acquired immuno-deficiency syndrome (aids)
DESCRIPTION
Definition AIDS is a chronic, life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging immune system, HIV interferes with the body's ability to fight off viruses, bacteria and fungi that cause disease. HIV makes man more susceptible to certain types of cancers and to infections which the body would normally resist. The virus and the infection itself are known as HIV. AIDS is the name given to the later stages of an HIV infectionTRANSCRIPT
Acquired Immuno-deficiency Syndrome
(AIDS)
Dr. Assad RahhalNational AIDS Program/ MOH
Definition AIDS is a chronic, life-threatening condition caused by
the human immunodeficiency virus (HIV). By damaging immune system, HIV interferes with the body's ability to fight off viruses, bacteria and fungi that cause disease. HIV makes man more susceptible to certain types of cancers and to infections which the body would normally resist.
The virus and the infection itself are known as HIV. AIDS is the name given to the later stages of an HIV infection
Infectious agent: HIV 1, HIV 2
Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte
Symptoms Early infection (window period)
Fever Headache Sore throat Swollen lymph glands Rash
Later infection (advanced HIV infection) Swollen lymph nodes — often one of the first signs of HIV
infection Diarrhea Weight loss Fever Cough and shortness of breath
Relationship between HIV copies (viral load) and CD4 counts over the average course of untreated HIV infection
CD4+ T Lymphocyte count (cells/mm³)HIV RNA copies per mL of plasma
Symptoms Latest phase of infection (AIDS)
In 1993, the Centers for Disease Control and Prevention (CDC) redefined AIDS to mean the presence of HIV infection as shown by a positive HIV-antibody test plus at least one of the following:
The development of an opportunistic infection — an infection that occurs when immune system is impaired — such as Pneumocystis carinii pneumonia (PCP)
A CD4 lymphocyte count of 200 or less — a normal count ranges from 800 to 1,200
Symptoms Latest phase of infection (AIDS)
Soaking night sweats Shaking chills or fever higher than 38 C for several
weeks Dry cough and shortness of breath Chronic diarrhea Persistent white spots or unusual lesions on the
tongue or in mouth Headaches Blurred and distorted vision Weight loss
Transmission Sexual transmission Infected blood
needle sharing accidental needle sticks tattoo, body piercing organ or tissue transplants or unsterilized dental or
surgical equipment. Mother to child
Risk factors Anyone of any age, race, sex can be infected with HIV unprotected sex with someone who is HIV-positive
(multiple partners, heterosexual, homosexual or bisexual). Unprotected sex means having sex without using a new latex or polyurethane condom every time.
Have another sexually transmitted disease, such as syphilis, genital herpes, chlamydia, gonorrhea or bacterial vaginosis.
Sharing needles during intravenous drug use. Have fewer copies of a gene called CCL3L1 that helps
fight HIV infection.
Complications Bacterial infections:
Bacterial pneumonia Mycobacterium avium complex (MAC). This infection is caused
by a group of mycobacteria, in advanced HIV infection and when CD4 lymphocyte count is less than 50, it is more likely to develop a systemic infection that can affect almost any internal organ, including bone marrow, liver or spleen
Tuberculosis (TB): the most common infection associated with HIV and a leading cause of death among people living with AIDS
Salmonellosis Bacillary angiomatosis (Bartonella henselae): purplish to bright
red patches on skin
Complications Viral infections:
Cytomegalovirus (CMV): damage to eyes, digestive tract, lungs or other organs. Most commonly, CMV causes infection and inflammation of the retina (CMV retinitis)
Viral hepatitis Herpes simplex virus (HSV) Human papillomavirus (HPV): one of the most common causes
of sexually transmitted diseases (warts on the genitals) Progressive multi-focal leuko-encephalopathy (PML): human
polyomavirus JC virus, speech problems, weakness on one side of the body, loss of vision in one eye, or numbness in one arm or leg
Complications Fungal infections:
Candidiasis Cryptococcal meningitis: caused by a fungus that is present in
soil, it may also be associated with bird or bat droppings Parasitic infections:
Pneumocystis carinii pneumonia (PCP): one of the most common opportunistic infections affecting PLWHA
Toxoplasmosis: caused by Toxoplasma gondii, a parasite spread primarily by cats. For many people with AIDS, toxoplasmosis leads to encephalitis
Cryptosporidiosis: leads to severe, chronic diarrhea in people with AIDS.
Complications Cancers:
Kaposi's sarcoma Non-Hodgkin's lymphoma
Other complications Wasting syndrome: it is defined as a loss of at least
10 percent of body weight and is often accompanied by diarrhea, chronic weakness and fever.
Neurological complications: confusion, forgetfulness, changes in behavior, depression, anxiety and trouble walking. One of the most common neurological complications is AIDS dementia complex, which leads to behavioral changes and diminished mental functioning
Kaposi sarcoma
Tests and diagnosis WHO disease staging system(1990, update in
September 2005): Stage I: HIV infection is asymptomatic and not
categorized as AIDS Stage II: includes minor mucocutaneous
manifestations and recurrent upper respiratory tract infections
Stage III: includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis
Stage IV: includes toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi's sarcoma; these diseases are indicators of AIDS.
