kuliah 1 hiv ,aids,opport

7/25/2019 Kuliah 1 Hiv ,Aids,Opport

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11

HIV/AIDS/OPPORTUNISTICHIV/AIDS/OPPORTUNISTICINFECTIONINFECTION



2

24 Years of HIV/AIDS24 Years of HIV/AIDS

1981 – Unusual immune deficiency identified

among previously healthy gay men in

US

1982 – Acquired Immune Deficiency

198 – !I" virus identified as cause of AIDS

198# – $irst therapy for AIDS – A%&

199' – (oncept of !AA)&

HAART (highly active antiretroviral therapy)



3



4

HIV INFECTION



5

General Popla!"on General

Popla!"on

R"s# Grop

Popla!"on

$r"%&e

Popla!"on

D'na")s of HIV Trans"ss"on



6

S!r)!re of HIVS!r)!re of HIV

• Surface

proteins – gp 120, gp

41

• Lipid

Membrane

– outer

surface

• Reersetranscriptase

– en!"me in

#ife c"c#e



$

Lie c"c#e of %&'Lie c"c#e of %&'

• (ttp)**+++medscapecom*ie+artic#e*5062-0.1



-

HIV en!r' "n!o !*e +o%'HIV en!r' "n!o !*e +o%'



9

Host cells infected with HIV have a very shortHost cells infected with HIV have a very short

lifespan.lifespan. HIV continuously uses new host cells to replicateHIV continuously uses new host cells to replicate

itself.itself. Up to 10 million individual viruses are producedUp to 10 million individual viruses are produced

daily.daily. During the rst 2 hours after e!posure" the virusDuring the rst 2 hours after e!posure" the virus

attac#s or is captured $y dendritic cells %type ofattac#s or is captured $y dendritic cells %type of

phagocyte& in mucous mem$ranes and s#in.phagocyte& in mucous mem$ranes and s#in.

'ithin ve days of e!posure" infected cells ma#e'ithin ve days of e!posure" infected cells ma#e

their way to lymph nodes and then to thetheir way to lymph nodes and then to theperipheral $lood" where viral replication $ecomesperipheral $lood" where viral replication $ecomes

very rapid. very rapid.

HIV LifecycleHIV Lifecycle



10

HIV LifecycleHIV Lifecycle

,- A!!a)*en!

Re.erse

Trans)r"p!"ons

A)! Here

2- En!r'

- Trans)r"p!"on

4- In!e&ra!"on

0- Pol'pro!e"n

Pro%)!"on

1- Release

- 3a!ra!"on

Pro!e"n

In*"+"!ors

A)! Here

/(ases) binding and entr", reerse transcription,rep#ication, budding, and maturation



11

Ho HIV Infe)!s !*e $o%'Ho HIV Infe)!s !*e $o%'



12

But few cells are infected:

Early stage of infection 1:10,000

Late 1:40

HIV could kill sub population of precursor

cells

eople de!elop "I#$ e!en w%en t%ey %a!e

HIV t%at does not ly&e cells

Why do all T4Why do all T4

cellscells

disappear?disappear?1. PUNCTURED

MEMBRANE

Virus destroys t%e cell as a result ofbudding



13

)elating Disease *rogression to !I"+)elating Disease *rogression to !I"+

1 ),A -evel and (D. (ell (ount1 ),A -evel and (D. (ell (ount

dapted +it( permission from offin AIDS 1610supp# 3)S$5S-4

V"ral 5oa%

,6777

,76777

,776777

,77

CD4 COUNT

,777 877 977 77 177 077

477

77

277

:



14

ro&ress on oro&ress on o%"sease%"sease

As'p!oa!") HIV ()l"n")al la!en)';• /atient often una+are of infection• &mmune s"stem ab#e to contro# irus to #imited e7tent• b#e to transmit %&' to ot(ers

S'p!oa!") HIV• Minor to moderate#" seere s"mptoms• Recurrent s"mptoms

AIDS• Seere immunosuppression associated +it(

opportunistic infections or cancers

<"!*o! an!"re!ro."ral !rea!en! – 308 +i## dee#op &9S in 3 "ears – 08 +i## dee#op &9S +it(in 10 "ears



15

HIV an% AIDSHIV an% AIDS



16

C5INICA5 3ANIFESTATIONSC5INICA5 3ANIFESTATIONS



17

CLINICAL STAGES OF HIVINFECTION

PrimaryInfection

Asymptomatic

Period

Pre AIDSsyndrome

AIDS

'e!er, (as%,"rt%ralgia,

L)E 2= 1 #s

*eneralised

Ly+p%adenopat%

y 'e!er, eig%t

loss

-pportunistic

Infection.alignant

diseases

A)>"s"!"on of ."rs

In)+a!"on Per"o%

L:;) L"mp( :ode ;n#argement



18

STAGE-I

A)!e (pr"ar'; Infe)!"on(Sero)on.ers"on;

