HAEMATOLOGICAL ASPECTS OF HUMAN IMMUNODEFICIENCY VIRUS

2. HAEMATOLOGICAL ASPECTSOF HUMAN IMMUNODEFICIENCY VIRUS DR.UNAIZA QAMAR PROFESSOR DR.SAMINA NAEEM

3. TOPICS TO BE COVERED • STRUCTURE AND FUNCTION OF HIV • HIV & HEMATOLOGY-PATHOLOGY • HIV & HEMATOLOGY-MORPHOLOGY

4. HIV STRUCTURE

7. HIV 1 & 2 • HIV-1 is a member of the primate Lentivirinae subfamily of retroviruses • RNA viruses • Infection long periods of clinical latency followed by a gradual onset of disease-related symptoms.

8. Transmission of Human Immunodeficiency Virus • Sexual Transmission • Parenteral Drug Use • Infected Blood Products • Mother-to-Child Transmission

9. Pathogenesis • IMMUNODEFICIENCY • ABERRANT IMMUNE REGULATION

33. IMMUNE DEFICIENCY-Depletion of CD4+ T Cells • 1.the direct cytopathic effect of HIV. • 2 .The host immunologic response against HIV-infected lymphocytes • 3.Formation of syncytial multinucleated giant cells • syncytia an aggressive clinical course.

35. ABERRANT IMMUNE REGULATION • Defects in B Cell Immunity • Spontaneous proliferation pronounced increase in autoimmune phenomena and an increased risk of B cell lymphomas.

36. HIV---A VICIOUS CYCLE • Defects in Immune Accessory Cells and Natural Killer Cells • Monocytes, macrophages, and follicular dendritic a chronic reservoir of HIV expression a progressive depletion

37. Stages of HIV infectionCDCI CLASSIFICATION • CDC 1:Recently observerd illness(IM like symptoms)+seroconversion • CDC 2:Well • CDC 3:Well,With generalized lymphadeonpathy • CDC 4: AIDS DEFINING ILLNESS • Significant constitutional disease(weight loss,fever,diarrohea) • Neurological • Infections • Neoplasms • Possible AIDS defining Illness HIV +ve +CD4 <200/ul AIDS even without AIDS defining Illness

39. PATHOLOGY HAEMATOLOGICAL ASPECTS OF HIV

40. The haematological features of HIV infection • Infection by the HIV and the consequent fully developed AIDS can have profound haematological effects in • the primary infection period • the phase of clinical latency, and • patients with advanced disease

41. HIV---JUST AN INFECTION OF CD4??? • NO!!! • It starts with CD4 but would end up in affecting virtually all blood cell lines and causing all sorts of diseases of Blood • Anemia • Malignancies • Auto immune phenomena • Immuno deficient phenomena

42. RBCS AND HIV

43. HIV Decreased red cell production ↓ CD34+ cells BM INFILTRATION INFECTION NEOPLASMS DIRECT SUPPRESSION OF ERYTHROID ACTIVITY Anemia of chronic disease Blunted erythropoietin production Iron deficiency anemia Ineffective production Folic acid deficiency Vitamin B12 deficiency Increased red cell destruction Coombs-positive hemolytic anemia Hemophagocytic syndrome Thrombotic thrombocytopenic purpura Medications

44. Consequences of Anemia in HIV Infection • Decreased Survival

46. HIV AND WBCS

47. Neutropenia • MULTIPLE ETIOLOGIES 1.DECREASED PRODUCTION: • Decreased G-CSF • Infiltration • Medications 2.INCREASED DESTRUCTION: • presence of neutrophil-bound Ig • Hypersplenism 3.DEFECTIVE NEUTROPHILS

48. Patients tolerate neutropenia well at even ANC <500

50. HIV AND PLATELETS