Tests and diagnosis HIV is diagnosed by testing your blood or oral mucus for
the presence of antibodies to the virus Enzyme-linked immunosorbent assay (ELISA) and
Western blot tests (checks for the presence of HIV proteins)
Rapid tests Home tests Viral load: used to decide when to start and when to
change treatment
WHEN TO START ARV THERAPY ?
Clinically advanced HIV disease: WHO Stage IV HIV disease, irrespective of
the CD4 cell count; WHO Stage III disease with consideration of
using CD4 cell counts <350/mm3 to assist decision-making
WHO Stage I or II HIV disease with CD4 cell counts <200/mm3
Factors considered in the selection of ART regimens potency; side-effect profile; laboratory monitoring requirements; potential for maintenance of future
treatment options; anticipated patient adherence; coexistent conditions (e.g. coinfections,
metabolic abnormalities);
Factors considered in the selection of ART regimens
pregnancy or the risk thereof; use of concomitant medications (i.e. potential drug
interactions); potential for infection with a virus strain with diminished
susceptibility to one or more ARVs, including that resulting from prior exposure to ARVs given for prophylaxis or treatment;
very importantly, availability and cost. The use of quality-assured a antiretroviral in fixed-dose
combinations
Treatments and drugs Improve quality of life, none of drugs can cure HIV/AIDS Treatment should focus on achieving the maximum suppression of
symptoms for as long as possible (highly active anti-retroviral therapy HAART)
Anti-retroviral drugs: Nucleoside analogue reverse transcriptase inhibitors
(NRTIs): • inhibit the replication of an HIV enzyme called reverse transcriptase
(zidovudine, lamivudine, didanosine, stavudine, abacavir, emtricitabine
• Protease inhibitors (PIs): interrupt HIV replication at a later stage in its life cycle by interfering with an enzyme known as HIV protease (saquinavir ritonavir, indinavir, nelfinavir, amprenavir, lopinavir/ritonavir (Kaletra), atazanavir and tipranavir. PIs are usually prescribed with other medications, to help avoid drug resistance.
Treatments and drugs Anti-retroviral drugs:
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs): bind directly to the enzyme reverse transcriptase (nevirapine, delavirdine, efavirenz and etravirine)
• Nucleotide reverse transcriptase inhibitors (NtRTIs): interfere with the replication of reverse transcriptase and prevent the virus from inserting its genetic material into cells (tenofovir)
FIRST-LINE ARV REGIMENS IN ADULTS AND ADOLESCENTS
Usage in women (of childbearing age or pregnant
Major potential toxicities *ARV regimen
Yes d4T-related neuropathy, pancreatitis and lipoatrophy;NVP-related hepatotoxicity and severe rash
Stavudine (d4T)/Lamivudine (3TC)/Nevirapine (NVP)
Yes ZDV-related GI intolerance, anemia, and neutropenia;NVP-related hepatotoxicity and severe rash
Zidovudine (ZDV)/3TC/NVP
No d4T-related neuropathy, pancreatitis and lipoatrophy;EFV-related CNS toxicity and potential for teratogenicity
d4T/3TC/Efavirenz (EFV)
No ZDV-related GI intolerance, anemia and neutropenia;EFV-related CNS toxicity and potential for teratogenicity
ZDV/3TC/EFV
*2 NRTIs + 1 NNRTIs
Stages of the epidemic
Low Grade Prevalence of HIV is consistently below 5% in any “high
risk groups” and below 1% in the “general population” Concentrated
Prevalence of HIV has surpassed 5% on a consistent basis in one or more “high risk groups” but remains below 1% in the “general population”
Generalized Prevalence of HIV has surpassed 1% in the “general
population”
Estimated per act risk for acquisitionof HIV by exposure route
Estimated infectionsper 10,000 exposuresto an infected source
Exposure Route Estimated infectionsper 10,000 exposuresto an infected source
Exposure Route
6.5 Insertive anal intercourse
9000 Blood Transfusion
10 Receptive penile-vaginal intercourse
2,500 Childbirth
5 Insertive penile-vaginal intercourse
67 Needle-sharing injection drug use
1 Receptive oral intercourse
30 Percutaneous needle stick
.5 Insertive oral intercourse
50 Receptive anal intercourse
Life expectancy in some Southern African countries/ 1958 - 2003
Prevention and control Prevention programs:
Health education: public, schools Abstain, Be faith, and Condom use (ABC) Treatment and rehabilitation of IDUs, harm reduction
and needle exchange programs VCT services, BCC, MARPs programs
Blood safety and universal precautions PMTCT Male circumcision Immunization of infected children (no BCG for
symptomatic)
Prevention and control Comprehensive STIs treatment and care Care and support for PLWHA Reporting of cases Notification of contacts and source of
infection (confidentiality) Provision of treatment, tuberculin test Viral load and CD+4 T cell count