INFECTIOUS

DISEASES
(Lecture 4)

BY

DR MARRYAM KHALID
MBBS, FCPS(MEDICINE),
MRCP I (UK)
MEDICAL UNIT III,LGH
HIV /AIDS
Objectives

 Introduction
 Pathophysiology
 Complications
 Investigations
 Treatment
 Prophylaxis
Introduction
 Viral infection with high prevalence worldwide
 Weakens immune system and paves way for different
kinds of infections and diseases
 37.9 million people are living with HIV in world
 Annual deaths by HIV/AIDS worldwide are 7,70,000 in
2018.
 About 0.1 to 0.2 percent of Pakistani population is
affected.
Cause
“Human Immunodeficiency Virus”

 A unique type of virus (a retrovirus)

 Invades the helper T cells (CD4 cells) in the body of the
host (defense mechanism of a person)
 Preventable, managable but not curable.
WHAT IS AIDS ???

 Disease caused by HIV virus infection

 Markedly reduced helper T cells or CD4 cells.
 Patients have a very weak immune system (defense
mechanism)
 Opportunistic infections and malignancies that rarely occur in
the absence of severe immunodeficiency (eg,Pneumocystis
pneumonia).
 THE VIRAL GENOME

 Two viral strands of RNA

found in core surrounded by
protein outer coat.
 Outer envelope contains a
lipid matrix which contains
specific viral glycoproteins
like p24,gp 120/
 The knob-like structures
responsible for binding to
target cell.
Modes of HIV/AIDS
Transmission
 Direct contact with infected blood
 Sexual contact: oral, anal, or vaginal
 Direct contact with semen or vaginal and cervical
secretions
 HIV-infected mothers to infants during pregnancy,
delivery, or breastfeeding
MYTHS ABOUT HIV /AIDS

Not transmitted by
 Coughing ,sneezing
 Public baths
 Hand shake
 Working together
 Sharing cups and
plates
 Touching and hugging
Pathophysiology
Natural history of HIV
infection
Virus can be transmitted during each stage

 Seroconversion
 Infection with HIV, antibodies develop
 Asymptomatic
 No signs of HIV, immune system controls virus
production
 Symptomatic
 Physical signs of HIV infection, some immune
suppression
 AIDS
 Opportunistic infections, end-stage disease
Pathophysiology
 Stage 1 (primary)
i. Short, flu-like illness - occurs one to six weeks after
infection
ii. Mild symptoms like pharyngitis ,sores ,lympahdenopathy

 Stage 2 (asymptommatic)
 Lasts for an average of ten years
 Asymptommatic
 Low level of HIV in the blood
 HIV antibodies are detectable in the blood
 Stage 3 (symptommatic)
i. The immune system deteriorates
ii. Opportunistic infections and cancers start to appear.
Opportunistic Infections
associated with AIDS
 When CD4 count > 500 cells
i. Bacterial infections
ii. Tuberculosis (TB)
iii. Herpes Simplex
iv. Herpes Zoster
v. Vaginal candidiasis
vi. Hairy leukoplakia
 when CD4 count <200
i. Pneumocystis carnii
ii. Cryptosporidium
iii. Cryptococcus
iv. Toxoplasmosis

 when CD4 count <50

i. mycobacterium avium complex (MAC) infection
ii. Histoplasmosis
iii. CMV retinitis
iv. CNS lymphoma
v. Progressive multifocal leukoencephalopathy
vi. HIV dementia
DIFFERENTIAL DIAGNOSIS

All opportunistic infections that occur in HIV/AIDS are

considered differentials like

 Burkitt lymphoma
 Candidiasis
 Cryptococcus
 MAC infections
Investigations
HIV enzyme-linked immunosorbent Screening test for HIV
assay (ELISA) Sensitivity > 99.9%

Western blot Confirmatory test

Speicificity > 99.9% (when combined with
ELIZA)

HIV rapid antibody test Screening test for HIV

Simple to perform

Absolute CD4 lymphocyte count Predictor of HIV progression

Risk of opportunistic infections and AIDS when
<200

HIV viral load tests Best test for diagnosis of acute HIV infection
Correlates with disease progression and
response to HAART
 Treatment
HAART (Highly Active
Antiretroviral Therapy)

For all patients infected

with HIV infection
regardless of viral load
and CD4 count
Atleast three drugs from
atleast two different
groups
HAART groups

1. Nucleoside Reverse Transcriptase inhibitors

 AZT (Zidovudine),Abacavir, lamivudine

2. Non-Nucleoside Reverse Transcriptase inhibitors

 Nevirapine, Efavirinz

3. Protease inhibitors
 (Ritonavir)

4. Integrase inhibitors
 Raltegravir

5. Chemokine receptor inhibtors

 Maraviroc
Prophylaxis

 For HIV-infected individuals with CD4 < 200 cells:

Pneumocystis jiroveci1 prophylaxis

 For HIV-infected individuals with CD4 < 75 cells:

Mycobacterium avium complex prophylaxis

 For HIV-infected individuals with CD4 < 50 cells:

Consider CMV prophylaxis
Prevention is better than cure

 No effective vaccine at the moment

 Prevention can be done by

i. Public health strategies to prevent HIV
transmission
ii. Screen all blood and blood products
iii. Follow universal precautions
iv. Educate in safer sex practices
THANK YOU