HIV IN ENT

Harshitha U S
Roll no-97
INTRODUCTION
 Retrovirus – Viral RNA into DNA.
 Two types – Type 1 and 2.
 Type 1 – more common and more pathogenic.
 Type 2 – less common and less pathogenic.
 Once entering the host , this attacks the T-
lymphocytes and other CD4 surface markers..
 With the fall of the CD4
lymphocytes[<500/cu.mm], the immunodeficiency
is seen and many other opportunistic and
malignancy can appear.
 When the CD4cell counts appear less than 200,
death may appear in about 2-3 years.
MODES OF TRANSMISSION
STRUCTURE OF HIV
LIFE CYCLE
COURSE OF DISEASE
INITIAL VIRAEMIA :
 mild c/f[1-2 weeks]
 Fever
 Headache
 Bodyache
 Macular rash
 Lymph node enlargement
LATENT PERIOD
> Asymptomatic up to 10 years.
> No virus is detected in plasma.
> Virus replicates in lymphoid
tissues such as LYMPHNODES,TONSILS and
ADENOIDS.
> Infection can be detected by CD4
number and their deteriorating function.
>Antibody test becomes positive in 2-4
months of infection.
ADVANCED DISEASE
• After several years.
• CD4<200 cells/cu mm.
• Patient’s immunity is compromised
and is more susceptible for
opportunistic infections.
 WINDOW PERIOD[3-12 weeks]
Following infection antibodies
appear in serum only after a period
of interval.
ENT MANIFESTATIONS IN HIV
 3 types of lesions are seen-
 Opportunistic infections
• Pneumocystic carinii
• Tuberculosis
• Candida albicans
• Cryptococcus neoformans
• Toxoplasma
• CMV
• Herpes simplex
 Unusual malignancies
• Kaposi sarcoma and lymphomas are common.
• KS can involve skin, mucus membrane or
viscera.
 Neurological disorders
• Can be due to primary HIV infection or
opportunistic organisms
• Primary HIV infections of CNS can cause
encephalopathy, myelopathy, peripheral
neuropathy and CN involvement[VII most
coomon,V,VIII occasionally]
HIV MANIFESTATIONS IN
DIFFERENT AREAS
 EAR
 External ear - Otitis externa
- Kaposi sarcoma
- Seborrhoeic dermatitis of Ext.canal
 Middle ear - Serous otitis media
- Acute otitis media
- Pseudomonas and Candida infections
 Inner ear – SNHL[due to viral infection of auditory
nerve or cochlea and demeylination of CNS
 Herpes zoster[Ramsay hunt syndrome]
 Facial paralysis
ASOM Candida infection
of middle ear
NOSE AND PARANASAL SINUSES

 Herpetic lesions of nose

 Recurrent sinusitis
 Chronic sinus infection
 Fungal sinusitis
 Kaposi sarcoma
 Lymphomas–B cell type
 Burkitt lymphoma
Herpetic lesions Sinusitis
of nose
LARYNX

 Laryngitis—fungal, viral (herpes

simplex, cytomegalovirus)
 Kaposi sarcoma
 Non-Hodgkin lymphoma
ORAL CAVITY AND OROPHARYNX

 Candidal infection of oral cavity can

be thrush-like,atrophic or hypertrophic
forms of candidiasis.
 Candida infection also involves
oropharynx, hypopharynx or
oesophagus. They cause difficulty and
painful swallowing.
 Herpetic lesions of palate, buccal
mucosa, lips or gums. Such lesion may
form large ulcers
Candida infection
of oral cavity
 Giant aphthous ulcers
 Adenotonsillar hypertrophy.
 Generalized lymphadenopathy
 Kaposi sarcoma of palate
 Non-Hodgkin lymphoma of tonsil or
tongue
 Hairy leukoplakia
 Gingivitis
SALIVARY GLANDS

 Parotitis
 Xerostomia
 Diffuse parotid enlargement
 Lymphoepithelial cysts of parotid.
They arise from parotid nodes, often
on both sides.
 Kaposi sarcoma
 Non-Hodgkin lymphoma
Parotitis
Xerostomia
NECK
 Lymphadenopathy - It could be only
a follicular hyperplasia or due to a
disease such as tuberculosis,
histoplasmosis, toxoplasmosis or
non-Hodgkin or Hodgkin lymphoma.
KAPOSI SARCOMA
 It is a multicentric noninvasive neoplasm
which may involve any part of
skin ,mucosa or viscera.
 It appears purplish in colour and may
need to be differentiated from angioma
or pyogenic granuloma.
 Diagnosis- biopsy shows proliferation of
spindle cells,endothelial cells,
extravasation of RBCs and haemosiderin
laden macrophages.
 Treatment- localised
radiation,intralesional vinblastine or
cryotherapy.
NON HODKINS LYMPHOMA
 B-cell lymphomas are more common (90%)
and many are due to Epstein–Barr virus.
 Risk of lymphomas increases as disease
progresses generally in patient with CD4+
count less than 200/mm3.
 CNS lymphomas occur in late stages of the
disease while systemic ones can occur
early.
 Nose ,PNS, oral cavity are commonly
involved.
HAIRY LEUKOPLAKIA
 It is a white, vertically corrugated
lesions on the anterior part of the
lateral border of tongue.
 It is probably caused by Epstein–Barr
virus.
 Differential diagnosis includes
leukoplakia, carcinoma in situ,
hypertrophic candidiasis or lichen
planus.
 Biopsy should be done to confirm.
Non Hodgkins
Lymphoma

Hairy
leukoplakia
DIAGNOSTIC TESTS
1. ELISA – very sensitive test.
2. Western blot – confirmatory test,
specific for HIV Ab.
3. CD4 count – normal 600-1500/cu.mm
decrease in count indicates
immunecompromised.
 Classified a/c to CD4 count

< 500cells/ 200-400 <200cells/cu.mm

cu.mm cells/cu.mm
HIV INFECTION AND HEALTH
WORKERS
1. Needle-stick injury: Hollow needle (e.g. injection
needle) is more dangerous than solid needle (e.g.
suture needle). The risk is. 0.3%, i.e. (1:300).
2. Cuts with contaminated knife or other sharp
instruments.
3. Exposure of open wound to infected blood or
body fluid of the patient.
4. Large mucous membrane exposure, e.g. by
splatter of blood, amniotic fluid, etc. Risk is
0.09%.
5. Exposure of skin to infected blood and body
fluids.
MANAGEMENT
1. After exposure wash the area thoroughly with
water and apply antiseptic.
2. ELISA – to establish negative baseline & repeat
the test at 6weeks,3 months,6 months for any
seroconversions.
 Drug prophylaxis-
• Start 2 drugs of NRTI
• ZIDOVUDINE and LAMIVUDINE * 4weeks
or
• LAMIVUDINE and STAVUDINE * 4weeks
• Treatment should be started immediately
certainly not later than 72 hrs.
UNIVERSAL PRECAUTIONS
ANTIRETROVIRAL DRUGS
 Antiretroviraldrugs can prevent
progression of HIV to AIDS.
 Drug resistance can occur.
 Combination drug therapy is more
effective and prevents drug resistance; it
is the standard of treatment today to
combine two or more drugs.

 HAART : Highly active antiretroviral

therapy.
o Best for HIV patients .
o It’s a combination therapy.
 ONE MUST BE CAREFUL TO OPEN
YOUR EYES BEFORE AIDS CLOSES IT
Thank you