Case:

EJ, 31 years old male from lingayen, works as an IT in Manila,

MSM, unprotected sexual contact
Came in due to DOB and fever
Admitted at private hospital in Manila due to pneumonia
OPD consults, treated for pneumonia and PTB
Persistence of DOB and fever
(+) weight loss, night sweets, anorexia, intermittent low grade fever, with several bouts of diarrhea
Pertinent PE
 Febrile, not in respiratory distress, tachypneic
 Red flaky scales on the eyebrows and face
 (+) orwl thrush
 Crackles left base

Sputum: positive cocci

CS: Streptococcus pneumoniae
HIV ELISA: Reactive
Ceftazidine
Cotriamoxazole
Fluconazole
Merooenem
Cotrimoxazole
Fluconazole

 Improved well being

 OPD follow-up
 Western blot: Reactive
 CD4: 4 cell/ul
 Started on ARV, no adverse reaction for introduction of anti koch’s

WHAT IS HIV?
 Virus spread through certain body fluid that attacks the body’s immune system
 CD4 T cells
 Over time, HIV can destroy so many of these cells that the body can’t fight off infections and
disease
WHAT IS AIDS?
 “Acquired Immunodeficiency Syndrome”
 The most advanced stage of HIV infection
 Defined by Either by Laboratory Parameters in an Asymptomatic Patient, or by an AIDS-Defining
Illness Usually an Opportunistic Infection
o CD4<200 is AIDS
o Opportunistic Infection: PCP, MAC, Cryptococcus Meningitis, Kaposi’s Sarcoma, CNS
Lymphoma, Esophageal Thrush Etc. = AIDS at any CD4 Count
WHERE DID IT COME FROM?
 Scientists identified a type of chimpanzee in Central Africa as the source of HIV infection in
humans
  They believe that the chimpanzee version of the immunodeficiency virus ( called simian
immunodeficiency virus or SIV) most likely was transmitted to humans hunted these
chimpanzees for meat and came into contact with their infected blood

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MODE OF TRANSMISSION
 Having anal or vaginal sex with someone who has HIV without using condom or taking medicines
to prevent or treat HIV
o Anal sex is the highest-risk sexual behavior. For the HIV-negative partner, receptive anal
sex (bottoming) is risker than insertive anal sex (topping)
o Vaginal sex is the second highest-risk sexual behavior
 Sharing needles or syringes, rinse water or other equipment used to prepare drugs for injection
with someone who has HIV, HIV can live in used needle up to 42days depending on temperature
and other factors
 Less commonly
o from mother to child during pregnancy birth or breastfeeding. Although the risk can be
high if a mother is living with HIV and not taking medicine; recommendations to test all
pregnant women for HIV and start HIV treatment immediately have lowered the
number of babies who are born with HIV
o By sucking with an HIV- contaminated needle or other sharp object. This is a risk mainly
for health care workers

EXTREMELY RARE CASES

 Oral sex- putting the mouth on the penis ( fellatio), vagina (cunninglingus) or anus (rimming). In
general there’s little to no risk of getting HIV from oral sex
 Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated
with HIV
 Eating food that has been pre-chewed by an HIV-infected person. The contamination occurs
when infected blood from a caregiver’s mouth mixes with food while chewing. The only known
cases are among infants
 Being bitten by a person with HIV. There is no risk of transmission if the skin is not broken
 Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-
contaminated body fluids
 Deep open-mouth kissing if both parents have sores or bleeding gums and blood from HIV-
positive partners gets into the bloodstream of HIV-negative partner. HIV is not spread through
saliva
TRANSMISSION RATE
TRANSMISSION CATEGORY RISK OF TRANSMISSION
Percutaneous/needlestick 0.3%
(blood)
IDU needle sharing 0.67%
Mucocutaneous (blood) 0.09%
Receptive anal intercourse 0.3-3%
Insertive anal intercourse 0.06%
Receptive vaginal intercourse 0.1-0.2%
Insertive vaginal intercourse 0.03-0.14
 Receptive oral (male) 0.06%
Mother to child 24%

