An HIV-positive patient presented with an intraoral Kaposi’s sarcoma lesion with an overlying candidiasis infection.
Post-exposure prophylaxis (PEP) is any prophylactic treatment started immediately after exposure to a pathogen (such as a disease-causing virus), in order to prevent infection by the pathogen and the development of disease.
Needlestick injury: A penetrating stab wound from a needle (or other sharp object) that may result in exposure to blood or other body fluids. The main concern is exposure to the blood or other body fluids of another person who may be carrying infectious disease. The pathogens of primary concern are the human immunodeficiency virus(HIV), hepatitis Bvirus (HBV) and hepatitis Cvirus (HCV).
Aids prevention and precaution
PREVENTION ANDPRECAUTION 1
o AIDS is Acquired Immunodeficiency Syndrome.o The final stage of HIV disease which severely damages the immune system.o It is caused by Human Immunodeficiency virus. 2
It interferes with the immune system making people more vulnerable to infections , including opportunistic infections and tumors that do not affect people with working immune systems. This susceptibility gets worse as the disease continues.
o AIDS – the ultimate clinical consequence of infection with HIV.o HIV is a retrovirus that primarily infects vital organs of the human immune system such as CD4+ T cells (a subset of T cells), macrophages and dendritic cells. 4
causeso HIV Virus , directly and indirectly destroys CD4+ T cells. Once the number of CD4+ T cells per microliters (µL) of blood drops below 200, cellular immunity is lost.o Acute HIV infection usually progresses over time to clinical latent HIV infection and then to early symptomatic HIV infection and later to AIDS, which is identified either on the basis of the amount of CD4+ T cells remaining in the blood , and / or the presence of certain infections.
The virus can be spread (transmitted):o Through sexual contacto Through blood -- via blood transfusions or needle sharingo From mother to child -- a pregnant woman can transmit the virus to her fetus through their shared blood circulation, or a nursing mother can transmit it to her baby in her breast milk 6
o Loss of appetite, weight loss, constant fever, prolonged fatigue, diarrhea, constipation, changing bowel patterns, swollen glands, chills coupled with excessive sweating, especially at nights, lesions in the mouth, sore throat, persistent cough, shortness of breath, tumours, skin rashes, headaches, memory lapses, swelling in the joints, pain in various parts of the body, vision problems and a regular feeling of lethargy and ill health . 8
With immune systems out of harmony, HIV- positive persons are susceptible to several types of cancer, particularly Kaposi`s sarcoma (KS), an uncommon form also known as AIDS- associated Kaposi sarcoma or KS-AIDS .
o KS-AIDS presents with cutaneous lesions that begin as one or several red to purple-red macules , rapidly progressing to papules, nodules, and plaques, with a predilection for the head, neck, trunk, and mucous membranes.o In the early stages, a mild flu and swollen glands are typical. But the symptoms are often unmistakable when full-blown AIDS develops.
o With the rise of the AIDS epidemic, KS, was initially one of the most common AIDS symptoms , and was erroneously referred to as the "AIDS rash".o Different from the classic form of Kaposi sarcoma, KS-AIDS tumors usually appear on the head, back, neck, muscular palate and the area of the gingiva .o In more advanced cases, they can be found in the stomach and intestines, the lymph nodes, and the lungs. 12
o There is currently no publicly available HIV vaccine or cure for HIV or AIDS.o The only known methods of prevention are based on avoiding exposure to the virus or, failing that, an antiretroviral treatment directly after a highly significant exposure, called post-exposure prophylaxis (PEP ).o PEP has a very demanding four week schedule of dosage. It also has very unpleasant side effects including diarrhea, malaise, nausea and fatigue. 13
o Treatment should begin within an hour of infection. After 72 hours post-exposure PEP is much less effective, and may not be effective at all .o Prophylactic treatment for HIV typically lasts four weeks.o In the case of HIV infection, post-exposure prophylaxis is administered which includes course of antiretroviral drugs which reduces the risk of seroconversion after events with high risk of exposure to HIV (e.g., unprotected sexual contact, needlestick injuries, or sharing needles. 14
o In the case of HIV infection, post-exposure prophylaxis is administered which includes course of antiretroviral drugs which reduces the risk of sero conversion after events with high risk of exposure to HIV (e.g., unprotected sexual contact, needle stick injuries, or sharing needles.
