HIV/AID awareness by Dr PZ Buthelezi-Mlambo

HIV/AID awarenessby Dr PZ Buthelezi-Mlambo

HIV AND AIDS chronic disease cannot be cured but well manage and controlled its not life death sentence.DEFINITION: Human Immune Deficiency Virus (HIV) that attack the Immune system, the bodys natural defense system ie. CD4 count without a strong immune system the body has trouble fighting off diseaseAIDS: the last stage of HIV infection low number of CD4 cells and get infections or cancer that rarely occur in healthy people

Therefore having HIV does not mean you have AIDS, even without treatment it takes long time for HIV to progress to AIDS, usually 10-12yrs. If HIV is diagnosed before it becomes AIDS, medicine can slow or stop the damage to the immune systemDifference: viral infection reduces insidious and progressive loss of immune function that eventually results in opportunistic infection and malignancies that used in define AIDSPrevalence: In 2008, HIV/AIDS was most prevalent in the South African provinces of KwaZulu-Natal (15.8% HIV-positive), Mpumalanga (15.4% HIV-positive), Free State (12.6% HIV-positive), and North West (11.3% HIV-positive), while only 3.8% of the population was HIV-positive in Western Cape

Routes of transmission

Unprotected sexual intercourseBlood transfusionSharing of needle or injection or bladesOrgan transplantationMother to childcontaminated blood products

#note it is not transmitted by hugging, eating on same plate toilet seat, coughing and sneezing

WHO- STAGINGSTAGE 1:AsymptomaticPersistent generalized lymphadenopathy STAGE 2:Moderate weight loss more than 10%Recurrent respiratory infections (sinusitis, tonsillitis, otitis media)Herpes ZoosterRecurrent oral ulcersPopular pruritic eruptionsSeborrhea dermatitisFungal nail infections

STAGE 3:Severe weight loss more than10%Chronic diarrhea more than 1 monthPersistent fever more than a monthPersistent oral conditionsOral hairy Pulmonary tuberculosisSevere bacterial infectionsUnexplained anemiaSTAGE 4:HIV wasting syndromePCPRecurrent several bacterial PneumoniaChronic herpes simpler infectionOesophageal candidatesExtra pulmonary tuberculosisHIV EncephalopathyStereptocal MeningitisLymphomaInfusive cervical cancerNephropathy or Cardiomyopathy

5Signs and symptomsHead: Fungal skin infectionmeningitisencephalopathy, strokeeyes: herpes zoot results in blindnessEars: discharging and lymphodesMouth gingivitisChest: pneumonia, TB,Abd: chronic diarrhoea vomiting, cervical cancer, chronic STI/UlcersLegs: peripheral neurisSkin: dermtaphy, dermatisBlood:

Diagnosis

Only diagnosed by doctor by taking sample/bloodsPre- and post-test counsellingPurpose of HIV testing is simply identify infected individuals, but also to educate both zero positive and zero negative people about prevention and limiting transmission of the virusBefore taking blood consent form must be signedBloodsElisa PCRCDD4 countViral load

HIV MANAGEMENTHIV TESTING IN CHILDENChildren should be tested for HIV infectionAll HIV exposed infantsChildren do with TB or have hoof TB treatmentFather or sibling with HIV infection death/ death of mother, father, siblingMothers HIV status is unknown and her whereabouts are unknownChild breast fed or well nursed by women of unknown or positive statusChildren and clinical feature of HIV infectionChildren who have experienced or breast risk of sexual assault

Test:HIV antibody detective test(eg hiv elisa)- cannot distinguish between mother and body antibioticsmmmmm HIV antibodies are transferred via the placenta to the baby during pregnancy so that all vertically exposed babies will be born with HIV antibodies and will test positive on antibody detectives test.The antibodies will remain in the babies blood upto18 months ie HIV exposed. Then viral detection test such as HIV DNA(detect HIV gene humanly) PCR (detect 6 weeks is required) to establish the infection status of child.Therefore HIV exposed but uninfected child will test PCR negative and HIV exposed infected child will test PCR positiveViral load 10 000 copies/ml (4) is regarded as confirmation of HIV infection if PCR is positive

Hiv/Aids management

Prevention is better than cure- zero infection new generation PMTCT: All pregnant women look early before 14 weeks gestationAll first antenatal books must be seen on same dayBooking bloods include RPR, RH, HB, HIVFolic acid, Vit C, calcium, should be given at first visitIf women test negative at 1st anetal visit- retest 12 weeks after 1st HIV test and 32 weeks of gestation in labour,6 weeks post every 3 months while breast feeding thereafter annuallyIf women test positive at first anental visitall women regardless of CD4 cell count will be initialed or fixed dose drugs(FTC+TOF, EFV) on same day they are diagnosed HIV positiveBlood creatine and CD4 are done the same day the review on 7 daysCD4 350 cell/mmCD4 count 350 continue with ARV for duration of pregnancy and for 1 week after gestation of breast feeding then stop ARVIf already on ARV and pregnant- check CD4 count, VC, .if virally suppressed continue with the if not suppressed, asses adherence the change toWomen diagnosed HIV positive during pregnancy intra Start NVP and TRUVIDA and 3 hrly AZTStart FDC as soon as possible if breast feeding

Hiv/Aids managementAll HIV exposed infants: NVP syrup for 6 weeks irrespective of feedingBW> 250g 1,5ml daily at same time everydaySw< 250g 1ml dailyPCR test at 6 weeks for all HIV If breast fed, repeat PCR test in 6 weeks after of breastExclusive breast feed is recommended feeding18 months rapid HIV test done for all HIV exposeCriteria to start ARVAll children 5yrs3yrs(