Lecture 77 - HIV Epidemiology and Natural course history Flashcards
HIV Epidemiology:
World Wide Incidence
US Incidence
At Risk Subpopulations
Worldwide: 33.3 Million People are Infected
2/3s of which in live in subsaharan Africa
1.1 Million Adults in the US – 50K new cases per year
Subpop: MSMs, IVDU
90% of women infected via heterosexual contact
HIV Transmission
Sexual exposure - driving risk factor in Africa
IVDU
Perinatal – mother to child
Other – Blood transfusion, organ tx, needle stick
HIV Testing and Diagnosis
What are some viral detection methods?
- 4th Generation Combination Assay (p24 antigen + IgG and IgM)
- Western Blot for HIV specific antigens
- Rapid Testing – oral secretions
- Viral Detection methods: - Quantification of Plasma Viral RNA – can be used during window period
Dectection of Pro-viral DNA – can be used in children < 18 months
for what tests and what instances would HIV testing result in false negative or false positive?
what is the window period
what is the eclipse period?
False Poitives: Cannot use serologic testing for children < 18months; if born to seropositive mothers, these children would be seropositive as well during that time and therefore false positive
False Negative: Seroconversion Window. If just looking for Antibodies, there are none in the first 2-3 week after infection
Eclipse Period – first 10 days after infection, antigens are not detectable
HIV Acute Infection — acute retroviral syndrome
symptoms
- Shortly after initial infection — high viral load
- Sx: Fever, LAD, sore throat, rash, myalgias, – flu like
- CD4 will also drop
Chronic HIV Infection: what qualifies as AIDS?
CD4<200
AIDS Defining Conditions such as — Candida, Cryptococcosis, Pneumocystis Jerovecii, Kaposis Sarcoma, Toxoplasmosis
CD4 > 500
symptoms and manifestations ?
Persistent Generalized LAD, otherwise unexplained
Secondary Syphilis (which can also manifest at any stage)
CD4 200 - 500
manifestations ?
TB Co infection; reactivation of latent TB – 13% of AIDS deaths world wide
Candida
Shingles
Kaposi’s Sarcoma (HHV-8)
CD4<200 = AIDS
manifestations?
Treat?
Pneumocystis Jirovecii (PCP)
Treat with TMP/SMX
CD4< 100
manifestations
Toxoplasma Gondii –
Cryptoccocus neoformans
CD4 < 50
Manifestations
Cytomegalovirus Retinitis
Polyoma JC VIrus –progressive multifocal leuoencephalopathy
What are the some of the systemic effects of HIV? – name a few
Bones: Osteopenia, osteoporosis with increased fracture risk
Cancer: AIDS defining cancers (Kaposi, Cervical, Non-Hodgkin lymphoma
Non-AIDS defining cancers (anal, lung, liver, Hodgkin, etc)
Cardiovascular disease: Dilated cardiomyopathy, atherosclerosis, MI
Hematologic: Bone marrow suppression, Anemia, neutropenia, thrombocytopenia (ITP/TTP)
- Kidneys: HIV-associated nephropathy (HIVAN)
- Liver: More rapid progression to cirrhosis from hepatitis B or C
AIDS cholangiopathy
Lungs: Pulmonary hypertension
Neurologic: HIV dementia and neurocognitive decline; neuropathy
Whats the difference between primary and secondary opportunisitic Infections
Primary – person has never had the disease. Prophylaxis to prevent them from getting it
Secondary – person has had the disease; prophylaxis to prevent them from getting it again (reactivation?)
OI Prophylaxis: Pneumocystis
- prophylaxis type
- Indication
- Medication
Primary, secondar
CD4 < 200
TMP/SMX
OI Prophylaxis: Toxoplasmosis
- prophylaxis type
- Indication
- Medication
Primary, secondary
<100 and toxo IgG+
TMP/SMX
