This document discusses the history, transmission, clinical manifestations, diagnosis, and treatment of AIDS/HIV. Some key points include: - HIV was first recognized in 1981 in the US and was isolated and identified as the causative agent of AIDS in 1983-1984. - HIV is transmitted through bodily fluids like blood, semen, vaginal fluids, and breastmilk. Common routes of transmission include unprotected sex, contaminated needles, and mother-to-child. - Left untreated, HIV progresses to AIDS when the CD4 count drops below 200 cells/uL. This severely weakens the immune system and leaves the body vulnerable to opportunistic infections. - While there is no vaccine yet, treatment involves

1. AIDS-
THE THREAT
TODAY
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INDIAN DENTAL ACADEMY
Leader in continuing Dental Education

2. HISTORY
• 1ST
RECOGNISED IN U.S IN
SUMMER OF 1981
• HIV WAS ISOLATED FROM THE
PATIENT WITH
LYMPHADENOPATHY IN 1983
• CAUSATIVE AGENT OF AIDS OS
HIV 1984
• ELISA 1985
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3. • A RETROVIRUS FROM FAMILY
OF RETROVIRAEDAE
• GENETIC INFORMATION IS
ENCODEDE BY RNA RATHER
THAN DNA
• RNA DEPENDENT DNA
POLYMERASE
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• Leader continuing dental
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• Offer both online and offline
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5. 3 SUBFAMILIES
• ONCOVIRINAE-HTLV TYPE 1 IN
HUMANS
• LENTIVIRINAE –HIV
• SPUMAVIRINAE
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6. Definition by CDC earlier
• The presence of a reliably
diagnosed disease atleast
moderately predictive of an
underlying cellular
immunodeficiency in a
previously healthy patient.
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7. DEFINATION
ANY PATIENT WHO HAS CD4+T
LYMPHOCYTE CELL COUNTS
<200/UL
HAS AIDS REGARDLESS OF
PRESENCE OF SYMPTOMS OR
OPPORTUNISTIC DISEASES.
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8. • CD4+ T CELL LYMPHOCYTE
CATEGORIES
• >500/UL
• 200-499/UL
• <200/UL
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9. Classification of HIV
• GP -acute infection
• GPII- asymptomatic infection
• GPIII- P.G.L
• GPIV-other diseases
• Sub GP A – constitutional disease
• B- neurological disease
• C-secondary infectious disease
• D- secondary cancers
• E- other conditionswww.indiandentalacademy.
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12. ETIOLOGIC AGENT
• 4 RECOGNIZED HUMAN
RETROVIRUSS PPPBELONG TO
2 DISTINCT GPS-
• HTLV 1
• HTLV 11
• HIV 1
• HIV 2
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13. • CATEGORY A – ASYMPTOMATIC
HIV INFECTION
• P.G.L.
• CATEGORY B-MEETS ONE OF
THER FOLLOWING CRITERIA-
• DEFECT IN CELL MEDIATED
IMMUNITY
• ORAL THRUSH
• SYMPTOMS OF FEVER WHICH IS
UNEXPLAINABLE
• DIARRHEA FOR ALMOST A MONTHwww.indiandentalacademy.
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14. • ORAL HAIRY LEUKOPLAKIA
• HERPES ZOSTER INVOLVING 2
DISTINCT EPISODES OR MORE
THAN ONE DERMATOME
• P.I.D
• CATEGORY C
• CANDID OF BRONCHI,TRACHEA,OR
LUNGS
• CANDIDIASIS , OESOPHAGEAL
• CERVICAL CANCER
• CMV disease
• ENCEPHALOPATHY HIV RELATED
• HERPES SIMPLEX , CHRONIC
ULCER>1 MONTH
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15. • HISTOPLASMOSIS
• KAPOSIS SARCOMA
• BURKITTS LYMPHOMA
• M. BACT. AVIUM COMPLEX
• M.TB
• PNEUMOCYSTIS CARNII
PNEUMONIA
• TOXOPLASMOSIS OF BRAIN
• WASTING SYNDROME DUE TO HIV
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16. TRANSMISSION
• HOMOSEXUAL AND
HETROSEXUAL
• BLOOD AND BLOOD PRODUCTS
• INFECTED MOTHER TO INFANT
• ANAL INTERCOURSE
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17. • MALE : FEMALE
TRANSMISSION IS 8 TIMES
MORE THAN FEMALE TO
MALE RATIO.
