AIDS

First recognized as a distinct entity in 1980s and has

become one of the most devastating afflictions in history.
Caused by infection with HIV - 1
 Immunodeficiency disease

Congenital (primary) Acquired (secondary)

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Causes
Acquired
Immunodeficiencies
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AIDS
AIDS is the most advanced stage of HIV infection
characterized by abnormally low CD4 lymphocyte
count (less than 200 cells/µL) or occurrence of
opportunistic infections associated with HIV-induced
immunosuppression

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Stage
Stage 0
• Early HIV infection (ie, within 180 days of
acquisition)
Stage 1
• CD4 lymphocyte count of 500 cells/μL or more
(or 26% or higher if count not available) for
patients aged 6 years and older
Stage 2
• CD4 lymphocyte count of 200 to 499 cells/μL (or
14%-25% if count is not available) for patients
aged 6 years and older
Stage 3 (AIDS)
• Fewer than 200 cells/μL (or less than 14% if count
is not available) for patients aged 6 years and
older
• Presence of certain opportunistic conditions also
defines HIV infection as stage 3 (AIDS),
regardless of CD4 lymphocyte count
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Clinical Presentation
» Many patients with early stage infection (stages 0-2)
have no abnormal findings on physical examination
» Some patients with early (acute) HIV infection have
transient manifestations including:
• Pharyngeal injection, with or without exudate
• Oral and pharyngeal candidiasis, which appears as
scattered or coalescing white plaques on the tongue and
mucosa
• Cervical lymphadenopathy
• Hepatosplenomegaly
• Vaginal candidiasis, which appears as scattered or
coalescing white plaques on the vaginal mucosa; may
appear on the vulva as small (1-3 mm), individual or
coalescing pustules with an erythematous base
• Diffuse maculopapular rash
» In later stages (most commonly stage 3), patients may
exhibit 1 or more of the following:
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• Oral lesions
• Candidiasis, which appears as scattered or coalescing white plaques
on the tongue and oral mucosa
• Oral hairy leukoplakia, in which the tongue is covered by a thick,
white, serpiginous coating of hairlike projections (shag rug
appearance)
• Mucocutaneous ulcerations
• Hepatosplenomegaly
• May be a manifestation of chronic viral hepatitis, disseminated
mycobacterial infection, or other opportunistic condition
• Genital manifestations
• Vaginal candidiasis
• Penile, anal, or vaginal evidence of HPV infection (genital warts,
cervical erosion)
• Evidence of other sexually transmitted diseases (mucosal ulceration,
syphilitic chancre, purulent cervical or penile discharge)
• Regional or generalized lymphadenopathy
• Skin manifestations
• Prurigo nodularis, consisting of a few to numerous firm dome-
shaped nodules, especially involving extensor surfaces, color
ranging from ambient to erythematous to brown/black
• Seborrheic dermatitis, which appears as erythematous plaques,
often with greasy scale, affecting scalp, ear, face, and intertriginous
areas
• Kaposi sarcoma, which appears as irregularly shaped purple or red
nodular lesions on skin or mucous membranes
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 Pathogenesis of AIDS
» HIV infection
» Established in lymphoid tissue and spread throughout body causes acute
viremia.
» The immune response of the host temporarily controls acute infection but
doesn’t prevent establishment of chronic infection of cells in lymphoid
tissues.
» If the infected cells activated by some extrinsic stimulus, the cells respond
by producing cytokine, that may also activate the provirus and lead to
enhance HIV production and progression to AIDS.
» During the course of HIV infection, the major source of infectious viral
particles is activated CD4+ T cells.
» The depletion of CD4+ T cells after HIV infection is caused by a cytopathic
effect of the virus, resulting from production of viral particles in infected
cells, as well as death of uninfected cells.
» The number of T cells lost during the progression to AIDS is
greater than the number of infected cells.

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 Clinical Features

» Acute HIV syndrome. Early after HIV infection,

patients may experience a mild acute illness
with fever and malaise, correlating with the
initial viremia.
» Latency. During latency, there may be few
clinical problems but usually there is a progressive loss
of CD4+ T cells in lymphoid tissues and destruction of
the architecture of these tissues.
» Clinical AIDS. The clinicopathologic manifestations of
full-blown AIDS are primarily the result of increased
susceptibility to infections and some cancers, as a
consequence of immune deficiency.

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 Clinical Features

» Patients not given antiretroviral drugs often are

infected by intracellular microbes, such as viruses,
the fungal pathogen Pneumocystis jiroveci, and
nontuberculous mycobacteria, all of which normally
are combated by T cell–mediated immunity.
» Suspectible to cancers caused by oncogenic viruses
» Tumor of small blood vessels called Kaposi’s sarcoma
caused by herpesvirus
» Loss of body mass caused by altered metabolism and
reduced caloric intake
» Dementia caused by infection of microgial cells in the
brain.

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Thank You
April Hansson
+1 23 987 6554
april@lucernepublishing.com
www.lucernepublishing.com