Human Immunodeficiency Virus

By TnT

Aetiology
O HIV gp120 binds to CD4 on lymphocytes and

other CD4-bearing cells O Interaction with co-receptors CCR5 and CXCR4 HIV entry into cells O Release viral RNA O Progressive and severe depletion of infected CD4 Th more susceptibly to infections with intracellular bacteria and mycobacteria O Other effects on certain tissues on top of immune dysfunction

Routes of acquisition
O Horizontal
O Sexual intercourse mostly heterosexual,

in UK cause of half of infections. Cotransmission of other STIs O Contaminated blood, blood products and organ donations low in developed countries since screening in 1985 O Contaminated needles IV drug addicts, HCW 0.3% chance following NS injury with known contaminate

O Vertical
O Mother to child in utero possibly but

majority of infections take place perinatally or via breast milk

Stages of Disease Progression

O Acute infection (2-4wks i.i)
O Acute retroviral syndrome/primary HIV infection O Natural response to HIV O Large viral load CD4 count fall rapidly

O Immune response bring virus count down to a

viral set point where CD4 count increase

O Clinical latency/ chronic HIV infection (8 years

+)
O Active low level HIV production, undetectable

HIV count and healthy CD4 count

O AIDS
O CD4 <200cells/mm3 (where normal levels are 500-1600) O Immune system badly damaged and vulnerable to

opportunistic infections O w/o tx -> 3 year survival

WHO Disease Staging System for HIV Infection and disease

O Stage I: HIV disease is asymptomatic and not

categorized as AIDS O Stage II: include minor mucocutaneous manifestations and recurrent upper respiratory tract infections. O Stage III: includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis. O Stage IV: includes toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi's sarcoma; these diseases are used as indicators of AIDS

Oral manifestations
O Nausea and vomiting
O Xerostomia O Squamous cell carcinoma and lymphoma O Oral candidiasis O Hairy Leukoplakia

O Herpes Simplex
O Aphthous ulcers O Kaposis Sarcoma