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

3. HISTORICAL ASPECTS
AIDS was first recognized in mid ( 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

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

5. 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

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

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

9. 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

10. Acute Retroviral Syndrome
Exanthem (maculopapular)

11. Acute Retroviral Syndrome
Lymphadenopathy

12. Acute Retroviral Syndrome
Rash
Lymphadenopathy
Aseptic meningitis
Encephalitis
Peripheral neuropathy

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

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

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

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

17. Oral Lesion
Oral Aphthous

18. Oral Lesion
Hairy Leukoplakia

19. Oral Lesion
Necrotizing Ulcerative periodentitis

20. Cutaneous Manifestation
Staphilococal Folliculitis

21. Cutaneous Manifestation
Herprs Zoster

22. Cutaneous Manifestation
Kaposi’s Sarcoma

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

24. Ocular Complication CMV Retinitis Acute Herpetic Necrotizing Retinitis
Toxoplasmic Chorioretinitis

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

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

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

28. GI Manifestation Diarrhea CMV Cryptosporidium MAC
Closteridium Difficile
Salmonella
Isospora

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

30. Lab. Diagnosis

31. INDIRECT TESTS:
Elisa
Western blot
DIRECT TEST:
PCR
P24Ag

32. 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

33. 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

34. 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

35. 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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