The slide is about HIV/ AIDs. A slide for Internal medicine

1. HIV/AIDS
HIV and AIDS
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2. GROUP 12
• AH/PAS/22/0135
• AH/PAS/22/0152
• AH/PAS/22/0134
• AH/PAS/22/0136
• AH/PAS/22/0144
• AH/PAS/22/0148
• AH/PAS/22/0149
• AH/PAS/22/0150
• AH/PAS/22/0154
• AH/PAS/22/0155
• AH/PAS/22/0133
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3. OBJECTIVES
• Definition of HIV and AIDS
• Epidemiology
• Aetiology of HIV and AIDS
• Pathophysiology
• Signs and symptoms
• Diagnosis(test)
• Complications
• Management
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4. Acronyms
• H.I.V. = Human Immunodeficiency Virus
• A.I.D.S. = Acquired Immunodeficiency Syndrome.
• A.R.Vs = Antiretroviral Drugs
• H.A.A.R.T = Highly Active Antiretroviral Therapy
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5. HIV AND AIDS
HIV is a Sexually Transmitted Infection (STI)
HIV is a virus that attacks the cells that help the body fight infection making person more vulnerable to
opportunistic infections and diseases.
Acquired immunodeficiency syndrome (AIDS):is a chronic, potentially life-threatening conditioncaused by the
human immunodeficiency virus (HIV).
AIDS is not a disease but rather the end stage of HIV infection in which the immune system is compromised,
making it vulnerable
AIDS is the late stage of HIV infection that occurs when the body’s immune system is damaged or severely
compromised due the the HIV virus.
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6. EPIDEMIOLOGY
• Since the first description of AIDS in 1981 and the identification of the
causative organism of HIV in 1983, more than 78 million people are
estimated to have been infected and 39 million people have died. At
least 35 million people worldwide are living with HIV infection.
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7. EPIDEMIOLOGY IN GHANA
• 1985
• Rumors of HIV in Ghana
• 1986
• First case of AIDS reported in
Ghana
• Technical Committee on AIDS
(MOH)
• National AIDS Control
Programme (NACP)
• 1987
• 107 HIV positive reported cases
• 1988
• 333 HIV positive cases reported
• 1989
• A thirty-member National
Advisory Council on AIDS was
established to advise the
government on policy matters
relating to the control and
prevention of AIDS in the
country. 7

8. TYPES OF HIV
• There are two types of HIV:
• HIV-1 and HIV-2.
• HIV-1
• is more virulent,
• is more easily transmitted and
• is the cause of the vast majority of HIV infections globally
• HIV-1 from chimpanzees and gorillas to humans
• HIV-2
• less transmittable and
• largely confined to West Africa.
• HIV-2 from sooty mangabeys to humans
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9. Structure of the HIV virus
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10. HIV PATHOGENESIS
• HIV is a type of virus classified as a
“Retrovirus.”
• A retrovirus is considered “retro” because it
reverses its genetic code.
• A cell’s genetic material is encoded from DNA
to RNA in most living organisms.
• A retrovirus is unique in that it
Functions in the opposite direction,
Its RNA coding to produce DNA within an
infected cell.
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11. When that occurs, the newly
produced DNA is
inserted into the host cell’s nucleus,
• effectively hijacking its genetic
machinery
• create multiple copies of itself,
• each capable of infecting and linking a
multiple of other host cells.
HIV preferentially targets white
blood cells called “helper” T-cells
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12. CONT’D
• Among these is CD4 and CD4 T-cells,
• whose job is to trigger the body’s immune response.
• By systematically depleting these immune cells,
• HIV diminishes the body’s ability to identify and neutralise the invading virus
and a host of other agents ( e.g., viral, bacterial, parasitic) it could otherwise
defend itself against.
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13. 13