• s!a""y asymptomatic

• #$-%$& may de'e"op 'ira" syndrome- Fever

- Maculopapular rash

- Arthralgia, Myalgia

- Lymph node enlargement

• HIV anti(ody tests are oftenne)ati'e



1

3ANIFESTATIONS OF3ANIFESTATIONS OF

PRI3ARY HIV INFECTIONPRI3ARY HIV INFECTION



20

STAGE-IISTAGE-II

Ear"y *asymptomatic+disease

• ,-$ years asymptomatic period

• In India. it is %-/ years

• 0e"ati'e"y symptom free1

minor symptoms



21

2INO0 S32PTO2S2INO0 S32PTO2S

S4in pro("ems• Se(orr5oeic dermatitis

• Ce""!"itis• Pr!rit!s

• Herpes 6oster reacti'ation



22

STAGE IISTAGE II

In'esti)ation

CD7 co!nt 8%$$1mm#

Le!copenia 9T5rom(ocytopenia



23

STAGE : IIISTAGE : III *Intermediate HIV Infection+*Intermediate HIV Infection+

Ear"ier 4no;n as Aids 0e"ated Comp"e<*A0C+

• 0ec!rrent HSV. H=V infection

• 2i"d orop5aryn)ea" or 'a)ina" candidiasis

• Ora" 5airy "e!cop"a4ia

• T!(erc!"osis

Atypica"

E<trap!"monaryE<tensi'e

• CD7 co!nt >$$-%$$1mm#



24

2INO0 S32PTO2S2INO0 S32PTO2S

• Fe'er

• Fati)!e• 2a"aise



25

Sta)e IV ? Late sta)e of HIVdisease

CD7 co!nt %$->$$1mm#

Sta)e V ? Ad'anced HIV disease

CD7 co!nt @%$1mm#

INFECTIOUS C5INICA5 CONDITIONSINFECTIOUS C5INICA5 CONDITIONS



26

INFECTIOUS C5INICA5 CONDITIONSINFECTIOUS C5INICA5 CONDITIONS

IN HIV / AIDSIN HIV / AIDS?077

CD4 CE55S

ACUTE RETROVIRA5 SYNDRO3E

CANDIDA5 VAGINITIS

277 @ 077

CD4 CE55S

PNEU3ONIAS6 PU53ONARY T$6

HERPES OSTER6 OROPHARYNGEA5 CANDIDIASIS

ORA5 HAIRY 5EUBOP5ABIA6 BAPOSIS SARCO3A

CRYPTOSPORIDIOSIS (SE5F 5I3ITED;

277 CD4 CE55S

PCP6 3I5IARY/ ETRA PU53- T$6 DISSE3INATEDHISTOP5AS3OSIS COCCIDIODO3YCOSIS

PROGRESSIVE 3U5TIFOCA5 5EUBOENCEPHA5OPATHY

,77 CD4 CE55S

DISSE3INATED HERPES SI3P5E

TOOP5AS3OSIS6CRYPTOCOCCOSISCRYPTO / 3ICROSPORIDIOSIS

CANDIDA5 OEGOPHAGITIS

07 CD4 CE55S

DISSE3INATED C3V

DISSE3INATED 3AC

NON INFECTIOUS C5INICA5 CONDITIONSNON INFECTIOUS C5INICA5 CONDITIONS



2$

NON INFECTIOUS C5INICA5 CONDITIONSNON INFECTIOUS C5INICA5 CONDITIONS

IN HIV / AIDSIN HIV / AIDS?077

CD4 CE55S

PERSISTENT GENERA5ISED 5Y3PHADENOPATHY (PG5;

GU55AIN @ $ARRE SYNDRO3E

3YOPATHY ASEPTIC 3ENINGITIS

277 @ 077 CD4 CE55S

CERVICA5 INTRAEPITHE5IA5 NEOP5ASIA / CANCER

$=CE55 HODGBINS 5Y3PHO3A6 ANAE3IA6 PURPURA 6

3ONONEURONA5 3U5TIP5E

5Y3PHOCYTIC INTERSTITI5 PNEU3ONIA (5IP;

277 CD4 CE55S

<ASTING6 DE3ENTIA6 NON HODGBINS 5Y3PHO3A

PERIPHERA5 NEUROPATHY6 VACO5AR 3YOPATHY6PROGRESSIVE PO5YRADICU5OPATHY6

CARDIO3YOPATHY

,77 CD4 CE55S

07 CD4 CE55S CNS 5Y3PHO3A



2-

CLINICAL FEAT0ES OFCLINICAL FEAT0ES OF

AIDSAIDS

Opport!nistic Infections• Disseminated C2V infection

• C1c disseminated HSV infection

• Pro)ressi'e m!"tifoca"

