kuliah 1 hiv ,aids,opport
TRANSCRIPT
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HIV/AIDS/OPPORTUNISTICHIV/AIDS/OPPORTUNISTICINFECTIONINFECTION
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24 Years of HIV/AIDS24 Years of HIV/AIDS
1981 – Unusual immune deficiency identified
among previously healthy gay men in
US
1982 – Acquired Immune Deficiency
198 – !I" virus identified as cause of AIDS
198# – $irst therapy for AIDS – A%&
199' – (oncept of !AA)&
HAART (highly active antiretroviral therapy)
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HIV INFECTION
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General Popla!"on General
Popla!"on
R"s# Grop
Popla!"on
$r"%&e
Popla!"on
D'na")s of HIV Trans"ss"on
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S!r)!re of HIVS!r)!re of HIV
• Surface
proteins – gp 120, gp
41
• Lipid
Membrane
– outer
surface
• Reersetranscriptase
– en!"me in
#ife c"c#e
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Lie c"c#e of %&'Lie c"c#e of %&'
• (ttp)**+++medscapecom*ie+artic#e*5062-0.1
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HIV en!r' "n!o !*e +o%'HIV en!r' "n!o !*e +o%'
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Host cells infected with HIV have a very shortHost cells infected with HIV have a very short
lifespan.lifespan. HIV continuously uses new host cells to replicateHIV continuously uses new host cells to replicate
itself.itself. Up to 10 million individual viruses are producedUp to 10 million individual viruses are produced
daily.daily. During the rst 2 hours after e!posure" the virusDuring the rst 2 hours after e!posure" the virus
attac#s or is captured $y dendritic cells %type ofattac#s or is captured $y dendritic cells %type of
phagocyte& in mucous mem$ranes and s#in.phagocyte& in mucous mem$ranes and s#in.
'ithin ve days of e!posure" infected cells ma#e'ithin ve days of e!posure" infected cells ma#e
their way to lymph nodes and then to thetheir way to lymph nodes and then to theperipheral $lood" where viral replication $ecomesperipheral $lood" where viral replication $ecomes
very rapid. very rapid.
HIV LifecycleHIV Lifecycle
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HIV LifecycleHIV Lifecycle
,- A!!a)*en!
Re.erse
Trans)r"p!"ons
A)! Here
2- En!r'
- Trans)r"p!"on
4- In!e&ra!"on
0- Pol'pro!e"n
Pro%)!"on
1- Release
- 3a!ra!"on
Pro!e"n
In*"+"!ors
A)! Here
/(ases) binding and entr", reerse transcription,rep#ication, budding, and maturation
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Ho HIV Infe)!s !*e $o%'Ho HIV Infe)!s !*e $o%'
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But few cells are infected:
Early stage of infection 1:10,000
Late 1:40
HIV could kill sub population of precursor
cells
eople de!elop "I#$ e!en w%en t%ey %a!e
HIV t%at does not ly&e cells
Why do all T4Why do all T4
cellscells
disappear?disappear?1. PUNCTURED
MEMBRANE
Virus destroys t%e cell as a result ofbudding
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)elating Disease *rogression to !I"+)elating Disease *rogression to !I"+
1 ),A -evel and (D. (ell (ount1 ),A -evel and (D. (ell (ount
dapted +it( permission from offin AIDS 1610supp# 3)S$5S-4
V"ral 5oa%
,6777
,76777
,776777
,77
CD4 COUNT
,777 877 977 77 177 077
477
77
277
:
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ro&ress on oro&ress on o%"sease%"sease
As'p!oa!") HIV ()l"n")al la!en)';• /atient often una+are of infection• &mmune s"stem ab#e to contro# irus to #imited e7tent• b#e to transmit %&' to ot(ers
S'p!oa!") HIV• Minor to moderate#" seere s"mptoms• Recurrent s"mptoms
AIDS• Seere immunosuppression associated +it(
opportunistic infections or cancers
