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TM: HIV Clinical Presentations + OIs (i) (Intro (dDx (EBV infectious…
TM: HIV Clinical Presentations + OIs (i)
Natural progression
Primary infection
mono-like syndrome: similar to glandular fever but lasts a bit longer (2-3 wks)
prodrome
will get better on its own
dDx: EBV, CMV, adenovirus, influence, parainfluenza, etc
1-6 wks incubation
often unrecognised
fever in >95%, lymphadenopathy in 74%, pharyngitis in 70%
maculopapular rash on face, trunk, palms
diarrhoea + headache in 32%, nausea/vomiting in 29%
occasionally thrush
neuro symptoms in 50%: headache, meningitis, encephalitis
Acute HIV syndrome
wk 2-9
wide dissemination of virus
seeding of lymphoid organs with viral particles
Clinical latency
wk 9 - approx 8 yrs
healthy + well, but infectious
Constitutional symptoms
can affects many body systems, non-specific, require further evaluation
weight loss, fevers, chills, night sweats, anorexia, diarrhoea, pruritus
OIs
as CD4 count decreases
thrush
oral hairy leukoplakia
PCP
when CD4 <200
lungs of healthy colonised but don't get ill with intact immune system
TB (esp extrapul) - may be fatal if MDR, esp in Africa
histoplasmosis
coccidioldomycosis (Valley fever, in California)
toxoplasmosis
atypical HSV (e.g. encephalitis)
cryptosporidiosis
CMV disease
MAI
death
Intro
good animal model (primates) - hence good understanding of pathogenesis
immunocompromised: infections + malignancies
initially called GRID (gay-related)
CD = cluster of differentiation
blood - easy sample to take
screening: ELISA, confirmatory = western blot (gel electrophoresis)
will be +ve in neonate if mam is HIV+ve, so use NAAT
AIDS can be reversed with modern ART
PGL: enlarged nodes @ 2+ non-adjoining sites other than inguinal nodes
HIV + TB = co-epidemics (synergy)
AIDS-defining illness + HIV+ve = AIDS dx
His don't normally cause infection in individuals with intact healthy immune systems
dDx
EBV infectious mononucleosis
CMV
toxoplasmosis
rubella
syphilis
primary herpes infection
viral hep
drug reactions
no cure in sight - public info + prevention campaigns
AIDS surveillance case definitions
clinical categories
A: asymptomatic, persistant generalised lymphadenopathy (PGL) or acute HIV syndrome
B: symptomatic but not AIDS-indicator condition
thrush
persistant vaginal candidiasis
oral hairy leukoplakia
bacillary angimatosis
bacterial infection that causes lesions on skin, liver, spleen, mucosal surfaces, other organs
cervical dysplasia
cervical carc in situ
constitutional symptoms
idiopathic thrombocytopenia purport
PID (esp if complicated by tubo-ovarian abscess)
listeriosis
C: AIDS-indicator condition
candidiasis of oesophagus, trachea, bronchi, lungs
invasive cervical carc
extrapul coccidioidomycosis/cryptococcosis
cryptosporidiosos with diarrhoea . 1 month
CMV of any organ other than liver/spleen/nodes
HSV > 1month
extrapul histoplasmosis
HIV-associated dementia
HIV-associated wasting
10% weightloss
chronic diarrhoea/weakness
Kaposi's sarcoma
lymphoma of brain
non-Hodgkin's B cell lymphoma (or unknown immunologic phenotype)
disseminated MAI/ M Kansasii/ TB
nocardiosis (bacterial infection from soil/water affecting lungs, brain, skin)
PCP pneumonia (prevent using co-trimoxazole or dapsone of allergic)
recurrent bacterial pneumonia (2+)
PML
JC virus affecting white matter
70% of people infected
demyelination
MS-like lesions
diverse symptoms depending where lesions are
difficult to tx
recurrent salmonella septicaemia (non-typhoid)
extra intestinal strongyloidosis
toxoplasmosis of internal organ
CD4 categories
1: >500
2: 200-499
3: <200
AIDS: A3, B3, C1, C2, C3
WHO clinical staging
Asymptomatic - CD4 >500 - PGL
mild symptoms - CD4 350-499 - recurrent infections, weightloss, herpes zoster, angular cheilitis, fungal nail infections, seborrhoea dermatitis
advanced symptoms - CD4 200-349
severe symptoms - CD4 <200