HIV INFECTION

ROUTES OF TRANSMISSION:
1. Sexual intercourse: vaginal and anal

2. Mother – to – child:
- Transplacental
- Perinatal
- Breast feeding

3. Contaminated blood, blood products and organ donations

4. Contaminated needles: IV drug users, needle stick injury

THE VIRUS:
HIV is a member of the lentivirus group of the retrovirus family. There are 2 subtypes:
HIV 1: most common
HIV 2: confined to west Africa, more indolent than HIV-1 and many drugs used for 1 are ineffective for 2.

HIV 1: has 4 strains- M, N, O, P.

PATHOGENESIS:
Dendritic cells transport the virus from mucosal surfaces to LN’S. HIV gp120 interacts with CD4  entry
into cells. The retroviruses contain reverse transcriptase, which allows viral RNA to be transcribed into
cell DNA and thus, incorporated into the cell genome.
N.B: any T cell is susceptible to infection and depletion, but those found in the GIT become heavily
infected and depleted early on  compromised mucosal immune function.

CLINICAL FEATURES:
Respiratory
Tuberculosis; bacterial pneumonia

Neurology
Cerebral toxoplasmosisa cryptococcal meningitisa; cerebral abscess; space-occupying lesion of unknown
cause; dementia.

Dermatology
Kaposi’s sarcoma

Gastroenterology
oral candidiasis; oral hairy leukoplakia; chronic diarrhoea of unknown cause; hepatitis infection

Oncology
NHL, Pri. CNS lymphoma, kaposi

Gynaecology
Cervical cancer

Haematology
Any unexplained blood dyscrasia including thrombocytopenia, neutropenia and lymphopenia.

Opthalmology diseases

ENT
Lymphadenopathy

Other
CMV, HIV-1 wasting syndrome

DIAGNOSIS:

HIV diagnosed either by the detection of virus specific antibodies (anti-HIV) or by direct identification
of viral material.

The recommended UK first-line assay is one which tests for HIV antibody AND p24 antigen
simultaneously. These fourth generation assays have the advantage of reducing the time between
infection and an HIV-positive test result to one month which is several weeks earlier than with sensitive
third generation (antibody only detection) assays

1. PCR RNA viral load test: acute HIV pts have very high loads. This test is also done to assess
effectiveness of therapy
2. p 24 antigen assay
3. ELISA: detects antibody to HIV. A positive result is achiever 1-12 weeks after infection.
- Negative ELISA: 99% sensitive to exclude HIV unless patient had a subsequent exposure
before testing (before seroconversion- occurs 3-7 weeks AFTER infection)
- Positive ELISA: confirm with western blot.
4. Diagnosing AIDS: presence of an indicator condition in HIV-1 positive person or CD4 < 200
TREATMENT:

ARV’s: in symptomatic patients regardless of CD4 count and in asymptomatic patients with CD4 < 500.
Triple drug regimen: 2 nucleoside reverse transcriptase inhibitors + a nonnucleoside reverse
transcriptase inhibitor OR A protease inhibitor

COMMON OPPORTUNISTIC INFECTIONS:

1. PCP
2. TB
3. Toxoplasmosis

CD4 CELL CUTOFF’S

 Any CD4 count: TB risk, kaposi’s
 CD4 <300 : Diarrhoea, candida
 CD4 <200 : PCP, Toxoplasmosis
 CD4 <100 : MAI/ MAC, Cryptococcus
 CD4 <50 : CMV