"e!coencep5a"opat5y

• E<tensi'e1E<trap!"monaryt!(erc!"osis

• Atypica" myco(acteria" infection

• PCP



2

CLINICAL FEAT0ES OFCLINICAL FEAT0ES OF

AIDS*contd+AIDS*contd+

• Candidiasis of oesop5a)!s.(ronc5i

• C1c cryptosporidiosis

• To<op"asmosis of (rain

• Isosporiasis

• Disseminated f!n)a" infection

*5istop"asmosis coccidiomycosis+• Cryptococcosis

• E<traintestina" stron)y"oidiasis



30

SECONDA03 NEOPLAS2SSECONDA03 NEOPLAS2S

• Baposis sarcoma

• Primary "ymp5oma of (rain

• Non Hod)4ins "ymp5oma



31

OTHE0 S32PTO2SOTHE0 S32PTO2S

• Pro"on)ed fe'er

• Si)nicant ;ei)5t "oss

*$& or more in one mont5+• Cac5e<ia

• C5ronic diarr5oea



32

SBIN 2ANIFESTATIONSSBIN 2ANIFESTATIONS

• Infection

• Neop"asm• Ot5ers



33

INFECTIONSINFECTIONS

• Herpes 6oster 1 simp"e<

• Candidiasis

• 2o""!sc!mconta)ios!m

• Fo""ic!"itis

• Hairy "e!4op"a4ia

• Perci""i!mmarneeiinfection



34


• Herpes 6oster 1simp"e<

• Candidiasis


• Fo""ic!"itis





35



• Candidiasis


• Fo""ic!"itis





36



• Candidiasis


• Fo""ic!"itis





3$

NEOPLAS2NEOPLAS2

• Baposis sarcoma

• Lymp5oma

• asa" ce""carcinoma



3-

NEOPLAS2NEOPLAS2

• Baposis sarcoma

• asa" ce""

carcinoma• Lymp5oma



3

OTHE0SOTHE0S

• Pr!ritic pap!"ardermatitis

• Se(orr5oeic dermatitis• Dr!) ras5

• Vasc!"itis

• Gin)i'itis

GAST0OINTESTINALGAST0OINTESTINAL



40

GAST0OINTESTINALGAST0OINTESTINAL

2ANIFESTATIONS2ANIFESTATIONS• Persistent diarr5oea

Cryptosporidiosis

Isospora

S5i)e""a

Sa"mone""a

E5isto"ytica

Giardia. 2Icrospora

• Co"itis

Cytome)a"o'ir!s

Baposis sarcoma



41

0ESPI0ATO030ESPI0ATO03

2ANIFESTATIONS2ANIFESTATIONS

Symptoms

- Persistent co!)5

- Dyspnoea- Cyanosis

- Hemoptysis

- P"e!ra" e!sion



42

Or)anisms ca!sin)Or)anisms ca!sin)

respiratory symptomrespiratory symptom

• 2yco(acteri!m t!(erc!"osis

• acteria" pne!monia• Atypica" myco(acteria

• PCP. C2V

• F!n)i



43

Ne!ro"o)ica" 2anifestationsNe!ro"o)ica" 2anifestations

Head ac5e "et5ar)y HIV encep5a"opat5y

Dementia a"a<ia Cryptococca" menin)itis

A"tered persona"ity CNS "ymp5omaCon'!"sion AIDS dementia comp"e<

incontinence

2enin)itis Cryptococca" menin)itis

T!(erc!"ar 1 acteria"



44

HIV NEPHROPATHYHIV NEPHROPATHY

• %ea" proteinuria

• Rapid deteriorations in rena# function



45

'S'S

• /ericarditis ,M"ocarditis , ;ndocarditis

• 9i# ardiom"opat(" 25 408

• /rimar" /u#monar" %"pertension<oint Manifestation

• /o#"art(ritis

• Reiters s"ndrome• ggraation of psoriatic art(ritis

PSYCHIATRICPSYCHIATRIC



46

PSYCHIATRICPSYCHIATRIC

MANIFESTATIONSMANIFESTATIONS

• :=&;>? 9&S@R9;RS

• 9;/R;SS&@:

• /:& 9&S@R9;R• &:S@M:&

• SA&&9L >;:9;:?



