slide1
Download
Skip this Video
Download Presentation
ACQUIRED IMMUNODEFICIENCY SYNDROME presented by : Deepti Awasthi

Loading in 2 Seconds...

play fullscreen
1 / 50

ACQUIRED IMMUNODEFICIENCY SYNDROME presented by : Deepti Awasthi - PowerPoint PPT Presentation


  • 130 Views
  • Uploaded on

ACQUIRED IMMUNODEFICIENCY SYNDROME presented by : Deepti Awasthi. CONTENTS. Introduction History Epidemiology HIV Virus Routes of transmission Pathogenesis. Clinical signs and manifestations Oral manifestations Lab diagnosis Prophylaxis Treatment Universal precautions References.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' ACQUIRED IMMUNODEFICIENCY SYNDROME presented by : Deepti Awasthi' - damon-haney


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
contents
CONTENTS
  • Introduction
  • History
  • Epidemiology
  • HIV Virus
  • Routes of transmission
  • Pathogenesis
  • Clinical signs and manifestations
  • Oral manifestations
  • Lab diagnosis
  • Prophylaxis
  • Treatment
  • Universal precautions
  • References
introduction
INTRODUCTION
  • Since, the initial recognition of AIDS in the US in 1981,tremendous advances have taken place in the understanding of this dreaded disease in the last decade as regards its epidemiology, etiology, immunology, pathogenesis, clinical features & morphologic changes in various tissue and organs of the body.
  • .
  • 1st DEC - world AIDS day by the WHO.
epidemiology
EPIDEMIOLOGY
  • Acc. To WHO, in nov 2003

40 million - infected worldwide

5 million – newly infected

3 million – died

2.2 million children - <15 yr

  • In india,

2nd largest after south africa

In 2003, 5 million infected

slide6

Status of HIV epidemic in India

Maharashtra

Manipur Andhra Pradesh Nagaland Tamil Nadu Karnataka

High Prevalent states

history
HISTORY
  • In monkeys – for over 100,000 years
  • In 1956 – in central africa : “ gay fever ”
  • In 1981 – first indication came from new york & los angeles
  • In 1983 – Luc Montagnier & colleagues from pasteur institute ,paris , isolated a retrovirus – LAV
  • In 1984 – Robert gallo & colleagues , USA : HTLV- III
slide8

In 1985, serological tests available for anti-HIV antibodies.

  • In 1986, international committee decided on the generic name - HIV
  • In india –

1st case reported in chennai

hiv virus
HIV virus
  • Lentivirus subgroup, family retroviridae.
  • 2 forms :

HIV-1 : US & central africa

HIV-2 : west africa & india

routes of transmission
ROUTES OF TRANSMISSION
  • 1. SEXUAL CONTACT

- 75% of all cases

- male to male & male to female is more potent route than female to male.

slide12

2. PARENTERAL

- 25%

1) I.V. Drug abusers

2) hemophiliacs

3) blood recipients

slide13

3. PERINATAL

  • Vertical transmission
  • Several risk factors:

- pre term delivery

- low maternal antenatal CD4 count

- illicit drugs during pregnancy.

- elective cesarean delivery – by 87% +

ZVT in the mother & infant.

slide14

Besides blood ,HIV has been isolated from no. of body fluids & tissues :

semen, vaginal secretions , cervical secretions, breast milk, CSF, synovial, pleural, peritoneal, pericardial & amniotic fluid.

