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Acute and Early HIV infection.pptx
1. Acute and Early HIV infection
CLINICAL MANIFESTATIONS
Dr. Ajit Kumar
2. Clinical Manifestations of HIV
• Early signs and symptoms
• Oral manifestations
• Malignancies
• Opportunistic Infections
• Neuro-psychiatric illnesses
• Women and HIV
3. CDC Stage of HIV Disease
• Stage I
• Stage II
• Stage III
• Stage IV
– A
– B
– C
• C1
• C2
– D
– E
Acute HIV infection
Asymptomatic HIV Early
Symptomatic HIV Late
Symptomatic HIV
Constitutional Disease
Neurological Disease Secondary
Infections
AIDS defining Other
infections
Secondary Cancers Other
Conditions
9. • It is estimated that 50–70% of individuals with HIV infection
experience an acute clinical syndrome ~3–6 weeks after primary
infection.
• The syndrome is typical of an acute viral syndrome and has been
likened to acute infectious mononucleosis.
10. • Symptoms usually persist for one to several weeks and
• gradually subside as an immune response to HIV infections have
been reported during this stage of infection, reflecting the
immunodeficiency that results from reduced numbers of CD4+ T
cells and likely also from the dysfunction of CD4+ T cells.
11. • A variety of symptoms and signs may be seen in association with
acute symptomatic HIV infection.
• This constellation of symptoms is also known as the acute
retroviral syndrome.
• None of the findings is specific for acute HIV infection.
• Prolonged duration of symptoms and the presence of
mucocutaneous ulcers, are suggestive of the diagnosis.
12. • Constitutional symptoms —
• Fever, fatigue, and myalgias are the most common
• Fever in the range of 38 to 40ºC.
• Adenopathy —
• Nontender lymphadenopathy
• Primarily involving the axillary, cervical, and occipital nodes.
• Second week of the illness, concomitant with the emergence of a
specific immune response to HIV.
• The nodes decrease in size following the acute presentation, but a
modest degree of adenopathy tends to persist .
• Mild hepatosplenomegaly also can occur .
13. • Oropharyngeal findings —
• Sore throat is a frequent manifestation of acute HIV infection.
• The physical examination: pharyngeal edema and hyperemia, usually
without tonsillar enlargement or exudate.
• Painful mucocutaneous ulceration is one of the most distinctive
manifestations of acute HIV infection.
• Shallow, sharply demarcated ulcers with white bases surrounded by
a thin area of erythema may be found on the oral mucosa, anus,
penis, or esophagus.
14. • Rash
The eruption typically occurs 48 to 72 hours after the onset of fever and
persists for five to eight days.
• The upper thorax, collar region, and face are most often involved,
although the scalp and extremities, including the palms and soles, may
be affected.
• The lesions are characteristically small (5 to 10 mm), well-
circumscribed, oval or round, pink to deeply red colored macules or
maculopapules.
• Vesicular, pustular, and urticarial eruptions have also been reported but
are not nearly as common as a maculopapular rash.
• Pruritus is unusual and only mild when present.
15. • Gastrointestinal symptoms —
• nausea, diarrhea, anorexia, and weight loss, averaging 5 kg.
• More serious gastrointestinal manifestations are rare and include
pancreatitis and hepatitis.
16. • Neurologic findings —
• Headache, often described as retroorbital pain exacerbated by eye
movement.
• The first severe neurologic syndrome to be recognized was
aseptic meningitis.
• Rarely, a self-limited encephalopathy may accompany acute HIV
infection.
• The peripheral nervous system also may be affected by acute HIV
infection.
• Facial nerve and brachial palsies have also been noted.
17. • Other :
• Apart from complaints of a dry cough, pulmonary
manifestations are uncommon during acute HIV infection.
• There have been rare reports of pneumonitis in this setting,
manifesting as cough, dyspnea, and hypoxia without evidence
for other infectious etiologies.
• Acute rhabdomyolysis and vasculitis are other unusual
manifestations
18. • Opportunistic infections —
• Rarely occur during the transient CD4 lymphopenia of early HIV
infection
• Oral and esophageal candidiasis is the opportunistic infection most
often seen in these patients.
• Two possibilities are that esophageal ulceration provides a local
environment that promotes the growth of Candida species, and that the
administration of antibiotics to empirically treat the symptoms of acute
HIV may alter normal oropharyngeal flora.
• Other opportunistic infections that have been reported during acute HIV
infection include
• CMV infection (proctitis, colitis, and hepatitis),
• Pneumocystis jirovecii pneumonia, and cryptosporidiosis .
22. Signs of Serious Illness
• Temperature ≥ 39°C with headache
• Respiratory rate ≥ 30/min
• Heart rate ≥ 120/min
• SpO2 (pulse oximeter) < 90%
• Altered mental status (e.g., confusion, strange behavior, reduced
consciousness)
• Other neurological problem (persistent severe headache, seizure,
paralysis, difficulty in talking, rapid deterioration of vision)
• Unable to walk unaided
• Any other condition that requires emergency management
27. Hairy Leukoplakia
• Treatment and Management:
–Generally does not require
treatment
–Antiviral treatment and topical
podophyllum resin have been used to treat -
- the result is temporary
–May wax and wane without
treatment
32. Lesions Caused By Human
Papilloma Virus (HPV)
Appearance:exophytic, papillary, oral
mucosal lesions
Several different types of HPV have been
reported to cause lesions
May be multiple
Often difficult to treat due to a high risk of
recurrence
33.
34. Kaposi’s Sarcoma
Appearance:Oral lesions appear as reddish purple, raised
or flat
Size ranges from small to extensive
Behavior is unpredictable
Definitive diagnosis: biopsy and histologic examination
No curative therapy--antiretroviral therapy, radiation
treatment, chemotherapy and sclerosing agents have been,
used to control oral lesions
