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Friday, November 16, 2007

Acquired Immunodeficiency Syndrome

Acquired Immunodeficiency Syndrome (AIDS) is defined as the most severe form of a continuum of illnesses associated with human immunodeficiency virus (HIV) infection. HIV belong to a group of viruses known as retroviruses, These virus carry their genetic material in the form of ribonucleic acid (RNA) rather than deoxyribonucleic acid (DNA).

Infection with HIV occurs when it enters the host CD4 (T) cell and causes this this cell to replicate viral RNA and viral proteins, which in turn invade other CD4 cells. The stage of HIV disease is based in clinical history, physical examination, laboratory evidence of immune dysfunction, sign and symptoms, and infection and malignancies. The stage of primary infection is acute and spans the time from infection to antibody development.

Three categories of infected states have been denoted are :
  • HIV asymtomatic (CDC catehory A; more than 500 CD4+ T lymphocytes/mm3)

  • HIV symptomatic (CDC category B; 200-499 CD4+ T lymphocytes/mm3)

  • AIDS (CDC category C; fewer than 200 CD4+ T lymphocytes/mm3


  • 1. Risk Factors in HIV Infection
    HIV is transmitted through bodily fluids by high-risk behaviors such as heterosexual intercourse with an HIV-infected partner, injection drug use and male homosexual relations. Also at risk are people who received transfusions of blood or blood products contaminated with HIV, Children born in mothers with HIV infections, breast-fed infant of HIV infected mothers and health care workers exposed to needle-stick injury associated with an infected patient.

    2. Clinical Manifestations
    Symptoms are widespread and may affect any organ system. Manifestations range from mild abnormalities in immune response without overt sign and symptoms to profound immunosupression, life-threatening infection, malignancy, and the direct effect of HIV on body tissues.

  • Respiratory System
  • - Shortness of breath, dyspnea, cough, chest pain, and fever are associated with opportunistic infections, including Pneumocyties carinii pneumonia (PCP), the most common infection, and Mycobacterium avium complex (MAC) or Mycobacterium avium intracellular (MAI) which is leading bacterial infection in AIDS patients.
    - HIV-associated tuberculosis occurs early in the course of HIV infection, often preceding a diagnosis of AIDS. If diagnosed early, HIV-associated tuberculosis responds well to antituberculosis therapy.

  • Gastrointestinal System
  • Loss of appetite, nausea and vomiting, oral and esophageal candidiasis and chronic diarrhea.

  • Wasting Syndrome
  • Multyfactorial protein-energy malnutrition, Profound involuntary weight loss exceeding 10% of base line body weight, Chronic diarrhea, chronic weakness and documented intermittent or constant fever with no concurrent illness, Anorexia, Gastrointestinal malabsorption and for some patients a hypermetabolic state.

  • Neurological complications
  • - System central (memory deficits, headache, lack of concentration, progressive confusion, psycomotor slowing, apathy and ataxia).
    - System Peripheral (pain and numbness in the extremities, weakness, diminished deep tendon reflexes, orthostatic hypotention and impotence.
    - Central and peripheral neuropathies, including vascular myelophaty (spastic paraparesis, ataxia and incontinence).
    Other neurologic disorder include Toxoplasma gondii, CMV and Mycobacterium tuberculosis infection with symptoms ranging from confusion to blindness, aphasia, paresis and dead.

  • Integumentary
  • - Kaposi's sarcoma (KS), herpes simplex and herpes zoster viruses and various form of dermatitis associated with painful vesicles.
    - Folliculities, associated with dry flacking skin or atopic dermatities (eczema or psoriasis).

  • Reproductive System (Female)
  • - Persistent recurrent vaginal candidiasis may be the first sign of HIV infection.
    - Ulcerative sexuallytransmitted diseases such as chancroid, syphillis and herpes are more severe in women with HIV.
    - Venereal warts and cervical cancer/cervical intraepithelial neoplasia (CIN) may be noted.
    - Women with HIV have a higher incidence of pelvic inflammatory disease (PID) and menstrual abnormalities.

    3. Assessment and Diagnostic Methodes
    Confirmation of HIV antibodies is done using enzyme immunoassay (EIA; formerly enzyme-linked immunosorbent assay [ELISA]), Western blot assay and viral load tests such as target amplification methods.

    4. Medical Management
    Currently there is no cure for HIV or AIDS, although researchers continue to work on developing a vaccine. Treatment decisions for an individual patient are based on three factors : HIV RNA (viral load), CD4 T-cell counts and the clinical condition of patient.

    The goal of treatment are maximal and durable suppression of viral load, restoration and/or preservation of immunologic function, improvement of quality of life and reduction of HIV-related morbidity and mortality. To determine and evaluate the treatment plan, viral load testing is recommended at diagnosis and then every 3 to 4 months there after in the untreated person. CD4+ T cell counts should be measured at diagnosis and generally every 3 to 6 months thereafter.

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