  • Salivary protein – secretoryleucocyte PI

anti –HIV activity

slide16

STERILIZATION & DISINFECTION

  • HEAT : Virus is very fragile & can be eliminated easily by hot water at 56% for 30 mins.
  • CHEMICALS : NaOCl – 0.1%

Ethanol – 70%

Formaldehyde – 5%

Glutaraldehyde – 2%

H2O2 – 0.3%

pathogenesis
PATHOGENESIS

Interaction of gp120 of HIV to CD4+T cell

internalisation of virion

uncoating of virion

reverse transcriptase

proviral DNA

unintegrated, integrated

Activated CD4+T cell inactivated CD4+T cell

budding,syncytia LATENT PHASE

CYTOPATHIC PHASE

Quantitative depletion qualitative failure to respond

slide18

HIV infection of nervous system :

  • Out of non-lymphoid organ involvement, HIV inf of nervous system is the most serious.
  • Some presenting features include :

acute aseptic meningitis

subacute encephalitis

vacuolar myelopathy

peripheral neuropathy

stages
STAGES

1) ACUTE HIV INFECTION

  • 3-6 wks – 50% persons experience low grade fever, malaise, headache, lymphadenopathy. Resolves within wks
  • Tests for HIV antibodies are –ve at onset & becomes +ve during its course- “SEROCONVERSION ILLNESS” .
  • P 24 antigen
slide20

2) ASYMPTOMATIC OR LATENT INFECTION

  • All persons pass through this phase which may last upto several years.
  • +ve HIV antibody tests
  • This period of clinical latency , does not mean microbiological latency as virus replication goes on throughout.
  • The CD4+T cell count decreases

< 200 = clinical AIDS sets in

slide21

3) PERSISTENT GENERALIZED

LYMPHADENOPATHY

4) AIDS RELATED COMPLEX (ARC)

  • Includes various constitutional symptom :
  • unexplained fever > 1mth
  • weight loss > 10%
  • chronic diarrhoea > 1mth
  • Oppurtunistic infections
slide22

5) AIDS

  • End stage disease
  • Irreversible breakdown of immune defence mechanism
  • Progressive oppurtunistic infection & malignancies.
oppurtunistic infections malignancies
OPPURTUNISTIC INFECTIONS & MALIGNANCIES
  • MALIGNANCIES:
  • Kaposi sarcoma
  • Lymphoma
  • BCC
  • Melanoma
slide24

VIRAL

CMV HERPES SIMPLEX

slide25

BACTERIAL

  • TB
  • Salmonellosis
  • Campylobacter inf
  • Nocardia & actinomycetes
  • Legionellosis
slide26

PARASITIC

  • PNEUMOCYSTITIS

CARINII PNEUMONIA

  • TOXOPLASMOSIS
slide27

MYCOTIC

  • Candidiasis
  • Cryptococcosis
  • Aspergillosis
  • Histoplasmosis
oral lesions in child
ORAL LESIONS in child

PAROTID SWELLINGS ORAL CANDIDIASIS

slide29

HAIRY LEUKOPLAKIA HERPETIC LESIONS

DELAYED TOOTH ERUPTION

advanced hiv aids disease definitions for surveillance for adults

ADVANCED HIV/AIDS DISEASE DEFINITIONS FOR SURVEILLANCE FOR ADULTS

Any clinical stage 3 or stage 4 disease

or,

where CD4 is available, any clinical stage and CD4 <350/mm3

slide31

Diff. b/w adult & pediatric AIDS:

  • Children develop humoralimmunodef. early, leading to recurrent bacterial inf.
  • Failure to thrive, chronic diarrhoea ,lymphadenopathy, TB – common manifestation.
  • Lymphocytic interstitial pneumonia- seen mostly in children.
lab diagnosis of aids
LAB DIAGNOSIS OF AIDS
  • A. IMMUNOLOGICALTESTS
  • Leucopenia
  • Lymphopenia
  • Thrombocytopenia
  • CD4+T cell < 200 / mm3
  • T4 : T8 is reversed.
  • Lymph node biopsy
slide34

B. SPECIFIC TESTS :

  • Antigen detection
  • The major core antigen , P24, earliest virus marker to appear in blood.
  • IgM antibodies appear in 4-6 wks, followed by IgG antibodies.

