Professional Documents
Culture Documents
HIV
Presenters
Ashwini E Haritha Moderators
Adithya Vikraman Navneeta Desikan Dr. Glennys
Jothilakshmi Anirudh K Dr. Shravana kumar
Sushmitha Gowtham S Dr.Manju Aishwarya
Sneha T Dr. S.Anandhalakshmi
CASE HISTORY :
Routine investigations :
This include Complete Blood Count : Hemoglobin levels , Urine analysis, Blood
glucose etc…
VDRL/ RPR Tests (for what ?)
USG
Blood grouping
Is HIV screening recommended for her ?
If yes what is the protocol to be followed according to
National AIDS control organisation (NACO) guidelines?
Before getting her tested!!!!!
Strategy I
Strategy IIA
Strategy IIB
Strategy III
STRATEGY I :
A1
+ve -ve
Consider positive Consider negative
A 1 +ve A 1 -ve
Report negative
A2
A 1 +ve A 1 -ve
A2 Report negative
A 1 +ve A2-ve
A 1 +ve A2+ve
Report positive with A3
post test counseling
A 1 +ve A2- ve A3+ve A 1+ve A2- ve A3-ve
Indeterminate Report negative
STRATEGY III
A1 +
A 1 -ve
A2 Report negative
A 1 +ve A2 -ve
A 1 + A2+
A3
Report positive
A3
A 1 + A2 -ve A3+ A 1+ A2- ve A3-ve
Indeterminate
A 1 + A2 + A3+ve A 1 + A2 + A3-ve High risk consider
Report positive with Indeterminate indeterminate
post test counseling
Low risk consider negative
For indeterminate results of strategy IIB and III ( first test is
positive but second or third test is negative ) Repeat the test
after 2 – 3 weeks and the sample should be sent to reference
centre for confirmation by WESTERN BLOT or RT – PCR .
Case history
Envelope:
Lipid part : Host derived
Protein part : gp120 and gp41
Nucleocapsid:
Icosahedral capsule
Cylindrical Inner core
- ssRNA
- viral enzymes
STRUCTURE OF VIRUS
HIV genes and antigens
Structural genes
Antigenic variation:
Duegag : codes
to error for nature
prone core of and shelltranscriptase
reverse of virus enzymes,
mutations
pol :are seenfor
codes in env
viralgenes leading to formation of different
enzymes
serotypes, subtypes, and Circulating recombinant forms CRFs
env : codes for envelope glycoprotein
Non-structural genes
codes for viral replication and pathogenesis.
HIV Serotypes
1.Attachment of gp120 to
a. CD4 receptor on T-Helper cells
b. CXCR4 receptor on T-lymphocytes
c. CCR5 receptor on macrophages
d. DC-SIGN receptor on dendritic cell
2.Fusion of HIV to host cell with help of gp41.
3.Penetration and uncoating of nucleocapsid and release of two
copies of ssRNA and viral enzymes.
4.Reverse Transcription:
ssRNA -----> ssDNA -----> dsDNA
5.Pre-integration complex:
A complex consisting of linear dsDNA, gag matrix protein,
accessory vpr protein and viral integrase migrates to the host cell nucleus.
6.Integration:
The viral dsDNA gets integrated into the host cell
chromosome, mediated by viral integrase, called provirus.
7.Transcription : Viral RNA is synthesized by host cell.
8.Viral Protein synthesis.
9.Protease enzymes cleaves peptides to various functional HIV
enzymes.
10.Virion budding and virion maturation.
Pathogenesis
Virus destroys the cell as a result of
budding
Syncytia may be
Uninfected poor or ineffective
Killing of CD4 cells CD4 cell at immune
2. Syncytium Gp120 response
Formation negative
Why do all T4
cells
disappear?
Cytotoxi
c T cell
Asymptomatic stage:
* Both humoral and cell mediated response are activated.
* Viremia drops and T-Helper cell count becomes normal.
* This is a stage of clinical latency not microbiological latency.
Natural course of HIV infection
Stage 1
Asymptomatic
Persistent generalized lymphadenopathy
Adults & adolescents
Stage 2
Opportunistic infections
Neoplasia
Kaposi’s sarcoma
Invasive cervical cancer
Lymphoma(cerebral, B-cell and non-Hodgkin)
Other conditions
HIV encephalopathy
Symptomatic HIV-associated nephropathy or
cardiomyopathy
Which are the most common opportunistic infections that are
associated with HIV?
OPPORTUNISTIC INFECTIONS
CNS
Respiratory system
GIT
GIT related infections
Giardiasis
Cryptosporidiosis
Isosporiasis
Chronic diarrhoea
Microsporidiosis
CMV - colitis associated with fever, crampy abdominal pain,
and frequent (often bloody) stools.
Respiratory system
Toxoplasmosis
Cryptococcal meningitis
CMV- encephalitis
retinal exudates and retinitis
WHAT IS CD4+ TEST & WHY IT IS DONE ?
Classification:
• Infectious manifestation
• Non-infectious manifestation
• Cutaneous adverse drug
• Specific mucosal manifestation
• Hair manifestation
• Nail manifestation
INFECTIOUS MANIFESTATION
VIRAL INFECTIONS BACTERIAL INFECTIONS
Herpes simplex virus Staphylococcus aureus
Epstein-Barr virus mycobacterial infection
Human Papilloma
Molluscum contagiosum
Bacillary angiomatosis
Perianal ulcer
FUNGAL INFECTIONS:
Dermatophytosis
Oral candidiasis
Non-infectious disease
Papulosquamous disorders
Pruritic eruptions of hiv
Pigmentary disorders
Cutaneous adverse drug reactions
Neoplasms
Non-infectious infection
Kaposi sarcoma
Psoriasis
SEVERE DRUG REACTIONS:
Stevens-johnson syndrome
OTHER MANIFESTATION:
Case history
She had received a negative result for tuberculosis. And was started on
antiretroviral therapy.
What is the recommended chemoprophylaxis for CD4 count <350
cells/µl?
Chemoprophylaxis for PCP
Cotrimoxazole Preventive Therapy [CPT]:
1. CD4 count < 350 cells / cu.mm
2. WHO clinical stage 3 & 4.
Alternate regimen - Dapsone 100mg O.D
Timing the Initiation of cotrimoxazole in relation to initiating ART
1. Start cotrimoxazole prophylaxis first
2. Start ART after starting cotrimoxazole / as soon as CPT is tolerated & patient
has completed “preparedness phase” of counselling
Isoniazid preventive therapy [IPT]
Isoniazid
1. Most effective bactericidal anti- TB drug
2. Protects against progression to active disease
3. Prevents TB re-infection after exposure to open case of TB
She is receiving daily co-trimoxazole prophylaxis for preventing
opportunistic infections and was started prior to ART.
At the 36 weeks of gestation she is admitted for safe
confinement.
MANAGEMENT
Hand hygiene
PERSONAL PROTECTIVE EQUIPMENT
OTHER PRECAUTIONS
Send Dried Blood Spot (DBS)of child for HIV-1 DNA PCR
Collect and send Whole Blood Specimen for HIV-1 HIV-1 DNA not
DNA PCR (At ART Centre) detected
All pregnant and breast feeding women with HIV receive lifelong ART regimen
Postpartum ART initiation to mother and prophylaxis to child
HIV exposed infants should be followed-up and managed
All babies detected positive <2years of age are given pediatric ART
HIV-exposed children should be immunized
Thank you