HIV IS NOT SPREAD BY:

 HIV does not survive long outside the human body (such as on surface) and it cannot reproduce
outside a human host
 It is not spread by:
o Mosquitoes, ticks or other insects
o Saliva, tears or sweat that is not mixed with the blood of an HIV-positive person
o Hugging, shaking hands, sharing toilets, sharing dishes, or closed-mouth or “social”
kissing with someone who is HIV-positive
o Other sexual activities that don’t involve the exchange of body fluid ( ex. Touching)
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WHAT ARE THE RISK FACTORS

 Having unprotected anal sex pr vaginal sex
 Having another STI such as syphillis, herpes, chlamydia, gonnrhea and bacterial vaginosis
 Sharing contaminated needles, syringes and other injecting equipment and drug solutions when
injecting drugs
 Receiving unsafe injections, blood transfusions, medical procedures that involve unsterile
cutting or piercing
 Experiencing accidental needle stick injuries, including among health workers
PATHOGENESIS
INSERT PIC PAGES 28-31

WHAT ARE THE SIGNS AND SYMPTOMS

 Stage 1: Acute HIV infection
o Within 2 to 4 weeks after infection with HIV, people may experience a flu-like illness,
which may last for a few weeks
o This is the body’s natural response to infection
o When people have acute HIV infection, they have a large amount of virus in their blood
and are very contagious
o But people with acute infection are often unaware that they are infected because they
may feel sick right away or at all
 Stage 2: Clinical latency (HIV inactivity or dormancy)
o This period is sometimes called asymptomatic HIV infection or chronic HIV infection
o HIV is still active but reproduce at very low levels
o People may not have any symptoms or get sick during this time
o At the end of this phase, a person’s viral load starts to go up and CD4 cell count begins
to go down
o As this happens, the person may begin to have symptoms as the virus levels increase in
the body, and the person moves into stage 3
 Stage 3 AIDS
o AIDS is the most severe phase of HIV infection. People with AIDS have such badly
damaged immune systems that they get an increasing number of severe illnesses called
opportunistic illnesses
o Without treatment people with AIDS typically survive about 3 years
 o People are diagnosed with AIDS when their CD4 cell counts drops below 200 cells/mm
or if they develop certain opportunistic illnesses. People with AIDS can have a high viral
load and be very infectious
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OPPORTUNISTIC INFECTION
 Nervous system
o Cryptococcal meningitis
o Toxoplasma encephalitis
o TB meningitis
o CMV renitis
 Pulmonary
o TB
o Pneumocystis pneumonia
o Aspergillus pneumonia
o CMV pneumonia
o Nocardia
o Bacterial pneumonia
 GI
o Candidiasis
o MAC
o Cyclospora
o Cryptosporidium
o Hepatitis B/C
 Skin
o Herpes simplex
o Herpes zoster
 Disseminated disease
o CMV
o Herpes
o MAC
o TB
o Bartonella
o Histoplasma/coccidiodes
OPPORTUNISTIC CANCERS
 Lymphoma (EBV)
o CNS lymphoma
o Non-hodgkin’s lymphoma
 Kaposi’s Sarcoma (HHV 8)
 Cervical cancer (HPV)
 Anal cancer (HPV)
 HEENT cancer ( HPV)
HIV AND TB
 HIV increases the risk of TB reactivation and dissemination
o TB increases the risk of HIV progression
 HIV has directly contributed to the increase in TB incidence in many setiings
  In TB endemic areas, pulmonary and/or extrapulmonary TB is a common presentation in HIV+
individuals
HIV AND OTHER STD
 STD such as syphilis, gonnorrehea, and herpes simplex increase the risk of HIV transmission
 Other STD are more frequently seen in HIV+ individuals