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Clinical Aspects of HIV Disease

Clinical Aspects of HIV Disease. Kara Chew, M.D. Division of Infectious Diseases David Geffen School of Medicine at UCLA. Objectives. Part I: Overview of clinical aspects of HIV infection and associated clinical disease Acute infection HIV Basics

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Clinical Aspects of HIV Disease

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  1. Clinical Aspects of HIV Disease Kara Chew, M.D. Division of Infectious Diseases David Geffen School of Medicine at UCLA

  2. Objectives Part I: Overview of clinical aspects of HIV infection and associated clinical disease • Acute infection • HIV Basics • Whirlwind tour of opportunistic infections in HIV/AIDS • Prevention of opportunistic infection Part II: Overview of occupational exposure risks and management for health care workers

  3. Take Home Points 1) Every organ system is impacted by HIV infection 2) Best strategy is for PREVENTION of morbidity with timely diagnosis of HIV infection and antiretroviral therapy

  4. The beginning: Acute Retroviral Syndrome (“acute HIV”) • Up to 80% of new HIV infections present with symptoms of viral illness, many misdiagnosed (influenza, infectious mononucleosis) • Fever, fatigue, rash, and headache • Lymphadenopathy, pharyngitis, myalgia, arthralgia, oral candidiasis • Nausea, vomiting, diarrhea; night sweats; oral ulcers • Duration of illness ranges from a few days to more than 10 weeks

  5. Acute retroviral syndrome rash

  6. Natural history of untreated HIV infection Pantaleo G, Graziosi C, Fauci AS. New concepts in the immunopathogenesis of human immunodeficiency virus infection. N Engl J Med. 1993;328:327-35.

  7. HIV Lifecycle and Drug Targets Volberding J and Deeks S, Lancet 2010;376:49-62

  8. HIV Lifecycle and Drug Targets Protease inhibitors Co-receptor inhibitors Fusion inhibitors Reverse transcriptase inhibitors Integrase inhibitors Volberding J and Deeks S, Lancet 2010;376:49-62

  9. Currently available antiretroviral therapy

  10. Treatment regimens are much simpler today • Fixed-drug, multi-class combination pills (one pill once daily) • Tenofovir/emtricitabine/efavirenz • Elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate • Emtricitabine/rilpivirine/tenofovir disoproxil fumarate • Once daily or twice daily regimens (3 pills once daily, 3 pills twice daily)

  11. Goals of Treatment • Reduce HIV-associated morbidity and prolong the duration and quality of survival • Restore and preserve immunologic function • Maximally and durably suppress plasma HIV viral load • Prevent HIV transmission Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Section accessed 2/14/13, page D-1.

  12. Who should be treated? Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Section accessed 2/14/13, page E-2.

  13. Risk for opportunistic infection

  14. A Whirlwind Tour of Infections in HIV/AIDS

  15. #1: Dermatologic Infectious Manifestations of HIV/AIDS

  16. Disseminated bacterial: Bacillary angiomatosis

  17. Disseminated Fungal: Cryptococcus

  18. Local Bacterial: staph aureus (MRSA) skin abscess

  19. Viral: Herpes simplex

  20. Viral: Dermatomal herpes zoster (varicella)

  21. Norwegian Scabies

  22. Important Non-infectious Dermatologic Manifestations • Seborrheic dermatitis • Eosinophilic folliculitis • Drug hypersensitivity • Kaposi’s sarcoma (sort of infectious…HHV-8)

  23. Seborrheic dermatitis

  24. Eosinophilic folliculitis

  25. Drug hypersensitivity

  26. Kaposi’s sarcoma

  27. Kaposi Sarcoma

  28. Kaposi Sarcoma

  29. #2: Oral manifestations of HIV/AIDS

  30. Oral candidiasis (thrush)

  31. Oral hairy leukoplakia (EBV)

  32. Herpes simplex

  33. Aphthous Ulcers

  34. #3: Gastrointestinal Manifestations of HIV/AIDS

  35. Esophagitis: Candida

  36. Diarrhea: Parasites (cyclospora, cryptosporidium, isospora)

  37. Colitis: Cytomegalovirus Normal Colon

  38. #4: Pneumonia

  39. Bacterial: Pneumococcal pneumonia

  40. Fungal: Pneumocystis pneumonia (PCP)

  41. Pneumocystis Pneumonia

  42. Malignancy: Kaposi’s sarcoma in airway

  43. Tuberculosis

  44. The Global TB Problem UNAIDS 2008

  45. #5: Ophthalmic

  46. Viral: CMV retinitis

  47. Parasitic: Toxoplasma chorioretinitis

  48. #6: Neurologic

  49. Parasitic: Toxoplasma encephalitis

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