<"!*o! an!"re!ro."ral !rea!en! – 308 +i## dee#op &9S in 3 "ears – 08 +i## dee#op &9S +it(in 10 "ears
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HIV an% AIDSHIV an% AIDS
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C5INICA5 3ANIFESTATIONSC5INICA5 3ANIFESTATIONS
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CLINICAL STAGES OF HIVINFECTION
PrimaryInfection
Asymptomatic
Period
Pre AIDSsyndrome
AIDS
'e!er, (as%,"rt%ralgia,
L)E 2= 1 #s
*eneralised
Ly+p%adenopat%
y 'e!er, eig%t
loss
-pportunistic
Infection.alignant
diseases
A)>"s"!"on of ."rs
In)+a!"on Per"o%
L:;) L"mp( :ode ;n#argement
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STAGE-I
A)!e (pr"ar'; Infe)!"on(Sero)on.ers"on;
• s!a""y asymptomatic
• #$-%$& may de'e"op 'ira" syndrome- Fever
- Maculopapular rash
- Arthralgia, Myalgia
- Lymph node enlargement
• HIV anti(ody tests are oftenne)ati'e
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3ANIFESTATIONS OF3ANIFESTATIONS OF
PRI3ARY HIV INFECTIONPRI3ARY HIV INFECTION
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STAGE-IISTAGE-II
Ear"y *asymptomatic+disease
• ,-$ years asymptomatic period
• In India. it is %-/ years
• 0e"ati'e"y symptom free1
minor symptoms
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2INO0 S32PTO2S2INO0 S32PTO2S
S4in pro("ems• Se(orr5oeic dermatitis
• Ce""!"itis• Pr!rit!s
• Herpes 6oster reacti'ation
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STAGE IISTAGE II
In'esti)ation
CD7 co!nt 8%$$1mm#
Le!copenia 9T5rom(ocytopenia
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STAGE : IIISTAGE : III *Intermediate HIV Infection+*Intermediate HIV Infection+
Ear"ier 4no;n as Aids 0e"ated Comp"e<*A0C+
• 0ec!rrent HSV. H=V infection
• 2i"d orop5aryn)ea" or 'a)ina" candidiasis
• Ora" 5airy "e!cop"a4ia
• T!(erc!"osis
Atypica"
E<trap!"monaryE<tensi'e
• CD7 co!nt >$$-%$$1mm#
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2INO0 S32PTO2S2INO0 S32PTO2S
• Fe'er
• Fati)!e• 2a"aise
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Sta)e IV ? Late sta)e of HIVdisease
CD7 co!nt %$->$$1mm#
Sta)e V ? Ad'anced HIV disease
CD7 co!nt @%$1mm#
INFECTIOUS C5INICA5 CONDITIONSINFECTIOUS C5INICA5 CONDITIONS
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INFECTIOUS C5INICA5 CONDITIONSINFECTIOUS C5INICA5 CONDITIONS
IN HIV / AIDSIN HIV / AIDS?077
CD4 CE55S
ACUTE RETROVIRA5 SYNDRO3E
CANDIDA5 VAGINITIS
277 @ 077
CD4 CE55S
PNEU3ONIAS6 PU53ONARY T$6
HERPES OSTER6 OROPHARYNGEA5 CANDIDIASIS
ORA5 HAIRY 5EUBOP5ABIA6 BAPOSIS SARCO3A
CRYPTOSPORIDIOSIS (SE5F 5I3ITED;
277 CD4 CE55S
PCP6 3I5IARY/ ETRA PU53- T$6 DISSE3INATEDHISTOP5AS3OSIS COCCIDIODO3YCOSIS
PROGRESSIVE 3U5TIFOCA5 5EUBOENCEPHA5OPATHY
,77 CD4 CE55S
DISSE3INATED HERPES SI3P5E
TOOP5AS3OSIS6CRYPTOCOCCOSISCRYPTO / 3ICROSPORIDIOSIS
CANDIDA5 OEGOPHAGITIS
07 CD4 CE55S
DISSE3INATED C3V
DISSE3INATED 3AC
NON INFECTIOUS C5INICA5 CONDITIONSNON INFECTIOUS C5INICA5 CONDITIONS
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NON INFECTIOUS C5INICA5 CONDITIONSNON INFECTIOUS C5INICA5 CONDITIONS
IN HIV / AIDSIN HIV / AIDS?077
CD4 CE55S
PERSISTENT GENERA5ISED 5Y3PHADENOPATHY (PG5;
GU55AIN @ $ARRE SYNDRO3E
3YOPATHY ASEPTIC 3ENINGITIS
277 @ 077 CD4 CE55S
CERVICA5 INTRAEPITHE5IA5 NEOP5ASIA / CANCER
$=CE55 HODGBINS 5Y3PHO3A6 ANAE3IA6 PURPURA 6
3ONONEURONA5 3U5TIP5E
5Y3PHOCYTIC INTERSTITI5 PNEU3ONIA (5IP;
277 CD4 CE55S
<ASTING6 DE3ENTIA6 NON HODGBINS 5Y3PHO3A
PERIPHERA5 NEUROPATHY6 VACO5AR 3YOPATHY6PROGRESSIVE PO5YRADICU5OPATHY6
CARDIO3YOPATHY
,77 CD4 CE55S
07 CD4 CE55S CNS 5Y3PHO3A
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CLINICAL FEAT0ES OFCLINICAL FEAT0ES OF
AIDSAIDS
Opport!nistic Infections• Disseminated C2V infection
• C1c disseminated HSV infection
• Pro)ressi'e m!"tifoca"