2. Virus isolation & culture

  • From peripheral lymphocytes
  • Viral replication can be detected by- reverse transcriptase activity
slide35

3. POLYMERASE CHAIN REACTION

  • Most sensitive & specific test
  • Gold standard for diagnosis in all stages
  • 2 forms : DNA & RNA

4. ANTIBODY DETECTION

  • Simplest & most widely employed technique.
  • 2-8 wks to months for antibodies to appear
  • Highly infectious
  • Seronegative infective – “window period”
  • 2 types : screening & confirmatory tests
slide36

Screening tests – high sensitivity

not highly specific

false + ve results

The most widely used screening test is ELISA.

  • Confirmatory tests – WESTERN BLOT.

In this HIV proteins are seperated acc. to their electrophoretic mobility by poly- acramide gel electrophoresis are blotted onto strips of nitrocellulose paper.

prophylaxis
PROPHYLAXIS
  • The prevention aims at –

Health education

Identification of sources

Elimination of high risk activities

  • No specific vaccine is available.
  • Several possible strategies have been explored for vaccine production. These include immunisation with –
  • Modified whole virus
  • Subunits

c)Target cell protection by anti-CD4 antibody

treatment
TREATMENT
  • Treatment & prophylaxis of infections & tumours

2. General management

3. Immunorestorative measures-

Administration of IL-2, thymic factors ,leucocyte transfusion & bone marrow transplantation.

4. Specific anti – HIV agents

slide41

NRTI

  • Zidovudine , stavudine , lamivudineDidanosine , abacavir.
  • NNRTI
  • Nevirapine, delavirdine
  • PI
  • Saquinavir , ritonavir , indinavir
  • FI
  • Enfuvirtide
  • Integrase I
  • Raltegravir
  • CCR5 antagonist
  • Maraviroc
prevention
PREVENTION
  • Safer sex methods
  • Screening of blood donors
  • Disposable syringes, needles etc
  • Infected women – advised against pregnancy
  • For interruption of perinatal transmission

ZVT 200 mg TID to the women & continued during delivery

decreases rate to < 8 %.

slide43
IRIS
  • When a pt. starts ART, his immune deficiencies improve. This sometimes results in uncontrolled inflammatory responses. Hence, pt. may show worsening of clinical features or lab parameters inspite of improving CD4 counts & decrease viral load.
  • TREATMENT

- Symptomatic - NSAIDS

- severe: prednisolone - life threatening: stop ART

slide44
PEP
  • ART should be started within the first few hours & no later than 72 hrs .
  • HIV testing should be done initially & following 3 & 6 months.
  • EXPOSURE

Less severe - 2 drug PEP

more severe - 3 drug PEP

slide45

Biohazard to Dental workers :

  • Larger quantity of blood loss
  • Repeated blood to blood contact
  • Longer
  • Length of surgical procedure
  • Needle prick injuries
universal precautions
UNIVERSAL PRECAUTIONS
  • Alert all the time.
  • Single chair room
  • Gloves – examination
  • Dental units covered with water proof sheets.
  • Impervious surgical gown, cap & mask.
  • For procedure – double gloves
  • Airotor use – avoided
slide47

In suction bottle – 2% glutaraldehyde 30 ml

2% NaOCl 60 ml

  • Needles discarded immediately
  • Bag containing waste – incineration
  • Instruments – reautoclaved twice by double

sterilization

slide48
Spillage of blood & body fluids , area saturated with 1% NaOCl for 30 mins. Then mopped with an old linen towel.
references
References :
  • Ananthanarayan and paniker’s textbook of microbiology ; 8th ed.
  • Kliegman, behrman, jenson,stanton. Nelson textbook of pediatrics ; vol.1
  • Harsh mohan . Essential pathology ; 3rded
  • Mehta PJ. Practical medicine ;19thed
  • Chandra S, chandra S. Textbook of pedodontics. 2002
  • Davidson S. principles & practice of medicine;19th ed.
  • www.google.com
ad