o Antiretroviral drugs are medications for the treatment of infection by retroviruses, primarily HIV. When several such drugs, typically three or four, are taken in combination, the approach is known as Highly Active Antiretroviral Therapy, or HAART.o The anti-retroviral drugs used are AZT – Zidovudine , Lamivudine and Indinavir. , should be given for health workers following exposures of susceptible areas to infected material from AIDS patient. 16
In The Out Patient Department (OPD) surgeons/health careworkers follow some precautions :o Use Gloves to examine the patients with open wounds.o During proctoscopy or sigmoidoscopy use gloves.o Hand gloves and eye protection during flexible endoscopy. 17
o Use disposable instruments.o Re-usable instruments like endoscopes - cleaned in soap and water and immersed in gluataraldehyde.o No surgical procedure involving sharp instruments in OPD.
o Operating room should be covered with a single sheet of polyethylene.o Minimum number of theatre personnel.o No Staff with abrasions or lacerations on their hands. 19
o Shoes, Gloves and Disposable , Water Resistant gowns and Eye Protection for anyone entering the room.o Double gloves and Eye Protection for staffs directly involved with operation (surgeon, assistant, scrub nurse).
Surgical techniqueo Avoid sharp injuryo Prefer scissors/ diathermy to the scalpelo Use skin clips.
o Avoid needle stick injuries.o Proper Autoclaving at the end of surgery.o Apply AZT- Zidovudine , Lamivudine , and Indinavir in exposed areas while interacting with patients. 22
o Necrotising Ulcerative Periodontitis (NUP)o Necrotising Ulcerative Stomatitiso Kaposi’s Sarcomao Non-Hodgkin’s Sarcomao Tooth extractiono Implant surgery 23
Necrotizing Ulcerative Periodontitis (NUP),an acute type of necrotizing periodontal disease characterized by erythema of the gingival and alveolar mucosa, ulcerated interdental papillae, interdental craters of the soft tissue and bone, and loss of periodontal attachment. May become chronic.
Necrotizing Ulcerative Stomatitis : It’s a disease with shallow ulcers on the cheeks, tongue, and lips.
The non-Hodgkin lymphomas (NHLs) are a diverse group of blood cancers that include any kind of lymphoma except Hodgkins lymphomas .Types of NHL vary significantly in their severity, from indolent to very aggressive.
Lymphomas are types of cancer derived from lymphocytes , a type of white blood cell . Lymphomas are treated by combinations of chemotherapy , monoclonal antibodies , immunotherapy , radiation , and hematopoietic stem cell transplantation. Non-Hodgkin lymphomas were classified according to the 1982 Working Formulation which recognizes 16 types. The Working Formulation is now considered obsolete.
Non-Hodgkin lymphoma and HIV The Centre for Disease Control and Prevention (CDC) included non-Hodgkins lymphoma (NHL) as AIDS-defining cancers in 1987.[3
Immune suppression rather than HIV itself is implicated in the pathogenesis of this malignancy, with a clear correlation between the degree of immune suppression and the risk of developing NHL. HIV-infected patients are at an increased risk for developing both Hodgkin lymphoma and NHL when compared with the general population
o Seroconversion: Development of detectable specific antibodies to microorganisms in the blood serum as a result of infection or immunization. • Often used in reference to blood testing for anti-HIV antibodies. In particular, “Seroconvert” is referred to the process of "becoming HIV positive.o Serology: The testing for antibodies, used to determine antibody positivity.o Serostatus: The presence or absence of particular antibodies in an individuals blood. Prior to seroconversion, the blood test is seronegative for the antibody; after seroconversion, the blood test is seropositive for the antibody. 30
o Seroreversion : The opposite of seroconversion. This is when the tests can no longer detect antibodies in a patient’s serumo Debridement : The medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. • Removal may be surgical , mechanical, chemical, autolytic (self-digestion), and by maggot therapy, where certain species of live maggots selectively eat only necrotic tissue. 31