HIV INFECTION

WHO CLINICAL STAGING

CLASSIFICATION
STAGE 1 STAGE 2
• Asymptomatic
• Unexplained weight loss
• Persistence generalised
lymphadenopathy • Recurrent upper respiratory tract
infection
• Angular cheilitis
• Recurrent oral ulcer
• Papular pruritic eruption
• Seborrhoeic dermatitis
STAGE 3

• Unexplained severe weight loss, persistent fever

• Unexplained chronic diarrhoea, oral hairy leucoplakia..
• Sever bacterial infection, unexplained anaemia, neutropenia, chronic
thrombocytopenia, ulcerative stomatitis, gingivitis.
STAGE 4 - HIV wasting syndrome

• Bacterial opportunistic infection – recurrent severe bacterial infection, extra

pulmonary tuberculosis, disseminated non-tubercular mycobacterial infection,
recurrent septicaemia.
• Viral opportunistic infection- chronic HSV infection, CMV disease
• Fungal opportunistic infection- Pneumocystis pneumonia, oesophageal
candidiasis, extra pulmonary crytococcosis
• Parasitic opportunistic infection- Toxoplasma encephalitis, chronic intestinal
cryptosporidiosis, atypical disseminated leishmaniasis
• Neoplasia- Kaposi sarcoma, invasive cervical cancer , lymphoma.
• Other condition like – HIV encephalopathy, symptomatic HIV associated
nephropathy or cardiomyopathy.
Centers for Disease Control
(CDC)
CLINICAL CATEGORIES
Category A
• Primary HIV infection
• Asymptomatic
• Persistent generalised lymphadenopathy
Category B
• Bacillary angiomatosis
• Candidiasis , oropharyngeal (thrust)
• Candidiasis , vulvovaginal; persistent , frequent or poorly responsive
to therapy
• Cervical dysplasia (moderate or severe)/cervical carcinoma in situ
• Constitutional symptoms such as fever or diarrhoea lasting for
>1month
• Oral hairy leucoplakia
• Herpes zoster,involving two distinct episodes or > 1 dermatome
• Idiopathic thrombocytopenic purpura
• Listeriosis
• Pelvic inflammatory disease
• Peripheral neuropathy
Category C
• Candidiasis of oesophagus,trachea, bronchi or lungs
• Cervical carcinoma – invasive
• Cryptococcosis – extrapulmonary
• Cryptosporidiosis, chronic (>1month)
• Cytomegalovirus disease( outside liver ,spleen and nodes
• Herpes simplex chronic (>1month) ulcers or visceral
• HIV encephalopathy
• HIV wasting syndrome
• Cystoisosporiasis (>1month)
• Kaposi’s sarcoma
• Lymphoma ( cerebral or B-cell non-Hodgkin)
• Mycobacterial infection, non- tuberculous , extrapulmonary or
disseminated
• Mycosis – disseminated endemic(e.g. Coccidioidomycosis, talaromycosis,
histoplasmosis)
• Pneumocystis pneumonia
• Pneumonia , recurrent bacterial
• Progressive multifocal leucoencephalopathy
• Toxoplasmosis – cerebral
• Tuberculosis –pulmonary and extrapulmonary
• Sepsis (salmonella)
 ICTC
(Integrated Counselling and Testing Centre)
• It was first established in India in the year 1997
• Main functions of ICTC:
1) Early detection of HIV
2) Provision of basic information on modes of transmission,
prevention of HIV/AIDS for promoting behavioural change,
reducing vulnerability.
3) Link people with other HIV prevention, care and treatment
services.
• Services provided by ICTC:
a) Counselling
b) Testing

a) Counselling
• Description: HIV/AIDS counselling is a confidential dialogue between a
client and a counsellor
• Types of HIV Counselling:
i) HIV PRE-TEST COUNSELLING
• Provision of basic information on HIV/AIDS
ii) HIV POST-TEST COUNSELLING
a) Negative test result:
• Counsellor reiterate basic information on HIV
• Assist client to adopt behavior that reduces the risk of HIV in future
• In case the client is in the window period, a repeat test is recommended
b) Positive test result:
• Help client in coping with test result
• Ensure access to treatment and cure

iii) FOLLOW UP COUNSELLING:

• Re-emphasis on adoption of safe behavior to prevent transmission of HIV
• Settings in which counselling may be
offered to clients:
a) Provider-initiated counselling and testing
b) Client-initiated counselling and testing
• Diagnosis of HIV
• Diagnosing HIV/AIDS is NOT like other infectious diseases because a
number of moral, ethical, legal and psychosocial issues are associated
with a positive HIV status.
• So, the following care should be taken (3Cs) while performing the test
for HIV:
i. Consent
ii. Confidentiality
iii. Counselling
• The Laboratory diagnosis of HIV can be
divided into 2 main categories:
1) Specific Tests
a) Screening tests (antibody detection):
• ELISA (takes 2-3 hours)
• Rapid tests (takes less than 30 minutes)
b) Supplemental tests (antibody detection):
• Western blot assay
• Immunofluorescence assay
c) Confirmatory tests:
• p24 antigen detection
• HIV RNA detection(Best confirmatory method)

-Reverse transcriptase PCR (RT-PCR)

• HIV DNA detection: Useful for diagnosis of pediatric HIV
-HIV DNA PCR
2) Non-Specific Tests
a) Low CD-4 T cell count
b) Detection of abnormal proteins produced by HIV
activated T-Cells like neopterin and Beta 2- macroglobulin
Thank you