4$

E

@titis,e7terna*interna

e##u#itis of auric#eSinusitis

Mastoiditis

Sensor" neura# deafness

EYE

Beratitis&ridoc"c#itis

RetinitisM',>o7op#asma

@rbita# ce##u#itis



4-

2AO0 SIGNS2AO0 SIGNS

Loss of (ody ;ei)5t 1 fai"!re tot5ri'e

> C5ronic diarr5oea

# Pro"on)ed fe'er



4

2INO0 SIGNS2INO0 SIGNS

0epeated common infection

- Pne!monia

- Otitis

- P5aryn)itis

> Genera"ised "ymp5adenopat5y

# Orop5aryn)ea" candidiasis

7 Persistent co!)5 for 8 mont5% Disseminated mac!"opap!"ar ras5



5050

>reating @pportunistic>reating @pportunistic

&nfection mong %&'&nfected&nfection mong %&'&nfected

"c#e of Ma#nutrition and"c#e of Ma#nutrition and



51

"c#e of Ma#nutrition and"c#e of Ma#nutrition and

&nfection in %&'*&9S&nfection in %&'*&9S



52

Rationa#e, ontRationa#e, ont

• @pportunistic infections cause

s"mptoms suc( as anore7ia and feer

t(at reduce food intaCe and nutrientuti#i!ation and increase nutrient

reDuirements

• Reduced food intaCe and poor nutrientabsorption +eaCen t(e immune s"stem

and (asten disease progression



53

Rationa#e, ontRationa#e, ont

&mportance of Managing&mportance of Managing



54

&mportance of Managing&mportance of Managing

S"mptoms at ## >imesS"mptoms at ## >imes

• Rapid mu#tip#ication of t(e irus dep#etes

t(e (ost of nutrients and increases

u#nerabi#it" to infections

• cting prompt#" and efficient#" at t(e onset

of s"mptoms is critica# to strengt(en t(e

immune s"stem and reduce t(e seerit" ofinfections

• :utritiona# repercussions and responses

ar as t(e disease ro resses



55

Eoa#sEoa#s

• /reent ma#nutrition

• &mproe (ea#t( and nutritiona# status

• S#o+ t(e progression of t(e disease

deDuate :utritiondeDuate :utrition



56

deDuate :utrition deDuate :utrition

• /reents ma#nutrition and +asting

• c(iees and maintains optima# bod" +eig(t

and strengt(

• ;n(ances t(e bod"Fs abi#it" to fig(t

opportunistic infections

• Ma" (e#p de#a" progression of t(e disease• &mproes t(e effectieness of drug treatments

• &mproes Dua#it" of #ife

S"mptomsS"mptoms



5$

S"mptomsS"mptoms

and :utritiona# Statusand :utritiona# Status

S"mptoms suc( as #oss of appetite, tastec(anges,feer, diarr(ea, nausea, omiting,

ora#t(rus(, anemia, b#oating, and (eartburn ma"negatie#" affect nutritiona# status because of

• Reduced food intaCe

• /oor nutrient absorption

• &ncreased nutrient needs

9ietar" Management9ietar" Management



5-


of S"mptoms, ontof S"mptoms, ont•

Anore"a ;at sma## amounts of food freDuent#" and

eat energ"dense foods

T*rs*) ;at soft mas(ed foods co#d or at room

temperature and aoid spices and sugar

Cons!"pa!"on) ;at more (ig(fiber foods and drinC

p#ent" of f#uids

$loa!"n& an% *ear!+rn) ;at sma## and freDuentmea#s, aoid gasforming foods, and eat #ong enoug(

before s#eeping




5


of S"mptoms, ontof S"mptoms, ont•

D"arr*ea) 9rinC #ots of f#uids and eat energ"and

nutrientdense foods

Nasea) ;at sma## freDuent mea#s, aoid #"ing do+n

immediate#" after eating, rest bet+een mea#s

Fe.er ) 9rinC p#ent" of f#uids and eat soups t(at are

ric( in energ" and nutrient foods

Ane"a) ;at ironric( foods, suc( as anima#products, green #eaf" egetab#es >aCe iron

supp#ement



6060

onc#usionsonc#usions

Dietary management of HIV/AIDS-relatedDietary management of HIV/AIDS-related

symptoms helps maintain food intake andsymptoms helps maintain food intake and

compensate for nutrient lossescompensate for nutrient losses

Dietary management complements medicalDietary management complements medicaltreatment and enhances the client’s capacity totreatment and enhances the client’s capacity to

fight opportunistic infectionsfight opportunistic infections

Health orkers and counselors should monitorHealth orkers and counselors should monitor

symptoms and food and drug regimen to ensuresymptoms and food and drug regimen to ensurenutritional status is maintainednutritional status is maintained

kuliah 1 hiv ,aids,opport

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