HIV

HIV/AIDS

HIV
There are two types of HIV virus HIV 1 and HIV 2 ,most cases are caused by type 1 ,the 2 types are indistinguishable clinically BUT HIV2 appeared to be less easily transmitted than
HIV1 and slower to progress to AIDS.
Most cases are due to type1.

Modes of transmission

1-sexual.
2- perinatal.
3-parenteral(occupational and intravenous drug injection).
4- blood transfusion.
5-organ donation.

Pathophysiology

HIV can infect numerous cell types, most significantly CD4 T-helper lymphocytes. HIV integrates into the
host cell genome, and long-lived cells can serve as a reservoir of virus, which contributes to the challenge
of developing a cure for HIV infection. Replication of HIV contributes to early death of T cells, depletion of
CD4 cells, and immunocompromise, resulting in increased risk for opportunistic infections and development
of AIDS.


NATURAL HISTORY:ACUTE HIV.
Most persons who develop HIV infection experience an acute symptomatic illness, referred to as acute
retroviral syndrome, within a few weeks of acquiring the infection. Severity varies, but presentation is most
often consistent with an infectious mononucleosis syndrome.

Differential diagnosis includes acute infection with Epstein-Barr virus, cytomegalovirus,

influenza, and a hepatitis virus and syphilis. Patients with acute infection may not yet be producing
antibodies against HIV antigen (the “window period”), which results in negative results on traditional HIV
serologic testing. Therefore, diagnosis of acute HIV infection during this time period relies on detecting the
virus by RNA polymerase chain reaction or p24 antigen testing. Because levels of virus are usually very
high in patients with acute infection, treatment is recommended to reduce the rate of transmission and
possibly to reduce the progression of disease.

SYMPTOMATOLOGY OF ACUTE HIV:

1-Fever.
2-lymphadenopathy.
3-pharyngitis.
4-rash.
5-myalgia/arthralgia.
6-diarrhea.
7-headache.
8-nausea/vomiting.
9-hepatosplenomegaly.
10-oral thrush.
11-weight loss.
12-neurological symptoms.


Whether patients with acute HIV infection are treated or not, signs and symptoms of infection resolve and
the disease enters a chronic stage. Although patients may be asymptomatic for years, active viral replication
and destruction of CD4 T-helper lymphocytes continue

Symptomatology of chronic HIV:

1-LYMPHADENOPATHY.
2-FATIGUE.
3-FEVER/NIGHT SWEATS.
4-WEIGHT LOSS.
5-CHRONIC DIARRHEA.
6-ORAL APHTHOUS/PERIODINTITIS//GINGIVITIS/ORAL HAIRY LEUKOPLAKIA.
7-PERIPHERAL NEUROPATHY.
8-LEUCOPENIA,ANEMIA,THROMBOCYTOPENIA.
9-NEPHROPATHY.
10-ONYCHOMYCOSIS/PSORIASIS/TINEA/SEBORRHOIC DERMATITIS.

AIDS definition

AIDS is diagnosed when certain indicator opportunistic infections or malignancies develop or when the CD4
cell count falls below 200/μL. Even before reaching this cell count level, however, patients may develop
recurrent or refractory infections, such as vaginal candidiasis, oral or genital herpes simplex virus infection,
pneumococcal pneumonia, and herpes zoster.


Laboratory tests to diagnose HIV:
1-ELISA.
2-P24 antigen test.
3-PCR.
4-HIV culture.

Initial evaluation of patient with HIV:

1-Repeat HIV tests if no documentation.
2-HIV resistance tests at baseline and after treatment failure.
3-Quantitative HIV RNA test(viral load).
4-T cells subsets (CD4 COUNT).
5-Cmoplete blood count with differential.
6-chemisteries:liver function, renal function ,fasting glucose.
7-Fasting lipid profile.
8-urinalysis.
9-serology for hepatitis A,B and C.
10-SEROLOGY for toxoplasmosis.
11-Tuberculin skin test, interferon gamma release assay.
12-pap smear.
13-tests of syphlis,other sexually transmitted diseases.