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18. • NORMAL DELIEVERY OF BABY
HAS MORE CHANCES OF
TRNSMITTING HIV.
• EXCLUSIVE BREAST FEEDING
HAS BEEN REPORTED TO CARRY
A LOWER RISK OF HIV
TRANSMISSION THAN MIXED
FEEDING.
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19. • HIV CAN BE TRANSMITTED IN
LOW TITRES FROM SALIVA OF A
SMALL PROPORTION OF
INFECTED INDIVIDUALS
• SECRETORY LEUKOCYTE
PROTEASE INHIBITOR BLOCKS
HIV INFECTION AND IS FOUND
IN SALIVA AT LEVELS THAT
APPROX THOSE REQUIRED FOR
INHIBITION OF HIV IN VITRO
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20. CLINICAL MANIFESTATION
• ACUTE HIV SYNDROME
• APPROX AFTR 3-4 WEEKS AFTER
PRIMARY INFECTION
• GENERAL-
• FEVER,PHARYNGITIS,LYMPHADE
NITIS,HEADACHE,ARTHRALGAI/M
YALGIA,LETHARGY/MALAISE.,
ANOREXIA,WEIGHT LOSS
• NEUROLOGIC-
MENINGITIS,ENCEPHALITIS,MYE
LOP-ATHY
• DERMATOLOGIC-
ERYTHEMATOUS
MACULOPAPULAR RASH,www.indiandentalacademy.
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21. • OPPORTUNISTIC
INFECTIONS
• INVERSION OF CD4+ /CD8+
T CELL RATIO NORMAL IS
2
• REDUCES TO 0.5
• LYMPHADENOPATHY 70%www.indiandentalacademy.
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22. • CD4+ T CELL COUNTS DECLINE
TO
• ~ 50 /UL PER YEAR
• WHEN CD4 + T CELL COUNT
FALLS <200 /UL , THE
RESULTING STATE OF
IMMUNODEFICIENCY IS
SEVERE
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23. • RESPIRATORY SYSTEM
• ACUTE BRONCHITIS AND
SINUSITIS
• MAXILLARY SINUS COMMONLY
INVOLVED
• MUCORMYCOSIS INFECTION OF
SINUSES
• PNEUMONIA
• MTB
• HISTOPLASMOSIS
• KAPAOSI SARCOMA AND
LYMPHOMA.www.indiandentalacademy.
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24. • CARDIOVASCULAR SYSTEM
• DILATED ARDIAOMYOPATHY
WITH C.H.F. CALLED AS HIV
ASSOCAITED
CARDIOMYOPATHY.
• PERICARDIAL EFFUSION
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25. • OROPHARYNX AND G.I
SYSTEM
• THRUSH, ORAL HAIRY
LEUKOPLAKIA, APTHUS
ULCERATION
• OESOPHAGITIS WITH
ODYNOPHAGIA
• FUNGAL INFECTION AUSES
DIARRHEAwww.indiandentalacademy.
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26. • KIDNEY AN D GIT
• HIV ASSOCAITED NEUROPATHY
• GIT INFECTION
• T. PALLIDUM
• CONDYLOMATA LATA
• VULVOVAGINAL CANDIDIASIS
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27. • THYROID FUNCTION IS NORMAL
(2-3%)
• LIPODYSTROPHY
• SJOGRENS SYNDROME
• AIDS ASSOCIATED
ARTHROPATHY
• PERSISTENT GENERALISED
LYMPHADENOPATHY
• ANAEMIA
• THROMBOCYTOPENIA
• SEBORRHEIC DERMATITIS
• HERPES ZOSTER
• HSV www.indiandentalacademy.
