HIV can be transmitted sexually, through blood or blood products, or from mother to child. It progresses through acute infection, asymptomatic latency, and AIDS if untreated. Complications include opportunistic infections like tuberculosis, cancers like Kaposi's sarcoma, neurological issues, and wasting syndrome due to immune system damage. Common infections are candidiasis, cryptococcal meningitis, toxoplasmosis, and cryptosporidiosis. Cancers include Kaposi's sarcoma and lymphomas. Other complications are wasting syndrome, neurological symptoms, and kidney disease like HIVAN.

1. HIV/ AIDS
1. RISK FACTOR
2. CLINICAL FEATURE
3. COMPLICATION
FATIN AMANINA BINTI ISMAIL (90)

2. RISK FACTOR
HIV can be transmitted by:
1. Sexual transmission
2. Transmission by blood or blood products
3. Occupational transmission
4. Maternal-fetal/ infant transmission

3. 1. Sexual transmission
• Unprotected sex
• Multiple sex partner
• Genital inflammatory state –
(urethritis, epididymitis)
• HIV concentrate in seminal fluid
particularly when there is more
lymphocytes and monocytes
• Unprotected sexual receptive
anal intercourse
• Trauma to the rectal mucosa
during sexual intercourse
• Direct inoculation of HIV from
semen into blood if there is any
traumatic tears
• Infection to susceptible target cells
such – Langerhans cells

4. 1. Sexual transmission
• Presence of other STI increase
risk of infection:
Causes genital ulceration:
• Treponema pallidum
• Haemophilus ducreyi
• Herpes simplex virus (HSV)
Non-ulcerative inflammatory STIs:
• Chlamydia trachomatis
• Neisseria gonorrhoea
• Trichomonas vaginalis
• Uncircumcised men:
• Increase risk of uncreative STIs
• Highly vascularized inner foreskin
tissue contains high number of
cellular component that is target
for HIV
Harrison’s Infectious Disease 2nd Edition, pg.851

5. 2. Transmission by blood or blood product
• Transplantation
• Blood containing organ or highly
vascularized
• Organs – kidney, liver, heart, etc.
• Injection drug user
• Sharing of needles and syringes
• Blood transfusion
• HIV contaminated blood
transfusion.
• Blood products
• Clotting factors

6. 3. Occupational transmission
• People who worked with HIV-
containing materials.
• Health care workers and laboratory
personnel
• Percutaneous injury:
• Stuck with needles or other sharp
medical instrument – puncture
wound
• Contact with mucous membrane of
non intact skin (exposed skin that is
chapped, abraded, or afflicted with
dermatitis
• Exposed to blood, tissue or other
infectious body fluids.

7. 4. Maternal-fetal/ infant transmission
• During pregnancy
• Trans placenta micro transfusion of
maternal blood
• Damage to the placenta cause
mixing of blood
• During delivery
• Most maternal-fetal infection occur
at this stage
• During the passage of the fetus
through the birth canal
• Breast feeding:
• Associated with:
HIV detection in breast milk
Presence of mastitis
Low maternal CD4+ cell counts
Maternal vitamin A deficiency

8. CLINICAL FEATURE
• Clinical features of HIV infection depend on the stages of the
disease:
• The acute HIV syndrome
• The asymptomatic stage – clinical latency
• AIDS (Symptomatic disease)

9. 1. The acute HIV syndrome
• 2-4 weeks after HIV infection
• The virus uses CD4 count to replicate and destroys them in the
process:
• Production of large amount of HIV
• CD4 cells can fall rapidly
• Eventually your immune response will begin to bring the level of
virus in your body back down to a level called a viral set point,
which is a relatively stable level of virus in your body.
• At this point, your CD4 count begins to increase, but it may not
return to pre-infection levels. It may be particularly beneficial to
your health to begin ART during this stage.
• At this stage, transmission to other people is high due to high level
of HIV in the blood stream.

