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Human Immunodeficiency Viru Sreal

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Department of Otorhinolaryngology Head and Neck Surgery, University of Medicine 2
Department of Otorhinolaryngology Head and Neck Surgery, University of Medicine 2

Medicine

EducationHealth & Medicine
1 of 81
HUMAN IMMUNODEFICIENCY VIRUS SUBMITTED BY- GROUP D1 MEDICAL WARD 25.4.2006
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Mode of transmission
Major mode of spreads ,[object Object],[object Object],[object Object],[object Object]
Transmission risk after exposure ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object]
High risk persons ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
COURSE OF INFECTION
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Immunological abnormalities in HIV infection ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
CLINICAL SEQUALE
Neurological ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Eye ,[object Object]
Gastrointestinal ,[object Object],[object Object],[object Object],[object Object]
Respiratory ,[object Object],[object Object],[object Object]
Cardiac ,[object Object],[object Object]
Renal Endocrine ,[object Object],[object Object]
Mucocutaneous ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Haematology ,[object Object],[object Object],[object Object],[object Object],[object Object]
Neoplasms ,[object Object],[object Object],[object Object]
[object Object]
Opportunistic infection ,[object Object],[object Object],[object Object],[object Object],[object Object]
Common AIDS defining condition ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL COURSE
Primary infection ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Asymptomatic infection (CD4> 500/cumm) ,[object Object],[object Object],[object Object]
Mildly symptomatic disease ( ARC) ( CD4 200-500/cumm) ,[object Object],[object Object]
Acquired immune deficiency syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Major signs ,[object Object],[object Object],[object Object],CRITERIA USED IN MYANMAR
Minor signs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
INVESTIGATION
laboratory confirmation ,[object Object],[object Object],[object Object]
Pre and post test counselling ,[object Object],[object Object],[object Object]
Baseline investigations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Investigation for systemic diseases ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TREATMENT OF HIV INFECTION
Aims ,[object Object],[object Object],[object Object],[object Object]
Asymptomatic HIV positive patient ,[object Object],[object Object],[object Object],[object Object]
Symptomatic HIV infection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
1)Nucleoside reverse transcriptase inhibitors(NRTIs) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
2)Non-nucleoside reverse transcriptase inhibitors(NNRTIs) ,[object Object],[object Object],[object Object],[object Object],[object Object]
3)Protease inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Indication to start HAART (Highly active antiretroviral therapy) Note; The higher the viral load; the earlier the treatment should be recommended Consider Monitor 2 monthly Monitor/ recommend based on viral load Recommend Seroconversion >350 200-350 <200 Decision CD4 count (cells/cumm)
Factors to consider when choosing HAART ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Combination treatment for the naïve patient ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Causes of virological failure ,[object Object],[object Object],[object Object],[object Object]
Enhancing immune mechanism ,[object Object],[object Object],[object Object],[object Object],[object Object]
PREVENTION & CONTROL
1) Sexual ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
2) Parenteral ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
3) Perinatal ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
4) Occupational ,[object Object],[object Object],[object Object],[object Object]
Prophylaxis of opportunistic infections Clarithromycin or rifabutin azithromycin <50/cumm MAI INH or rifampicin& pyrazinamide Rifampicin & INH (+) ve tuberculin test Tuberculosis Gancyclovir <50/cumm CMV Dapsone & pyrimethamine Co-trimoxazole <100/cumm Toxoplasmosis Dapsone, Co-trimoxazole <200/cumm Pneumocystis Alternative First-line Indication (CD4 count) Organisms/ infection
Post exposure prophylaxis (PEP) ,[object Object],[object Object],[object Object]
Basic & expanded post- exposure prophylactic regimen As above + Indinavir (Indivan) 800mg 8 hrly OR Efavirenz( Efavir) 600mg OD at night OR Nelfinavir 750mg tds Occupational HIV exposure that posses an increase risk of transmission( e.g. larger volume of blood or higher virus titer in blood) Expanded (28days) Zidovudine 300mg b.d +lamivudine 150mg b.d (Duovir) OR Stavudine 30/40 mg b.d + lamivudine 150mg b.d (Lamivir-s 30/40 ) Occupational HIV exposure for which there is a recognized risk Basic (28days) Drug regimen Indication Category
Follow up ,[object Object],[object Object],[object Object],[object Object]
THANK YOU
Q & A Programme All questionnaires are warmly welcomed .

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Human Immunodeficiency Viru Sreal

  • 1. HUMAN IMMUNODEFICIENCY VIRUS SUBMITTED BY- GROUP D1 MEDICAL WARD 25.4.2006
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  • 51. TREATMENT OF HIV INFECTION
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  • 63. Indication to start HAART (Highly active antiretroviral therapy) Note; The higher the viral load; the earlier the treatment should be recommended Consider Monitor 2 monthly Monitor/ recommend based on viral load Recommend Seroconversion >350 200-350 <200 Decision CD4 count (cells/cumm)
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  • 76. Prophylaxis of opportunistic infections Clarithromycin or rifabutin azithromycin <50/cumm MAI INH or rifampicin& pyrazinamide Rifampicin & INH (+) ve tuberculin test Tuberculosis Gancyclovir <50/cumm CMV Dapsone & pyrimethamine Co-trimoxazole <100/cumm Toxoplasmosis Dapsone, Co-trimoxazole <200/cumm Pneumocystis Alternative First-line Indication (CD4 count) Organisms/ infection
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  • 78. Basic & expanded post- exposure prophylactic regimen As above + Indinavir (Indivan) 800mg 8 hrly OR Efavirenz( Efavir) 600mg OD at night OR Nelfinavir 750mg tds Occupational HIV exposure that posses an increase risk of transmission( e.g. larger volume of blood or higher virus titer in blood) Expanded (28days) Zidovudine 300mg b.d +lamivudine 150mg b.d (Duovir) OR Stavudine 30/40 mg b.d + lamivudine 150mg b.d (Lamivir-s 30/40 ) Occupational HIV exposure for which there is a recognized risk Basic (28days) Drug regimen Indication Category
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  • 81. Q & A Programme All questionnaires are warmly welcomed .