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28. • NEUROLOGIC
• AIDS ENCEPHALOPATHY
• AIDS DEMENTIA
• PERIPHERAL NEUROPATHY
• MYOPATHY
• ACUTE RETINAL NECROSIS
• CAT SCRATCH DISEASE
• HUMAN PAPILLOMA VIRUS
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29. ORAL LESIONS
• FUNGAL-CANDIDIASIS
,HISTOPLASMOSIS
• BACTERIAL-HIV necrotizing
gingivitis,periodontitis,actinomy
cosis,sinusitis.
• Submandibular cellulitis
• Viral-EBV-hairy leukoplakia
• VZ-herpes zoster
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30. • Neoplasm-trigeminal
neuropathy,facial palsy
• Unknown etiology-rec.apthus
ulceration ,progressive
necrotizing ulceration,delayed
wound
healing,xerostomia,salivary
gland enlargement.
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31. • Pathophysiology-
• Deficiency of subset of T cell i.e
helper T cell
• CD4 is present on T cells
• 2 major targets
• Immune system
• C.N.S
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32. • SEVERE LOSS OF cd4+ T cell
• IMPAIRMENT IN FUNCTION
OF SURVIVING HELPER T
CELL
• CD4 HAS HIGH AFFINITY
FOR HIV.
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34. STEPS IN INFECTION• Binding of gp120 envelope
glycoprotein to CD4 molecule
• Fusion of virus to cell membrane
and internalization
• Astrocytes,skin fibroblasts and
bowel epithelial cells are infected
through an entirely different
receptor(CD4 not present)
• In CNS galactosyl ceramide , a
myelin associated glycolipid ,is
the receptor.
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35. • After internalization , the viral
genome undergoes reverse
transcription
• Formation of proviral DNA
• Integrated into host genome
• Provirus remains latent
• Or
• Transcribed with formation of
complete viral particles that bud
from cell membrane.
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36. • Productive infection of T cell is the
mechanism by which HIV causes
lysis of CD4 + T cell
• Mech. Other than direct cytolysis-
• Loss of immature precursor of CD4+
T cell lymphocyte by direct infection
of thymic progenitor cells
• Fusion of uninfected and infected
cells
• Autoimmune destruction of both
infected and uninfected CD4+T cell
• CD4/CD8-.5www.indiandentalacademy.
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37. HIV testing
• ELISA
• WESTEN BLOT
• P.C.R
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38. TREATMENT
• reverse transcriptor inhibitor
• Ziduvudine
• Protease inhibitor
• Sequinavir
• Ritonavir
• Indinavir
• Mild disease-2 drug
combination(ziduvudine &lamivudine)
• Severe HIV –triple therapy2 nucleoside
reverse transcriptase inhibitors with
protease inhibitor.HAART.
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39. prevention
• Proper barrier
• Double gloving
• Protective eyewear
• Masks
• Gowns and aprons
• Face sheilds
• Needles in puncture resistant
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40. HIV postexposure
management
• A test immediately
• Report and seek medical
evaluation for acute febrile illness
that occurs within 12 weeks after
exposure.
• Seronegative workers should be
retested 6 weeks, 12 weeks and 6
months after exposure.
• Ziduvudine as chemoprophylaxis
• Health care workers –lamivudine
and ziduvudine
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41. • High risk-indinavir
• Prophylaxis 1-2 hr of
exposure
• 200mg ziduvudine every 4 h
for 28-42days.
• Procedures orderly
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42. Needle prick
• Running water
• Post exposure prophylaxis
within 1 hr of injury
• Ziduvidine 250mg BD
• Lamivudine 150mg BD
• Indinavir 800 mg TDS for 1
month
• HIV test repeatedly after 12
months
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43. HIV VACCINES
• LIVE CANARYPOX.
• ANKARA
• PEPTIDE AND SUBUNIT
VACCINES
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