10. 1. The acute HIV syndrome

11. 2. The asymptomatic stage – Clinical latency
• During this stage of the
disease:
• HIV continues to multiply
in the body but at very low
levels
• People with chronic HIV
infection may not have any
HIV-related symptoms
• They can still spread HIV to
others
• Without treatment with
HIV medicines, chronic HIV
infection usually advances
to AIDS in 10 to 12 years

12. 3. Symptomatic disease
• AIDS is the final stage of HIV infection
• HIV has destroyed the immune system, the body cannot fight
off opportunistic infections and cancer
• A diagnosis of AIDS is made in anyone with:
• HIV infection and a CD4+ T cell count <200/cells/mm3 (Normal - 500 to
1,600 cells/mm3) or
• Who develops one of the HIV-associated diseases
• Symptoms that you may have during this time can include:
• Weight loss
• Chronic diarrhoea
• Night sweats
• Fever
• Persistent cough
• Mouth and skin problems
• Regular infections
• Serious illnesses or diseases

13. COMPLICATION
• The main complication of HIV is weakened immune system:
• Disease of the respiratory system
• Disease of the cardiovascular system
• Disease of the oropharynx and gastrointestinal system
• Hepatobiliary disease
• Disease of the kidney and genitourinary tract
• Disease of the endocrine system and metabolic disorders
• Immunologic and rheumatologic disease
• Immune reconstitution inflammatory syndrome
• Disease of the hematopoietic system
• Dermatologic disease
• Neurologic disease
• Ophthalmologic disease
• Disseminated infections and wasting syndrome
• Neoplastic disease

14. 1. Infections common to HIV/ AIDS
• Tuberculosis (TB)
• In resource-poor nations, TB is the most common
opportunistic infection associated with HIV and a
leading cause of death among people with AIDS.
• Cytomegalovirus
• This common herpes virus is transmitted in body fluids
such as saliva, blood, urine, semen and breast milk.
• A healthy immune system inactivates the virus, and it
remains dormant in your body.
• If your immune system weakens, the virus resurfaces
— causing damage to your eyes, digestive tract, lungs
or other organs.
• Candidiasis
• Candidiasis is a common HIV-related infection.
• It causes inflammation and a thick, white coating on
the mucous membranes of your mouth, tongue,
oesophagus or vagina.

15. 1. Infections common to HIV/ AIDS
• Cryptococcal meningitis
• Meningitis is an inflammation of the membranes and fluid surrounding your
brain and spinal cord (meninges).
• Cryptococcal meningitis is a common central nervous system infection
associated with HIV, caused by a fungus found in soil.
• Toxoplasmosis
• This potentially deadly infection is caused by Toxoplasma gondii, a parasite
spread primarily by cats.
• Cryptosporidiosis
• This infection is caused by an intestinal parasite that's commonly found in
animals.
• The parasite grows in your intestines and bile ducts, leading to severe,
chronic diarrhea in people with AIDS.

16. 2. Cancers common to HIV/ AIDS
• Kaposi's sarcoma
• A tumour of the blood vessel walls, this
cancer is rare in people not infected with
HIV, but common in HIV-positive people.
• Kaposi's sarcoma usually appears as pink,
red or purple lesions on the skin and
mouth.
• Kaposi's sarcoma can also affect the
internal organs, including the digestive
tract and lungs.
• Lymphomas
• This type of cancer originates in your
white blood cells and usually first appears
in your lymph nodes.
• The most common early sign is painless
swelling of the lymph nodes in your neck,
armpit or groin.

17. 3. Other
• Wasting syndrome.
• Aggressive treatment regimens have reduced the number of cases of
wasting syndrome, but it still affects many people with AIDS.
• It's defined as a loss of at least 10 percent of body weight, often
accompanied by diarrhoea, chronic weakness and fever.
• Neurological complications.
• Although AIDS doesn't appear to infect the nerve cells, it can cause
neurological symptoms such as confusion, forgetfulness, depression,
anxiety and difficulty walking.
• One of the most common neurological complications is AIDS dementia
complex, which leads to behavioural changes and diminished mental
functioning.
• Kidney disease.
• HIV-associated nephropathy (HIVAN) is an inflammation of the tiny filters in
your kidneys that remove excess fluid and wastes from your bloodstream
and pass them to your urine.

18. COMPLICATION

19. COMPLICATION

20. COMPLICATION

21. COMPLICATION

22. REFERENCES
1. Kumar, Abbas, Aster. 2013. Robbins Basic Pathology 9th Edition.
2. Dennis L. Kasper, Anthony S. Fauci. 2013. Harrison’s Infectious
Disease 2nd Edition.
3. http://www.who.int/hiv/en/
4. http://www.medicinenet.com/acquired_immunodeficiency_syn
drome_aids/page9.htm
5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509795/