Includes investigations and treatment of AIDS and Mechanism of Action of Anti HIV drugs. Surgical precautions in handling a HIV patient has also been included.

1. AIDS
Management
Presented by : T Manish Kumar

2. INVESTIGATIONS
 HIV enzyme linked immunosorbent assay (ELISA)
 Western Blot
 CBC
 Absolute CD4 lymphocyte count
 CD4 lymphocyte percentage
 HIV viral load tests
 B2 – Microglobulin
 p24 antigen

3. HIV Enzyme linked immunosorbent assay
(ELISA)
• Screening test for HIV infection.
• Sensitivity > 99.9%
• It is used to detect the HIV – antibodies.
• To avoid the false-positive results, repeatedly reactive results must be
confirmed with Western blot.

4. Western Blot
• Confirmatory test for HIV
• Its specificity when combined with ELISA is > 99.99%
• It is based on detecting specific antibody to viral core protein (p24)
and envelop glycoprotein (gp 41)

5. Complete Blood Count (CBC)
• Anaemia
• Neutropenia
• Thrombocytopenia

6. Absolute CD4 lymphocyte count
• It is the most widely used predictor of HIV.
• Risk of progression to an AIDS opportunistic infection or malignancy is
high with CD4 < 200 cells/uL
• Normal CD4 count is > 500 cells/uL

7. CD4 Lymphocyte Percentage
• Risk of progression to an AIDS opportunistic infection or malignancy is
high with percentage < 14%
• Percentage may be more reliable than the CD4 count.

8. HIV Viral Load Tests
• These tests measure the amount of actively replicating HIV virus.
• It correlates with
 Disease progression
 Response to anti-retroviral therapy

9. B2 - Microglobulin
• It is a cell surface protein indicative of macrophage - monocyte
stimulation.
• Levels > 3.5 mg/dl is associated with rapid progression of the disease.
• This is not useful in IV drug abusers.

10. TREATMENT

11. Anti-Retroviral Drugs
 Entry Inhibitors
 Nucleoside Reverse Transcriptase inhibitors (NRTIs)
 Non – Nucleoside Reverse Transcriptase inhibitors (NNRTIs)
 Integrase Inhibitors
 Protease Inhibitors

13. Entry Inhibitors
 CD4 inhibitors : Enfuvirtide, Ibalizumab
 CCR5 inhibitors : Maraviroc, Vicriviroc, Cenicriviroc
 GP-120 inhibitors : Fostemsavir
These are 2nd line drugs used in treatment of Resistant HIV

14. NRTIs
Its effective against both HIV 1 and HIV 2
Drugs:
• Zidovudine
• Lamivudine
• Tenofovir
• Emtricitabine
• Abacavir
Side Effects:
• Lactic acidosis
• Peripheral neuropathy
• Myopathy
• Pancreatitis

15. NNRTIs
Effective only against HIV 1
Drugs:
• Nevirapine (DOC for prevention of perinatal HIV transmission)
• Efavirenz (1st line drug for HIV treatment)
• Etavirine
• Delavirdine
• Rilpivrine
Side Effects:
• Hepatotoxicity (Nevirapine)
• Teratogenicity
• Rash
• Gynecomastia

16. Integrase Inhibitors
• Effective against both HIV 1 and HIV 2
Drugs:
• Raltegravir
• Dolutegravir
• Bictegravir
Side effects:
• Hepatotoxicity
• Rhabdomyolysis

17. Protease Inhibitors
Effective against HIV 1 and HIV 2
Drugs:
• Lopinavir
• Ritonavir
Side effects
• Dyslipidaemia
• Hyperglycaemia
• Central Obesity
• Hepatotoxicity

18. NACO Guidelines
• TREATMENT REGIMEN
 Adults or Adolescents > 10 years and Weight > 30 kg
Tenofovir + Lamivudine + Efavirenz

19.  Adults or Adolescents > 10 years and weight < 30 kg or Renal failure
Abacavir + Lamivudine + Efavirenz
 Age : 3-10 years
Zidovudine + Lamivudine + Efavirenz
 Age > 3 years
Zidovudine + Lamivudine + Lopinavir

20. Standard ART Dosage
• Tenofovir 300 mg
• Lamivudine 300 mg
• Efavirenz 600 mg
• Emtricitabine 200 mg
• Dolutegravir 50 mg

21. HIV with Pregnancy
• Female on a regimen continue the same regimen
• Female not on treatment:
 If history of use of Nevirapine present regimen is:
Tenofovir + Lamivudine + Lopinavir
 If history of use of Nevirapine not present regimen is:
Tenofovir + Lamivudine + Efavirenz

22. Post Exposure Prophylaxis
• PEP is best is given within 2 hours
• But it can be given for a maximum of 72 hours
Regimen:
 According to NACO: Tenofovir + Lamivudine + Lopinavir/Ritonavir
 According to WHO: Tenofovir + Lamivudine + Raltegravir/Doutegravir

23. SURGICAL PRECAUTIONS

24. Universal Precautions Against HIV
• Care in handling sharp objects like needles, blades.
• All cuts and abrasions in an HIV patient should be covered with a
waterproof dressing.
• Minimal parenteral injections
• Equipment and areas which are contaminated with secretions should
be wiped with sodium hypochloride solution or 2% glutaraldehyde
• Contaminated gloves, cottons should be incinerated.

25. • Equipment should be disinfected with glutaraldehyde.
• Walls and floors should ne cleaned properly with soap water.
• Separate operation theatre and staff to do surgeries to HIV patients is
justifiable.
• Avoid shaving whenever possible before surgery in HIV patients.
• All people inside the OT should wear disposable gowns, plastic
aprons, goggles, overshoes and gloves.
• Additional double gloves should be worn.

26. • Suction bottle should be half filled with freshly prepared glutaldehyde
solution.
• Spilled body fluids should be diluted with glutaraldehyde.
• OT should be fumigated after surgery to HIV patients.

27. HIV – Hospital and Surgeon
• Isolation of HIV patient is not required
• Proper care should be taken to prevent transmission of virus.
• Open wounds, disposal of excreta, fluid, discharge, pus and other
infective materials should be taken care of properly.
• Risk of HIV infection through needle prick is very less (0.03%)

28. THANK YOU