Management of a patient with aids

1. Managementof apatient with AIDS
PREPARED BY
SALMAN HABEEB

3. AIDS is the name given to a group of disorders
related to immunodeficiency produced as a result of
the infection by the Human Immunodeficinecy Virus
(HIV).
DEFINITION

4.  In the United States, in 1981 among 2 groups,
one in San Francisco and the other in New
York City. Numerous young homosexual men
presented with opportunistic infections that,
at the time, were typically associated with
severe immune
deficiency: Pneumocystis pneumonia (PCP)
and aggressive Kaposi sarcoma
HISTORY- SPREAD OF AIDS

5.  During that time, various other causes were considered,
including lifestyle factors, chronic drug abuse, and other
infectious agents.
 CDC used the term 'AIDS' (acquired immune deficiency
syndrome) for the first time

6.  It is widely believed that HIV originated in Kinshasa, in
the Democratic Republic of Congo around 1920 when
HIV crossed species from chimpanzees to humans.
 The spread of HIV was retrospectively shown to follow
the trucking routes across Africa from logging camps,
and the bush-meat trade combined with aggressive
logging and improved transportation in the mid-20th
century may have allowed what was likely occasional
cross-species transmission events to propagate across
the country and, eventually, the globe.

7. GLOBAL PREVALENCE

8. INDIA

10. • Family : Retroviridae
• Subfamily : Lentivirus
• There are two types of HIV viruses. HIV-1 & HIV-2
• HIV virus is RNA virus containing reverse
 transcriptase
• It contain two major envelop proteins.
 1. gp 120 – external
 2. gp 41 - transmembrane
Viral morphology

11.  .The envelope has 72 surface spikes or knob-like
structures containing trimers or tetramers of envelop
glycoprotein
 SIZE- 80-120 nm in diameter,
Human immunodeficiency virus

12. HIV VIRUS

13. MODE OF TRANSMISSION

14.  Unprotected sexual contact with an HIV – infected
partner is the most common mode of transmission
 In India heterosexual transmission is the most common
mode of transmission
SEXUAL TRANSMISSION

15.  Sharing of equipments contaminated equipments
 Blood transfusions
 Needle stick injuries are most common work related
transmission
it depends
viral load of patient, depth of puncture
wound
Contact with blood and blood
products

16.  It is the most common route of infection for children
 Mother to child transmission occur during pregnancy,
at the time of delivery after the birth through breast
feeding
 25% of chance infection from untreated mother
Perinatal transmission

17.  HIV cannot replicate unless it is in a living cell
 With the help of knobs on viral envelope it will bind
on CD4 cells
 Once it bound, viral RNA enters the cell, where it is
transcribed into a single stranded viral DNA with the
assistance of reverse transcriptase enzyme
 Strand copies itself becoming double stranded DNA
pathophysiology

18.  Which enters into cell’s nucleus using another enzyme
integrase splices into the genome becoming a
permanent part of cell genetic structure.
 HIV production in the cells starts with long strands of
HIV RNA
 These are cut into appropriate length in help of
enzyme protease

19.  Initial infection with HIV results viremia after a few
weeks the HIV levels in the blood remain low which
may last 10-12 years
 Even without clinical symptoms the viral replication
occurs at a constant rate

20.  In normal immune response B cells and T cells interact
with foreign antigens
 B cells make HIV specific antibody which will reduce
the viral load
 T cells mount a cellular immune response and trap the
viruses in the lymph nodes

21.  HIV infects human cells with CD4 receptors on their
surfaces, these includes lymphocytes,
monocytes/macrophages etc
 Immune dysfunction in HIV is caused predominantly
by damage and destruction of CD4 T cells/ helper T
cells/ CD4 T lymphocytes
 These cells are targeted because they have more CD4
receptors compared to other cells

22.  Adults normally have 800-1200 CD4 T cells per
microlliter of blood
 The normal life span of a CD4 T cell is about 100 days,
but HIV infected cells will die after an average of only
2 days
 Generally immune system will remain healthy with
more than 500 CD4 T cells/micro lit
 Immune problems starts count below 500
 Severe infections count below 200

23. CLINICAL MANIFESTATIONS

24.  Duration – 1-3 weeks
 Manifestations- fever, swollen lymph nodes, sore
throat, headache, nausea, vomiting (flu-like
syndrome)
 Some patient develop neurologic complications
 High viral load is noted in body
ACUTE INFECTION

