Professional Documents
Culture Documents
HIV and ENT Manifestations of HIV
HIV and ENT Manifestations of HIV
CASE OF DENNIS
2 forms of HIV
HIV 1
Most associated with AIDS in the US, Europe, and Central Africa
HIV 2
Prevalent in West Africa
Spreads more slowly in comparison to HIV 1
Causes disease more slowly in comparison to HIV 1
Phases of HIV
3 phases which occur over 8 to 12 years
Primary Infection phase:
Signs and symptoms appear 2 to 4 weeks after exposure lasting a few
days to 2 weeks
Patient has fever, fatigue, myalgia, sore throat, night sweats, GI
problems, lymphadenopathy, maculopapular rash, and headache.
During this phase there is a high amount of viral replication
(up to 1 million/ml) and a decreasing amount of CD4+
After a few weeks the immune system catches up controlling viral
replication where it remains for several years.
If diagnosed in this stage and therapy is started treatment may reduce the
number of long-living CD4+ infected cells
Classification of HIV
3 Categories relating to the amount of CD4+ cells per microliter of
blood (normal is 800 to 1000 cells/microliter)
Category 1: >500 cells/microliter
Category 2: 200 to 499 cells/mircroliter
Category 3: <200 cells/microliter.
The clinical staging and case definition of HIV for resource-constrained
settings were developed by the WHO in 1990 and revised in 2007.
Staging is based on clinical findings that guide the diagnosis, evaluation,
and management of HIV/AIDS, and it does not require a CD4 cell count.
This staging system is used in many countries to determine eligibility for
antiretroviral therapy, particularly in settings in which CD4 testing is not
available.
10
Since the beginning of the epidemic, almost 78 million people have been
infected with the HIV virus and about 39 million people have died of HIV.
Globally, 35.0 million [33.237.2 million] people were living with HIV at the
end of 2013. An estimated 0.8% of adults aged 1549 years worldwide are
living with HIV, although the burden of the epidemic continues to vary
considerably between countries and regions. Sub-Saharan Africa remains
most severely affected, with nearly 1 in every 20 adults living with HIV and
accounting for nearly 71% of the people living with HIV worldwide.
Ear:
Otitis media
Kaposi's sarcoma of pinna
Sensorineural hearing loss (usually due to cytomegalovirus
affecting inner ear or CN Vlll)
Facial paralysis (viral origin)
Nose:
Sinusitis (due to both aerobic and anaerobic
infections)
Fungal sinusitis due to aspergillus or mucormycosis.
It is rapidly invasive and extends intracranially
Oral cavity:
Candida infection
Angular cheilitis
Recurrent aphthous ulcers
kaposis sarcoma
The most common malignancy associated with HIV disease is KS, an idiopathic multiple sarcoma
of the skin. KS occurs in 43% of homosexual or bisexual men with advanced HIV disease, only
4% of injection drug users, and essentially no hemophiliacs.(1) Although considered an
opportunistic neoplasm, KS can manifest early in the patient's course with HIV infection, and may
be the first clinical manifestation of their immunodeficiency.It is a multicentric neoplasm which
may involve skin,mucosa or viscera. There is excessive proliferation of spindle cells of vascular
origin. It is non-invasive and respects the fascial planes. In the oral cavity, Kaposi's sarcoma is
mostly seen in the palate, but may occur on the tongue or gingiva or the posterior wall of pharynx.
I t appears purplish in colour and may need to be differentiated from angioma or pyogenic
granuloma. It can occur at any stage of HIV infection, even in those with normal CD4 counts.
Size of the tumour may vary from a few mm to several centimetres. Diagnosis is based on biopsy
which may show proliferation of spindle cells, endothelial cells,extravasation of red blood cells
and haemosiderin laden macrophages.Methods of treatment include local or systemic
chemotherapy and radiation therapy. Cure is not a realistic goal; therefore, extensive surgical
procedures, such as maxillectomy or lymphadenectomy, are not indicated given the systemic
nature of this malignancy. The goals of therapy are to relieve symptoms .
HIV lymphadenopathy
HIV Lymphadenopathy
The terms "persistent generalized lymphadenopathy" and "HIV lymphadenopathy" describe the
syndrome of unexplained diffuse lymphadenopathy involving two or more extrainguinal sites for longer
than 3 months. Up to 70% of patients infected with HIV will develop this syndrome within the first few
months after seroconversion, long before any other symptoms of HIV infection appear.(8)
The lymph nodes in HIV lymphadenopathy are soft and symmetrically distributed and can range from
1 to 5 cm.(9) Such findings are common in the head and neck locations, especially the posterior
triangle.
oral candidiasis
Oral candidiasis (thrush) is by far the most common oral condition in this population. Even for
patients with CD4 counts from 200 to 500 mm3, thrush often is a recurring problem. This
infection typically presents as tender, white, pseudomembranous or plaque-like lesions with
underlying erosive erythematous mucosal surfaces; however, the less typical atrophic or chronic
hypertrophic form is also often encountered. Another common form of oral candidiasis is angular
cheilitis, which typically presents as a clinically obvious, nonhealing fissure at the oral
commissure (the corners of the mouth). In atypical cases, a potassium hydroxide preparation of
scrapings from these lesions is usually diagnostic
6. P-24 antigen: P-24 is core protein of the AIDS virus. Presence of this antigen indicates active
HIV replication. Test is positive even prior to seroconversion.
7. pCR (polymerase chain reaction): It is a quantitative test which measures viral load and thus
correlates with progression of disease
RECENT ADVANCES:
Biosensor is the most recent advance in the field of diagnosis.though not commericially
available,its has more specificity and sensitivity, helps in early diagnosis ,rapid and would be
cheap on availability.
Antiretroviral Drugs
(a) Nucleoside analogues
Zidovudine (AZT)
Didanosine (ddI)
Zalcitabine (ddC)
. Stavudine (d4T)
Lamivudine (3TC) (reverse transcriptase inhibitor)
(b) Protease inhibitors
Saquinavir
Ritonavir
Indinavir
(c) Combination of drugs
recent advances
PREP?
TRUVADA?
claw gene therapy?
references
1.
2.
3.
4.
5.
6.
7.
8.
http://hivinsite.ucsf.edu/InSite?page=kb-04-01-13
http://www.sciencedirect.com/science/article/pii/S019607090500181X
http://www.ajol.info/index.php/cme/article/viewFile/43971/27488
http://nopr.niscair.res.in/bitstream/123456789/31468/1/IJBT%2014(1)%209-18.pdf
http://www.cdc.gov/hiv/basics/prep.html
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm312210.htm
http://www.cdc.gov/hiv/prevention/research/prep/
https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/pre-exposure-prophylaxis/