14. Mode of Transmission
HIV is primarily spread through
• sexual contact,
• Contaminated needles,
injections and needle-stick
injuries)
• Accidental blood exposure
• Transmission from mother to
child (vertical transmission)
HIV is not spread through
• Sweat
• Tears
• Saliva
• Feaces
• Urine
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15. Clinical manifestations of HIV
.Primary HIV infection
• Asymptomatic infection
• Minor HIV-associated disorder
• Acquired immunodeciency syndrome
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16. Clinical features of primary infection
• Fever
• Maculopapular rash
• Pharyngitis
• Lymphadenopathy
• Myalgia/arthralgia
• Diarrhoea
• Headache
• Oral and genital ulceration
• Meningo-encephalitis
• Bell's palsy
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17. Asymptomatic infection
• A prolonged period of clinical latency follows primary infection,
during
• which infected individuals are asymptomatic. Persistent generalised
• lymphadenopathy with nodes typically < 2 cm diameter is a common
• nding. Eventually, the lymph nodes regress, with destruction of node
• architecture as disease advances.
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18. Minor HIV-associated disorder
• A wide range of disorders indicating some impairment of cellular
immunity occur in most patients before they develop AIDS (CDC
category B
• or WHO stages 2 and 3). Careful examination of the mouth is
important
• when patients are being followed up, as oral candidiasis and oral
hairy
• leucoplakia are common conditions that require initiation of
prophylaxis
• against opportunistic infections, irrespective of the CD4 count
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19. Acquired immunodeciency syndrome
• Acquired immunodeciency syndrome
• AIDS is defined by the development of specifed opportunistic
infections,
• cancers and severe manifestations of HIV itself (CDC category C or
WHO stage 4).
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20. CLINICAL FEATURES OF HIV AND AIDS
• Lymphadenopathy
• Weight loss
• Fever
• Mucocutaneous diseases
• Seborrhoeic dermatitis.
• Herpes simplex infections
• Herpes zoster 20

21. CLINICAL FEATURES OF HIV AND AIDS
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22. HIV PATIENT
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23. COMPLICATIONS OF HIV AND AIDS ON THE
BODY SYSTEMS
• GIT: chronic Diarrhoea
• Hepatobiliary disease:Chronic viral hepatitis i.e A,B and C
• HIV cholangiopathy : secondary sclerosing cholangitis
• Respiratory disease:Pneumocystis jirovecii pneumonia (Pneumocystis
pneumonia, PCP), Pulmonary tuberculosis, Bacterial pneumonia.
• Nervous system and eye disease:Cognitive impairment, CMV
encephalitis, Primary CNS lymphoma.
• Haematological abnormalities :anemia, neutropenia,
thrombocytopenia.
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24. DIAGNOSTIC TESTS OF HIV AND AIDS
• HIV testing involves various methods to detect the presence of HIV
antibodies, antigens, or the virus itself in a person's blood, saliva, or urine.
• Viral load and CD4 counts is the clinical diagnostic
tool for diagnosing HIV
• Other Methods used for HIV testing:
• Antibody Tests:
• Antigen/Antibody Tests:
• Nucleic Acid Tests (NATs):
• Rapid Tests:
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25. HIV pre- and post-test counselling
PRE TEST
• Discuss meaning of positive and
negative test results
• Realize importance of maintaining
confidentiality
• Identify person to whom positive
result could be disclosed
• Explore knowledge and explain
natural history of HIV
• Discuss transmission and risk
reduction
• Assess coping strategy
• Explain test procedure
• Obtain informed consent
POST TEST
• Test result negative
• Discuss transmission and need for
behaviour modification
• Advise second test 3 months after last
exposure
• Test result positive
• Explain meaning of result
• Organise medical follow-up
• Assess coping strategy
• Stress importance of disclosure
• Explain value of antiretroviral therapy
• Provide written information and useful
Internet resources
• Discuss condentiality issues 25

26. OPPORTUNISTIC INFECTIONS
• Opportunistic infections are those caused by otherwise common,
harmless viruses, bacteria, fungi, or parasites which can cause disease
when immune defences have been compromised.
Examples:
Bacteria tuberculosis,Pneumocystis jirovecii pneumonia, Cerebral
toxoplasmosis Bacterial pneumonia ,Bacteraemia
Cystoisosporiasis,Malaria. 26

27. Prevention of opportunistic infections
The best way to prevent opportunistic infections is to improve the CD4 count with ART. However, infections
continue to occur in the ART era as CD4 counts take time to improve if ART is initiated in patients with
profound immune suppression, immune reconstitution on ART may be suboptimal, and CD4 counts may decline
if antiretroviral resistance develop.
Preventing exposure
Safe water and food
Practising safer sex
Chemoprophylaxis
Co-trimoxazole primary prophylaxis
TB preventive therapy
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28. AIDS Defining Illnesses
AIDS-defining illnesses are those which are directly associated with
advanced HIV and AIDS infection.eg
• Histoplasmosis, disseminated
• Kaposi's sarcoma (KS)
• Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia
complex
• Burkitt lymphoma (or equivalent term)
• Immunoblastic lymphoma (or equivalent term)
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29. An approach to HIV and AIDS-positive
patients
• Full medical history
• Ask the patient who is aware of the HIV diagnosis
• Secure confidentiality;
• Anti-retroviral drugs
• recreational drugs
• Prophylaxis,
• Travel history
• Potential source of infectious agents (food hygiene, pets, contacts
with acute infections, contact with tuberculosis, sexually transmitted
infections) 29