"e!coencep5a"opat5y
• E<tensi'e1E<trap!"monaryt!(erc!"osis
• Atypica" myco(acteria" infection
• PCP
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CLINICAL FEAT0ES OFCLINICAL FEAT0ES OF
AIDS*contd+AIDS*contd+
• Candidiasis of oesop5a)!s.(ronc5i
• C1c cryptosporidiosis
• To<op"asmosis of (rain
• Isosporiasis
• Disseminated f!n)a" infection
*5istop"asmosis coccidiomycosis+• Cryptococcosis
• E<traintestina" stron)y"oidiasis
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SECONDA03 NEOPLAS2SSECONDA03 NEOPLAS2S
• Baposis sarcoma
• Primary "ymp5oma of (rain
• Non Hod)4ins "ymp5oma
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OTHE0 S32PTO2SOTHE0 S32PTO2S
• Pro"on)ed fe'er
• Si)nicant ;ei)5t "oss
*$& or more in one mont5+• Cac5e<ia
• C5ronic diarr5oea
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SBIN 2ANIFESTATIONSSBIN 2ANIFESTATIONS
• Infection
• Neop"asm• Ot5ers
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INFECTIONSINFECTIONS
• Herpes 6oster 1 simp"e<
• Candidiasis
• 2o""!sc!mconta)ios!m
• Fo""ic!"itis
• Hairy "e!4op"a4ia
• Perci""i!mmarneeiinfection
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INFECTIONSINFECTIONS
• Herpes 6oster 1simp"e<
• Candidiasis
• 2o""!sc!mconta)ios!m
• Fo""ic!"itis
• Hairy "e!4op"a4ia
• Perci""i!mmarneeiinfection
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INFECTIONSINFECTIONS
• Herpes 6oster 1simp"e<
• Candidiasis
• 2o""!sc!mconta)ios!m
• Fo""ic!"itis
• Hairy "e!4op"a4ia
• Perci""i!mmarneeiinfection
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INFECTIONSINFECTIONS
• Herpes 6oster 1simp"e<
• Candidiasis
• 2o""!sc!mconta)ios!m
• Fo""ic!"itis
• Hairy "e!4op"a4ia
• Perci""i!mmarneeiinfection
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NEOPLAS2NEOPLAS2
• Baposis sarcoma
• Lymp5oma
• asa" ce""carcinoma
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NEOPLAS2NEOPLAS2
• Baposis sarcoma
• asa" ce""
carcinoma• Lymp5oma
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OTHE0SOTHE0S
• Pr!ritic pap!"ardermatitis
• Se(orr5oeic dermatitis• Dr!) ras5
• Vasc!"itis
• Gin)i'itis
GAST0OINTESTINALGAST0OINTESTINAL
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GAST0OINTESTINALGAST0OINTESTINAL
2ANIFESTATIONS2ANIFESTATIONS• Persistent diarr5oea
Cryptosporidiosis
Isospora
S5i)e""a
Sa"mone""a
E5isto"ytica
Giardia. 2Icrospora
• Co"itis
Cytome)a"o'ir!s
Baposis sarcoma
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0ESPI0ATO030ESPI0ATO03
2ANIFESTATIONS2ANIFESTATIONS
Symptoms
- Persistent co!)5
- Dyspnoea- Cyanosis
- Hemoptysis
- P"e!ra" e!sion
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Or)anisms ca!sin)Or)anisms ca!sin)
respiratory symptomrespiratory symptom
• 2yco(acteri!m t!(erc!"osis
• acteria" pne!monia• Atypica" myco(acteria
• PCP. C2V
• F!n)i
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Ne!ro"o)ica" 2anifestationsNe!ro"o)ica" 2anifestations
Head ac5e "et5ar)y HIV encep5a"opat5y
Dementia a"a<ia Cryptococca" menin)itis
A"tered persona"ity CNS "ymp5omaCon'!"sion AIDS dementia comp"e<
incontinence
2enin)itis Cryptococca" menin)itis
T!(erc!"ar 1 acteria"
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HIV NEPHROPATHYHIV NEPHROPATHY
• %ea" proteinuria
• Rapid deteriorations in rena# function
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'S'S
• /ericarditis ,M"ocarditis , ;ndocarditis
• 9i# ardiom"opat(" 25 408
• /rimar" /u#monar" %"pertension<oint Manifestation
• /o#"art(ritis
• Reiters s"ndrome• ggraation of psoriatic art(ritis
PSYCHIATRICPSYCHIATRIC
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PSYCHIATRICPSYCHIATRIC
MANIFESTATIONSMANIFESTATIONS
• :=&;>? 9&S@R9;RS
• 9;/R;SS&@:
• /:& 9&S@R9;R• &:S@M:&
• SA&&9L >;:9;:?
