- HIV – Human Immunodeficiency Virus

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- HIV –

Human

Immunodeficiency Virus

a blood-borne virus typically transmitted via sexual intercourse, shared IV drug, and mother-to-child transmission (MTCT), which can occur during the birth process or during breastfeeding.

EPIDEMIOLOGY

Most commonly occurs in USA and Sub-saharan Africa.

PATHOLOGIC CYCLE

ETIOLOGI HIV disease is

caused by

infection with HIV-1 or HIV-2,

which are

retroviruses in the

Retroviridae family,

Lentivirus genus.

GEJALA KLINIS

The patient with HIV may present with signs and symptoms of any of the stages of HIV infection. No physical findings are specific to HIV infection; the physical findings are those of the presenting infection or illness.

Manifestations include the following:

 Acute seroconversion manifests as a flulike illness, consisting of fever, malaise, and a generalized rash

 The asymptomatic phase is generally benign.

 Generalized

lymphadenopathy is common and may be a presenting symptom

 AIDS manifests as recurrent, severe, and occasionally life- threatening infections or opportunistic malignancies

 HIV infection can cause some sequelae, including AIDS- associated

dementia/encephalopathy and HIV wasting syndrome

(chronic diarrhea and weight loss with no identifiable cause)

Diana Fadhilah Sari - Notes

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The history should address risk factors for possible exposure to HIV, including the following:

 Unprotected sexual

intercourse, especially receptive anal intercourse

 A large number of sexual partners

 Previous or current sexually transmitted diseases (STDs)

 Sharing of intravenous (IV) drug paraphernalia

 Receipt of blood products (before 1985 in the United States)

 Mucosal contact with infected blood or needle-stick injuries

 Maternal HIV infection (for newborns, infants, and children)

Evidence for risk factors or minor concurrent opportunistic infections (eg, herpetic lesions on the groin, widespread oral candidiasis) may be clues to HIV infection.

PX. PENUNJANG

Secondary testing that may be performed to assist with diagnosis or staging includes the following:

 Viral culture

 Lymph node biopsy

 Proviral DNA polymerase chain reaction (PCR)

 Genotyping of viral DNA/RNA Screening Assays

 Enzyme-linked

immunoabsorbent assay (ELISA) should be used for screening. Most ELISAs can be used to detect HIV-1 types M, N, and O and HIV-2.

 Testing for HIV-2 should be ensured for patients from an HIV-2 endemic area or those who have indeterminate results on HIV-1 Western blot testing. Not all HIV tests include detection of HIV-2 or Group O.

CD4+ T-cell Count

The CD4 T-cell count is a reliable indicator of the current risk of acquiring opportunistic infections.

Viral Load

Viral load in peripheral blood is used as a surrogate marker of viral replication rate. This is a surrogate because most of the viral replication occurs in the lymph nodes rather than in the peripheral blood.

The test is a quantitative amplification of the viral RNA using nucleic acid sequence- based amplification (NASBA), reverse-transcription

polymerase chain reaction (RT- PCR), or similar technologies.

Histologic Findings

Certain histologic findings are characteristic of various features Diana Fadhilah Sari - Notes

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of HIV infection and AIDS. The lymph node architecture is progressively disrupted;

(reversible) this can be reversed with effective antiviral therapy.

Findings include hyperplasia, multinucleated syncytia of T cells, and loss of the normal follicular dendritic network.

CLASSIFICATION & CLINICAL GRADING

- WHO CLINICAL STAGING OF HIV-

PROGNOSIS

The prognosis in patients with untreated HIV infection is poor, with an overall mortality rate of >

90%. The average time from infection to death is 8-10 years, although individual variability ranges from less than 1 year to long-term non progression.

COMPLICATIONS

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PATHOPHYSIOLOGY

TREATMENT