30. Full physical examination
• Signs of adverse drug reactions, e.g. skin rashes, oral ulceration
• Signs of disseminated sepsis
• Clinical evidence of immunosuppression, e.g. oral candida, oral hairy
leukoplakia
• Focal neurological signs and/or meningism
• Evidence of altered mental state – organic or functional
Examine:Genitalia, e.g. herpes simplex, syphilis, gonorrhoea
• Lymphadenopathy
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31. Immediate investigations
• Full blood count and differential count
• Liver and renal function tests
• Plasma glucose
• Blood gases, including acid–base balance
• Blood cultures, including specimens for mycobacterial culture
• Microscopy and culture of available/appropriate specimens: stool, sputum, urine,
cerebrospinal fluid
• Malaria screen in recent travellers from malaria areas
• Serological tests for cryptococcal antigen, toxoplasmosis; save serum for viral studies
• Chest X-ray
• CT/MRI scan of brain if there are focal neurological signs and always before lumbar
puncture
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32. MANAGEMENT OF HIV AND AIDS
The aim is to:
• Induce viral suppression
• maintain physical and mental health
• improve the quality of life
• increase survival rates
• restore and improve immune function
• avoid onward transmission of the virus
• provide appropriate clinical care as needed
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33. Antiretroviral Therapy (ART)
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34. Antiretroviral Therapy (ART)
ART has transformed HIV from a progressive illness with a fatal outcome
into a chronic manageable disease with a near-normal life expectancy.
The goals of ART are to:
1.Reduce the viral load to an undetectable level for as long as possible
2. Improve the CD4 count to over 200 cells/mm3 so that severe HIV related
disease is unlikely
3.Improve the quantity and quality of life without unacceptable drug
toxicity
4. Reduce HIV transmission
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35. Selecting antiretroviral regimens
There are several classes of antiretroviral drugs:
• a) Nucleoside Reverse Transcriptase Inhibitors (NRTIs):
• b) Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs):
• c) Protease Inhibitors (PIs):
• d) Integrase Inhibitors:
• e) Entry Inhibitors:
.
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36. Selecting antiretroviral regimens
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37. Types of ARVs
•
Nucleoside Reverse
Transcriptase Inhibitors (NRTIs):
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38. Types of ARVs
•
Non-Nucleoside Reverse
Transcriptase Inhibitors
(NNRTIs):
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39. Protease Inhibitors (PIs):
PIs interfere with the protease enzyme, which HIV requires to assemble
new virus particles.
• Atazanavir (ATV)
• Darunavir (DRV)
• Lopinavir (LPV)
• Saquinavir (SQV)
• Indinavir (IDV)
• Ritonavir (RTV)
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40. Integrase Inhibitors
• These drugs inhibit the integrase enzyme, which HIV uses to integrate
its genetic material into the DNA of host cells.
• Raltegravir (RAL)
• Dolutegravir (DTG)
• Elvitegravir (EVG)
• Bictegravir (BIC)
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41. ARVs
• Entry Inhibitors:
• Entry inhibitors block the entry of HIV into host cells by targeting viral
proteins involved in the fusion process.
• Fusion Inhibitor: Enfuvirtide (T-20)
• CCR5 Antagonists: Maraviroc (MVC)
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42. Prevention of HIV and AIDS
• Pre-exposure prophylaxis
Daily tenofovir plus emtricitabine
• Post-exposure prophylaxis
• Tenofovir together with
emtricitabine is the most widely
used dual NRTI combination,
together with either a PI or an
integrase inhibitors.
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43. REFRENCE
Aidsinfo.nih.gov AIDSinfo, a service of the US Department of Health
and Human
Services (HHS).
bhiva.org British HIV Association.
who.int/health-topics/hiv-aids World Health Organization.
Kumar and clark
Davidson Principle and practice of medicine ED24
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