Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS)

exp date isn't null, but text field is

Human immunodeficiency virus (HIV) is a virus that affects primarily CD4 cells (T-helper cells) and leads to the progressive destruction of the immune system which protect the body against infections and malignancies. Without treatment, HIV may gradually destroy the immune system and lead to AIDS which is the most advanced stage of the HIV infection.

Clinical Course of HIV Disease:

Acute (Primary) HIV Infection(acute seroconversion illness)

This occurs 1-4 weeks after infection. Infected people experience transient flu-like symptoms, which may include:

  • Mild fever
  • Muscle aches and pains
  • Fatigue
  • Enlargement of lymph nodes
  • Sore throat
  • Fever
  • Skin rash

This stage is difficult to diagnose using standard laboratory assays.

Seroconversion:
  • Usually occurs within 4 weeks. Patients develop antibody response, which is detectable by a positive HIV antibody test.
Asymptomatic infection

The individual feels well despite ongoing viral replication. Usually lasts a variable period and is marked by a gradual decline in CD4 cell counts.

Early Symptomatic Infection:
  • Generalized lymphadenopathy
  • Weight loss
  • Night sweats
  • Pruritic skin rash
  • Unexplained fever
  • Chronic diarrhoea
  • Oral candidiasis
  • Oral hairy leucoplakia
  • Herpes zoster
  • Pneumococcal infections
  • Pulmonary TB
Late Disease/AIDS-defining Illness

 This period is marked by the appearance of opportunistic infections and neoplasms:

  • Pulmonary/extrapulmonary tuberculosis and disseminated TB
  • Pneumocystis pneumonia
  • Cryptococcal meningitis
  • Recurrent bacterial pneumonia
  • Candida oesophagitis
  • CNS toxoplasmosis
  • Kaposi sarcoma
  • Non-Hodgkin’s lymphoma
  • Disseminated/extrapulmonary coccidiomycosis, cryptococcosis or histoplasmosis
  • Chronic (> 1 month) intestinal cryptosporidiosis or isosporiasis
  • Disseminated extrapulmonary mycobacteria (non-tuberculous)
  • Progressive multifocal leukoencephalopathy (PML)
  • Recurrent salmonella septicaemia
  • HIV wasting syndrome
Staging of HIV/AIDS

WHO Clinical Stage I

WHO Clinical Stage II

WHO clinical stage III

WHO Clinical Stage IV

FOR ADULTS AND CHILDREN

·        Asymptomatic

·        Persistent                         generalized                       lymphadenopathy

For Adults

·Moderate unexplained weight loss (under 10% presumed weight)

·Angular cheilitis

For Adults and Children

·Papula Itchy Skin Eruptions

·Recurrent oral ulcerations (2 or more episodes in 6 months

·Herpes Zoster

·Recurrent respiratory tract infections (sinusitis, otorrhea, tonsilitis, otitis media)

·Fungal infections

Additional for children

· Unexplained persistent hepatomegaly &splenomegaly

·Extensive wart virus infection

·Extensive molluscum contagiosum

·Unexplained persistent parotid gland enlargement

·Lineal gingival erythema

 

For Adults

Unintentional weight loss >10% of body weight in absence of other illness

For Adults and children

·Oral candidiasis (after first 6 weeks of life)

·Oral hairy leukoplakia

·Persistent diarrhea (>1 month in adults and >14 days in children)

·Unexplained anaemia(<8g/dl),            neutropenia (1000mm3),or thrombocytopenia (50,000mm3)

·Pulmonary TB

·Acute necrotizing               ulcerative                          gingivitis/periodontitis

·Unexplained fever above (37.6°C intermittent or continuous for> 4 weeks)

Additional for children

·Unexplained moderate malnutrition not adequately responding to standard therapy (for children younger than 5 years, moderate malnutrition is defined as weight -for- height, <-2 z-score or mid upper arm conference≥115mm to <125mm)

·Lymph node TB

·Severe recurrent bacterial pneumonia

·Symptomatic lymphoid interstitial pneumonia

·Chronic HIV-associated lung disease

For Adults and children

·HIV Wasting syndrome

·Pneumocystis pneumonia

·Chronic Herpes simplex infection (orolabial or cutaneous> 1 month, or any organ)

·Extra pulmonary TB

·Kaposi Sarcoma

·Cytomegalovirus (CMV) infection affecting another organ with onset at age > 1 month

·Cryptococcus (including                 meningitis)

·Central Nervous system toxoplasmosis (after neonatal period)

·Disseminated endemic mycosis (extrapulmonary histoplasmosis, coccidiomycosis)

·Cryptosporidiosis with diarrhea>1 month

·Isosporiasis with diarrhea> 1 month

·Progressive multifocal leukoencephaly

·Candidiasis of the esophagus, trachea, bronchus

·Atypical mycobacterium (MAC)

·Lymphoma

·HIV encephalopathy

·HIV-associated cardiomyopathy or nephropathy

Additional for children

·Unexplained severe wasting, stunting or severe malnutrition not responding to standard therapy

·Recurrent severe bacterial infections (empyema, sepsis, meningitis, pyomyositis, bone or joint infections) or bacteremia

·Extrapulmonary TB, (excluding TB lymphadenopathy)

 

Differential diagnosis

  • Tuberculosis
  • Untreated diabetes mellitus
  • Malnutrition
  • Malignancies
  • Other chronic diseases

Investigations

Clinical assessments include medical history and physical examinations

  • Full blood count and differentials
  • VDRL (or RPR)
  • Sputum Xpert for MTB/Rif
  • Tuberculin test (PPD)
  • Sputum smears for TB
  • Urea, electrolytes, and creatinine
  • Blood glucose
  • Liver function tests
  • Lipid studies (fasting triglycerides, LDL, HDL)
  • HBV, HCV serology
  • Cervical (PAP) smears
  • CD4 T cell counts
  • HIV RNA level (viral load)
  • HIV DNA (paediatric diagnosis <18 months of age)
  • Genotype and phenotype assays for resistance testing

Treatment objectives

  • Clinical: prevent disease progression
  • Immunological: restore immunity
  • Virologic: control or suppress viral replication
  • Public health: reduce infectivity

Referral

Refer to the Consolidated HIV Guideline for diagnosis, treatment, and prevention.