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E
@titis,e7terna*interna
e##u#itis of auric#eSinusitis
Mastoiditis
Sensor" neura# deafness
EYE
Beratitis&ridoc"c#itis
RetinitisM',>o7op#asma
@rbita# ce##u#itis
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2AO0 SIGNS2AO0 SIGNS
Loss of (ody ;ei)5t 1 fai"!re tot5ri'e
> C5ronic diarr5oea
# Pro"on)ed fe'er
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2INO0 SIGNS2INO0 SIGNS
0epeated common infection
- Pne!monia
- Otitis
- P5aryn)itis
> Genera"ised "ymp5adenopat5y
# Orop5aryn)ea" candidiasis
7 Persistent co!)5 for 8 mont5% Disseminated mac!"opap!"ar ras5
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5050
>reating @pportunistic>reating @pportunistic
&nfection mong %&'&nfected&nfection mong %&'&nfected
"c#e of Ma#nutrition and"c#e of Ma#nutrition and
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"c#e of Ma#nutrition and"c#e of Ma#nutrition and
&nfection in %&'*&9S&nfection in %&'*&9S
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Rationa#e, ontRationa#e, ont
• @pportunistic infections cause
s"mptoms suc( as anore7ia and feer
t(at reduce food intaCe and nutrientuti#i!ation and increase nutrient
reDuirements
• Reduced food intaCe and poor nutrientabsorption +eaCen t(e immune s"stem
and (asten disease progression
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Rationa#e, ontRationa#e, ont
&mportance of Managing&mportance of Managing
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&mportance of Managing&mportance of Managing
S"mptoms at ## >imesS"mptoms at ## >imes
• Rapid mu#tip#ication of t(e irus dep#etes
t(e (ost of nutrients and increases
u#nerabi#it" to infections
• cting prompt#" and efficient#" at t(e onset
of s"mptoms is critica# to strengt(en t(e
immune s"stem and reduce t(e seerit" ofinfections
• :utritiona# repercussions and responses
ar as t(e disease ro resses
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Eoa#sEoa#s
• /reent ma#nutrition
• &mproe (ea#t( and nutritiona# status
• S#o+ t(e progression of t(e disease
deDuate :utritiondeDuate :utrition
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deDuate :utrition deDuate :utrition
• /reents ma#nutrition and +asting
• c(iees and maintains optima# bod" +eig(t
and strengt(
• ;n(ances t(e bod"Fs abi#it" to fig(t
opportunistic infections
• Ma" (e#p de#a" progression of t(e disease• &mproes t(e effectieness of drug treatments
• &mproes Dua#it" of #ife
S"mptomsS"mptoms
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S"mptomsS"mptoms
and :utritiona# Statusand :utritiona# Status
S"mptoms suc( as #oss of appetite, tastec(anges,feer, diarr(ea, nausea, omiting,
ora#t(rus(, anemia, b#oating, and (eartburn ma"negatie#" affect nutritiona# status because of
• Reduced food intaCe
• /oor nutrient absorption
• &ncreased nutrient needs
9ietar" Management9ietar" Management
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9ietar" Management9ietar" Management
of S"mptoms, ontof S"mptoms, ont•
Anore"a ;at sma## amounts of food freDuent#" and
eat energ"dense foods
T*rs*) ;at soft mas(ed foods co#d or at room
temperature and aoid spices and sugar
Cons!"pa!"on) ;at more (ig(fiber foods and drinC
p#ent" of f#uids
$loa!"n& an% *ear!+rn) ;at sma## and freDuentmea#s, aoid gasforming foods, and eat #ong enoug(
before s#eeping
9ietar" Management9ietar" Management
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9ietar" Management9ietar" Management
of S"mptoms, ontof S"mptoms, ont•
D"arr*ea) 9rinC #ots of f#uids and eat energ"and
nutrientdense foods
Nasea) ;at sma## freDuent mea#s, aoid #"ing do+n
immediate#" after eating, rest bet+een mea#s
Fe.er ) 9rinC p#ent" of f#uids and eat soups t(at are
ric( in energ" and nutrient foods
Ane"a) ;at ironric( foods, suc( as anima#products, green #eaf" egetab#es >aCe iron
supp#ement
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onc#usionsonc#usions
Dietary management of HIV/AIDS-relatedDietary management of HIV/AIDS-related
symptoms helps maintain food intake andsymptoms helps maintain food intake and
compensate for nutrient lossescompensate for nutrient losses
Dietary management complements medicalDietary management complements medicaltreatment and enhances the client’s capacity totreatment and enhances the client’s capacity to
fight opportunistic infectionsfight opportunistic infections
Health orkers and counselors should monitorHealth orkers and counselors should monitor
symptoms and food and drug regimen to ensuresymptoms and food and drug regimen to ensurenutritional status is maintainednutritional status is maintained