Natural History and Clinical Staging of HIV

Training for Medical Officers Day 2 Session 7

Session Objectives
List the modes of HIV transmission Discuss the pathogenesis and life cycle of HIV Describe the progression of HIV Classify an HIV-infected patient according to the WHO clinical stages

Natural History of HIV and Staging of HIV

Modes of HIV Transmission

Sharing Semen and Vaginal Fluids

Sharing Needles & Syringes

Needle Stick Injury

Through Infected Blood

Natural History of HIV and Staging of HIV

During Pregnancy or Birth

3

Breast Feeding
I-TECH, 2005

Risk of HIV Transmission with Single Unprotected Exposure (Risk per 10,000 exposures)

Natural History of HIV and Staging of HIV

Source: HIV Web Study, 2006

How HIV Infects the Body

HIV makes contact with cells located within the genital mucosa Virus is carried to regional lymph nodes (1-2 Days)

Exponential viral replication

Widespread systemic dissemination to the brain, spleen, distant lymph nodes, etc. (5-11 Days)
Natural History of HIV and Staging of HIV 5
Source: GHTM Fellowship Programme, 2006

Path of the Virus

Day 0
HIV exposure at mucosal surface (sex) Virus collected by dendritic cells, carried to lymph node HIV replicates in CD4 cells, released into blood

Day 0-2

Day 4-11

Day 11+
Natural History of HIV and Staging of HIV 6

Virus spreads to other organs

1998 Massachusetts Medical Society. All Rights Reserved

HIV Lifecycle

I-TECH, 2005

Natural History of HIV and Staging of HIV

Life Cycle of HIV

Natural History of HIV and Staging of HIV

Stages of HIV Infection

Viral transmission (2-3 wks) Acute retroviral syndrome (2-3 wks) Seroconversion (2-4 wks) Asymptomatic chronic HIV infection (Avg. 8yrs) Symptomatic HIV infection/AIDS (Avg. 1.3 yrs)
Natural History of HIV and Staging of HIV 9

CD4 Count & Viral Load Over Time

Natural History of HIV and Staging of HIV

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Source: Fauci, et al, Immu. Mech HIV Inf, 1996

Progression of HIV
Acute Seroconversion Asymptomatic HIV (Clinical latency) Symptomatic HIV Acquired Immune Deficiency Syndrome (AIDS)

Natural History of HIV and Staging of HIV

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Patterns of HIV Progression

Typical progressors Rapid progressors Slow progressors Long-term non-progressors

Natural History of HIV and Staging of HIV

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WHO Clinical Staging

11 Case Studies

Natural History of HIV and Staging of HIV

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Case Study 1

I-TECH, 2005

Natural History of HIV and Staging of HIV

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Case Study 2

I-TECH, 2005

Natural History of HIV and Staging of HIV

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Case Study 3

I-TECH, 2005

Natural History of HIV and Staging of HIV

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Case Study 4

I-TECH, 2005

Natural History of HIV and Staging of HIV

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Case Study 5

I-TECH, 2005

Natural History of HIV and Staging of HIV

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Case Study 6

I-TECH, 2005

Natural History of HIV and Staging of HIV

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Case Study 7

Indian Ink Staining of Cryptococcus in CSF

I-TECH, 2005

Natural History of HIV and Staging of HIV

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Case Study 8

Natural History of HIV and Staging of HIV

I-TECH, 2005

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Case Study 9

Courtesy of : GHTM, Chennai, 2006

Natural History of HIV and Staging of HIV

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Case Study 10
37 year-old HIV-positive male Lost 9 kg in last 3 months (previously 75
kg)

Reports having a fever for the past month Goes to bed by late afternoon Treated for pulmonary TB 5 months ago

What is his WHO clinical stage?

Natural History of HIV and Staging of HIV 23

Case 11
34 year-old HIV positive male Suffers from bacterial sinusitis and a fungal infection on his toes Has no problem keeping up with his usual activities and weight is stable Treated for herpes zoster 4 years ago

What is his WHO Clinical Stage?

Natural History of HIV and Staging of HIV 24

Key Points
The most common mode of HIV transmission in India is sexual Understanding the natural history of HIV is important in predicting progress of the disease and determining when to begin ART Clinical staging allows clinicians to reliably predict in patients:
The risk for death and opportunistic infections The need for disease prevention and ART
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