIV nephropathy Proteinuria  serum creatinin Focal & segmental glomerulo sclerosis

Ocular Complication CMV Retinitis Acute Herpetic Necrotizing Retinitis Toxoplasmic Chorioretinitis

Pulmonary Complication Pneumococal Aspergiloma H.Influenae Gram neg. bacillary TB MAC PCP

Neurologic Manifestation Cognitive Dysfunction Focal Lesion Meningitis & Encephalitis Peripheral Neuropathy Myelopathy

Esophagitis: Candida, CMV, HSV GI Manifestation Esophagitis: Candida, CMV, HSV

GI Manifestation Diarrhea CMV Cryptosporidium MAC Closteridium Difficile Salmonella Isospora

Malignancies in HIV infection Kaposi’s Sarcoma Non-hodgkin Lymphoma

Lab. Diagnosis

INDIRECT TESTS: Elisa Western blot DIRECT TEST: PCR P24Ag

تعريف مورد HIV+: در بزرگسالان: در نوزادان: يك آزمايش الايزا و يك آزمايش وسترن بلات مثبت درافرادي كه به طور مستمر درخطرهستند، تكرار آزمايش هر شش ماه يك بار در نوزادان: آزمايش PCR در 4 تا 6 ماهگي و تاييد با آزمايشهاي سرولوژيك در 18 ماهگي آزمايش الايزا در 6 و 18 ماهگي در سن كمتر از 18 ماهگي ،‌آزمايش الايزا مثبت همراه با علائم نشانگر ايدز

تعريف مورد ايدز: درصورت دسترسي به امكانات شمارش CD4 مرحله 1 و 2 و3 عفونت با شمارش كمتر از 200 مرحله 4، بدون درنظر گرفتن شمارش CD4 درصورت عدم دسترسي به امكانات شمارش CD4 مرحله 2 ، با شمارش لنفوسيت كمتر از 1200 مرحله 3 و 4، بدون درنظر گرفتن شمارش لنفوسيت

STAGING: Clinical stage 1: Clinical stage 2: Asymptomatic Persistent Generalized Lymphadenopathy Clinical stage 2: Weight loss<10% Minor Dermal manifestations Herpes Zoster in 5 recent years Recurrent upper respiratory infections

Continue: Clinical stage 3: Clinical stage 4: Weight loss > 10% Chronic diarrhea > 1 month Fever>1 month Oropharingial candidiasis Hairy locoplaque Pulmunary TB Sever Bacterial infections Clinical stage 4: Chronic wasting syndrom PCP Brain Toxoplasmosis …

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