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  1. 1. It is the progressive state of immunodeficiency, caused by the organism, HUMAN IMMUNO DEFICIENCY VIRUS (HIV) MORPHOLOGY  HIV is a spherical enveloped virus, about 90-120 nm in diameter.  It contains two identical copies of single stranded RNA genome  In association of with viral RNA is the reverse transcriptase enzyme.  The virus core is surrounded by a nucleocapsid composed of protein  The virus contains a lipoprotein envelope  The major virus coded envelope glycoprotein are the projecting spikes on the surface and the anchoring transmembrane pedicles
  2. 2.  Sexual contact  Parenteral transmission  Perinatal transmission CLINICAL FEATURES HIV infects all cells expressing at their surface the CD4 antigen, which is the receptor for the virus. It infects primarily the CD4+ lymphocytes CLASSIFICATION SYSTEM FOR HIV INFECTIONS AND AIDS (centre for disease control, USA)
  3. 3.  Group 1 : acute HIV infection  Group 2 : asymptomatic infection  Group 3 : persistent generalized lymphadenopathy  Group 4 :  Subgroup A : constitutional disease  Subgroup B : neurological disease  Subgroup C : secondary infectious disease  Subgroup D : secondary cancers  Subgroup E : other conditions ACUTE HIV INFECTIONS The illness is chacterised by acute onset of fever, malaise, sore throat, myalgia, arthralgia, skin rash and lymphadenopathy ASYMPTOMATIC INFECTIONS This includes all infected persons who are usually well. They show positive HIV antibody tests, and are infectious PERSISTENT GENERALISED LYMPHADENOPATHY Enlargement of lymph nodes is seen SYMPTOMATIC HIV INFECTIONS When CD4+ lymphocytes count falls below 400 mm3, the patient may develop symptoms like fever, diarrhoea, weight loss, night sweats and opportunistic infections OPPORTUNISTIC INFECTIONS AND MALGNANCIES COMMONLY ASSOCIATED WITH HIV INFECTIONS  BACTERIAL 1. Mycobacterial infections – tuberculosis and non tuberculosis infections 2. M. avium complex 3. Salmonellosis
  4. 4.  VIRAL 1. CMV 2. Herpes simplex 3. Varicella zoster 4. Epstein barr virus  MYCOTIC 1. Pneumocystis jiroveci pneumonia 2. Candidiasis 3. Aspergillosis 4. Histoplasmosis 5. Coccidioidomycosis  PARASITIC 1. Toxoplasmosis
  5. 5. 2. Cryptosporidiosis 3. Isosporiasis 4. Generalised strongyloidiasis  MALIGNANCIES 1. Kaposi’s sarcoma 2. B cell lymphoma or non Hodgkins lymphoma ORAL MANIFESTATIONS 1. Patients with AIDS are at greater risk for bacterial, viral, fungal infections of the mouth 2. Dental caries and gingivitis may occur 3. Acute ulcerative gingivitis may act as an indicator that the patient may hav aids 4. Herpes simplex infections may be present as multiple, deeper, more painful oral lesions in patients with aids 5. Hair leukoplakia is an early sign of immunodefeciancy, induced by Epstein barr virus 6. Candidiasis may be present in most patients with HIV infections, asymptomatic erythematous lesions of candidiasis, angular chelitis, mucocutaneous candidiasis are seen
  6. 6. RANGE OF SURGERY IN HIV PATIENTS 1. ANORECTAL DISEASE: It is the most frequent reason for surgical treatment in HIV patients, seen commonly in homosexuals, grouped together as “ AIDS ANUS SYNDROME” CAN BE CLASSIFIED AS : a. Anal warts, diarrhoe b. Incontinence in homosexuals 2. ABDOMINAL PAIN: it is due to gastrointestinal oppurtinistic infection, usually caused by cytomegalovirus. It is a type of colitis, produces abdominal pain, cramps, loose stools, blood and mucous in stools a. APPENDICITIS: is alsocommon due to CMV b. ABDOMINAL LYMOHOMA , with involvement of liver and spleen also causes abdominal pain c. SEVERE ABDOMINAL PAIN: may be due to perforation of small or large bowel which should be treated as an emergency 3. LYMPHOMA & KAPOSI’S SARCOMA: they are due to reduced cellular immunity, due to following reason: a. Immunosuppresion used in organ transplantation b. Severe malnourishment c. HIV infection d. Lymphoproliferative disease Kaposi’s sarcoma can affect skin surface, gastro intestinal tract from mouth to anus, lungs etc. It present as pigmented multifocal skin lesions
  8. 8. 4. OESOPHAGAL ULCERS: can present and odynophagia. Endoscopy should de done by using a glove & the scope should be washed thoroughly with soap & water and immersed in cetremide solution for 15 min 5. Very often surgeons are called for lymph node biopsy for evaluation of fever or generalized lymphadenopathy. DIAGNOSIS OF AIDS An individual with opportunistic infections, lymphopenia, low CD4 but relatively normal CD8 in the pheripheral blood, raised IgG & IgA levels & poor skin tests to common recall antigens may well have AIDS, particularly if they come from group at risk LABORATORY DIAGNOSIS 1. Antigen detection , p24 is the earliest virus marker to appear in the blood. ELISA can be used for detection of this antigen 2. Detection of virus nucleic acid, through polymerase chain reaction(pcr) 3. Antibody detection a. Screening tests  ELISA TEST  RAPID TEST  SIMPLE TEST b. Supplemental tests  WESTERN BLOT TESTS
  9. 9. PROPHYLAXIS No effective vaccine has yet been found out. High rate of mutation of virus has made difficulty in developing the vaccine ANTIRETROVIAL THERAPY (ART) Specific treatment with antiretroviral drugs is the mainstay in the management of HIV infections. HIGHLY ACIVE ANTIRETROVIAL THERAPY (HAART) is effective in inhibition of HIV replication in most of the HIV infected individuals NUCLEOSIDE REVERSE TRANSCIPTASE INHIBITORS ZIDOVUDINE LAMIVUDINE STAVUDINE NON NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS NEVIRAPINE DELAVIRIDINE PROTEASE INHIBITORS SAQUINAVIR RITONAVIR LOPINAVIR INDINAVIR TIPRANAVIR
  10. 10.  UNIVERSAL PRECAUTIONS TO BE FOLLOWED ARE IN OUTPATIENT DEPARTMENT  Any patients with open wounds, gloves are worn when examining thepatient  Hand gloves and eye protection durng flexible endoscopy  Use disposable instruments  Reusuable instruments like endoscope are washed with soap & water and immersed in gluterldehyde soln  No surgical procedures involving sharp instruments is performed in the OPD IN OPERATING ROOM  Operation room is covered with single sheet of polythene  The no of threatre personel is reduced to minimum  The staff with abrasions & lacerations on their hands are not allowed inside the threatre SURGICAL TECHNIQUE  Avoid sharp injury  Prefer scissors to scalpel  Use skin clips  Avoid needle stick injury  Proper autoclaving at the end of surgery
  11. 11. THANK YOU