25.  This phase is has been referred to as asymptomatic
disease phase
 Duration can last upto 8 years
 Patient may had fatigue, headache, night sweats,
persistent generalised lymphadenopathy etc..
 Infected people unaware of their infection continue
their usual activities which transmit HIV to others
EARLY CHRONIC INFECTION

26.  In these stage CD4+ T-cell count drops to 200-500
cells/micro.lit and viral dose increases
 Common infections in this phase includes
oropharyngeal candidiasis or oral thrush
vaginal candidiasis infection
Genital /oral herpes
Kaposi’s sarcoma- human herpes virus
INTERMEDIATE CHRONIC INFECTION

27.  Oral hairy leukoplakia
caused by EBV
it causes painless, white, raised lesions on lateral
aspect of the tongue

28.  Patient becomes severely immunocompromised
 Development of one or more opportunistic diseases
that contribute to disability , death
LATE CHRONIC INFECTION/
AIDS

29.  PATIENT SHOULD HAVE ANY ONE OF THESE
CONDITIONS
1. CD4+ cells count less than 200 cells/microliter
2. Development of any of the following opportunistic
infections
fungal- candidiasis of bronchi, trachea,lungs or
esophagus, pneumocystitis pneumonia
viral- cytomegalovirus, herpes simplex with chronic
ulcers
protozoal- Toxoplasmosis of the brain
CDC AIDS DIAG.CRITERIA

33.  Bacterial- Mycobacterium tuberculosis any site,
recurrent pneumonia, salmonella septicemia
 Development of one of the opportunistic cancers
Kaposis sarcoma
Burkitt’s lymphoma
immunoblastic lymphoma
 Wasting syndrome – loss of 10% or more body mass

34.  ELISA TEST
It is a highly sensitive enzyme immunoassay is done
to detect serum antibodies that bind to HIV antigens on
test plates
Blood samples that are negative in the test are considered
as negative
 If the test is positive , the test is repeated
DIAGNOSIS

35.  If the test is repeatedly positive , a more specific
confirming test as Western blot (WB) or
immunofluorescence assay is done

36.  The progression of infection is monitored by two
important laboratory assessments
 1. CD4+ T cell count
 2. Viral load
Other laboratory diseases

37. OPPORTUNISTIC DISEASES
1. Candida Albicans- Oral thrush, whitish yellow
patches in mouth , esophagus , G.I tract
2. Kaposi’s sarcoma- caused by Human herpes virus
manifestations- Vascular lesions on the skin,
mucous membrane and viscera with wide range of
presentation
CLINICAL MANIFESTATION

38.  Pneumocystic pneumonia- caused by pneumocystis
jiroveci
clinical manifestations- Pneumonia, Non productive
cough, hypoxemia, progressive shortness of breath,
fever , night sweats, weight loss

39.  Meningitis- caused by Cryptococcus neoformans
headache, fever, seizures, cognitive
impairement, motor impairment
Cytomegalovirus infection – retinitis, esophagitis,
pneumonitis

40.  Hepatitis B, C viral infection
jaundice, fatigue, abdominal pain,
nausesa,vomiting etc
Tuberculosis- mycobacterium tuberculi – respiratory and
disseminated disease, productive cough, fever, night
sweats, weight loss etc

41. Management focuses on
 Monitoring HIV disease progression and immune
function
 Initiating and monitoring ART
 Preventing the development of opportunistic diseases
 Decreasing the complications of treatment
 Preventing further transmission of HIV
management

42. No drugs or combination of drugs can cure HIV, but the
therapy can decrease the viral replication and delay
progression of disease
GOALS
1.Decrease the viral load
2.Maintain or raise CD4+ T Cell counts
3.Delay the development of HIV related symptoms and
opportunistic diseases
DRUG THERAPY FOR HIV INFECTION

43. Currently three groups of antirtroviral drugs are used,
that inhibit the ability of the virus to make DNA copy
early in the repliication
Currently three groups of antirtroviral drugs are used,
ANTIRETROVIRAL THERAPY

44.  Mechanism of action
combine with reverse transcriptase enzyme to
block the process needed to convert HIV RNA into HIV
DNA
Non nucleoside reverse transcriptase
inhibitors (NNRTIs)