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DR AZAM MUSHTAQ
MBBS, DTCD, FCPS
ASSISTANT PROFESSOR CHEST DEPTT NISHTAR HOSPITIAL MULTAN.
WHAT IS HIV??
Human Immunodeficiency Virus A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of
Human T cell lymphotrophic virus (HTLV-III) Lymphadenopathy associated virus (LAV) AIDS associated retrovirus (ARV)
mechanism)
Patients predisposed to multiple opportunistic
AIDS (definition)
Opportunistic infections and malignancies that
rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS.
Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell.
Unsterilized blades
Through Sex
Unprotected Intercourse
Oral Anal
Mother-to-Baby
Before Birth During Birth
Stage 1 - Primary
Short, flu-like illness
Stage 2 - Asymptomatic
Lasts for an average of ten years
levels
HIV antibodies are detectable in the blood
Stage 3 - Symptomatic
appear.
CD4<500
Bacterial infections
Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposis sarcoma
CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia
the first cause of mortality in HIV infected patients (1030%) 10 million patients co-infected in the world. Immunosuppression induced by HIV modifies the clinical presentation of TB :
1. 2. 3.
Subnormal clinical and roentgen presentation High rate of MDR/XDR High rate of treatment failure and relapse (5% vs < 1% in HIV)
Anonymous Testing
No name is used Unique identifying number Results issued only to test recipient
23659874515
Anonymous
Best test for diagnosis of acute HIV infection Correlates with disease progression and response to HAART
Urine Testing
Urine Western Blot As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV
Oral Testing
Orasure The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST!
Treatment Options
INH for those with positive PPD and normal chest radiograph
RPR or VDRL for syphilis Toxoplasma IgG serology CMV IgG serology
Pneumococcal vaccine
Influenza vaccine in season Hepatitis B vaccine for those who are HBsAb-negative Haemophilus influenzae type b vaccination Papanicolaou smears every 6 months for women
cells/mcL:
cells/mcL:
cells/mcL:
Abstinence
HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use
Monogamous relationship
A mutually monogamous (only one sex
partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected
Protected Sex
Use condoms every time you have
sex Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex
not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms
Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO.
18% 4% 4% 3% 3% 2% 1% 1%
Total = 39.4 million
Latin America
Eurasia
North America
East Asia Western Europe North Africa/Middle East Caribbean Oceania
< 1%
18% 6% 5% 4% 2% 1% 1%
Total = 4.9 million
Oceania
<1%
4%
2%
1%
awareness in three major cities Estimated 60,000 iv drug users in pakistan (1 in 5 infected with HIV) 38,000 homosexuals reported in lahore in 2002 40% of 1.5 million annual blood donors not screened for HIV 20% of blood transfusions come from professional donors with high prevalence of infectious diseases Significantly large number of migrants and refugees.
UNDER-REPORTING
Until September 2004, only 300 cases of full-blown AIDS and another 2300 cases of HIV infection were reported to the National AIDS Control Program. The reasons for under reporting are: Social stigma attached to the infection, Limited surveillance Voluntary counseling and testing systems Lack of knowledge among the general population and health practitioners.
In its early stages, the program was focused on diagnosis of cases that came to hospitals, but progressively began to shift toward a community focus
awareness and in the care and support of persons living with HIV/AIDS. Also working on education and prevention interventions targeting sex workers, truck drivers, and other high-risk groups. But reaching less than 5 percent of the vulnerable population.