1 / 36

Clinical manifestations of HIV Emerging trends

Introduction. Human immunodeficiency virusCharacterized by opportunistic infections and malignanciesChanging in the clinical spectrum of the diseaseRelated to multiple factors. HIV virus. HAART. Protease therapyDecline in morbidity and mortality1997 StudyPre-HAART and HAART erasReduced viral loads and increased CD4 cells .

Anita
Download Presentation

Clinical manifestations of HIV Emerging trends

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Clinical manifestations of HIV Emerging trends Garfield Forbes

    2. Introduction Human immunodeficiency virus Characterized by opportunistic infections and malignancies Changing in the clinical spectrum of the disease Related to multiple factors

    3. HIV virus

    4. HAART Protease therapy Decline in morbidity and mortality 1997 Study Pre-HAART and HAART eras Reduced viral loads and increased CD4+ cells

    5. Evolving epidemiological trends Reduced rate of mortality decline Viral resistance Compliance Side effects linked to HAART

    6. Pathogenesis of the trends Drug toxicity Prolonged exposure to HIV Cytokine mediated Immune changes accompanying viral suppression

    7. HAART toxicity Mitochondrial metabolism Lactic acidosis Pancreatitis Pregnant females –Stavudine/ ddI

    8. Lactic acidosis Abdominal pains Vomiting Nausea Hepatic steatosis Abnormal LFTS Peripheral lipoatrophy

    9. HAMMAS HIV- associated metabolic and morphologic abnormality syndrome Insulin resistance- GLUT-4 Dyslipidemia ? PI Documented prior to HAART

    10. Skeletal changes Osteopenia Cytokine mediated IL-2, TNF HAART increases level of TNF Interventions in high risk groups

    11. TNF

    12. TNF mechanisms

    13. Cardiovascular changes Accelerated atherosclerosis Myocardial infarction- markedly increased risk Hypercoaguable state Vasculitis Increased VLDL/ Cholesterol Indinavir Switching therapy

    14. Haematologic changes Cytopenias Immune thrombocytopenic purpura TTP

    15. Malignancies Kaposi sarcoma- declining incidence Non-Hodgkins lymphoma-mixed

    16. Opportunistic infections Reduced incidence worldwide Reporting bias PCP CMV Bacterial pneumonias Toxoplasmosis Cryptococcosis

    17. Pathogenesis of OIs Co-pathogenesis Up regulation of HIV replication Latently infected CD4+ cells activated Increased susceptibility to de novo infections Cellular signaling by cytokines IL-6 and TNF

    18. OIs Prophylaxis Trial following Increased CD4+ cells and reducing viral loads Antigen specific immunity lost

    19. Immune reconstitution syndromes Early in therapy Inflammatory manifestations Low CD4+ count a high risk factor MAC Tb- Cavitary lung lesions HHV-8, CMV Fever, lymphadenitis Steroids and antimicrobials

    20. Tuberculosis Higher prevalence Often precedes diagnosis of HIV infection Extra-pulmonary and miliary forms more common

    21. Pulmonary Tb

    22. Syphilis Ocular Neurosyphilis CSF pleocytosis VDRL- Positive in 2/3

    23. Herpes viruses HHV-8 GBV-Type C

    24. Increasing viral resistance Multiple resistant strains Implications for public health

    25. Acute HIV infection Transient symptomatic illness Mononucleosis type symptoms Rapid viral replication Aggressive immune response Index of suspicion

    26. Acute HIV infection

    27. Acute intervention in Acute HIV infection Early diagnosis Triple therapy Reduction in reservoirs

    28. Acute HIV intervention

    29. Acute HIV infection

    30. Acute infection

    31. Progressive multifocal leucoencephalopathy

    32. PML Reactivation of JC virus Progressive neurological deterioration Defective oligodendrocyte and myelin maintenance PI response

    33. The wasting syndrome Tumor necrosis factor – alpha Alteration of gut permeability GI immunologic changes

    34. Conclusion Important in Diagnosis and early targeted interventions Public Health importance Research

    35. Thank you

    36. Thank You

More Related