Human Immunodeficiency Virus (HIV) - pathogenesis, clinical manifestations, diagnosis and treatment

Human Immunodeficiency Virus

Pathogenesis

HIV-1 infected CD4 lymphocytes with the marker. CD4 lymphocytes are involved in cell-mediated immunity and the reduction also affects the activation of B cells This process causes the syndrome known as AIDS (acquired immunodeficiency syndrome), which then makes the patient susceptible to infections (opportunistic infections) that normal people are out to fight in this situation.

HIV can be transmitted through sexualContact, IV drug use, breastfeeding and needlestick injuries.

Clinical

Acute HIV infection leads to excite fever, fatigue, rash, headache, lymphadenopathy, pharyngitis, myalgia, GI, night sweats, aseptic meningitis, oral ulcers and tial. within days or weeks after exposure.

In the long asymptomatic period, the body produces antibodies to the virus in 3-4 weeks and occurs in a period without symptoms (up to 12 years), but HIV-1 RNA and antibodiesThe levels can be measured in this period. AIDS phase of HIV infection, immunodeficiency, high concentrations of virus infections result opportunisitic.

Physical examination:

Investigation of a patient with HIV, you want to change the weight, skin changes (signs of opportunistic infections), to seek a fever. Consider a weight loss of more than 10%. Pneumocystis carinii pneumonia is the most common cause of fever. Patients may have normal lung function, even withactive infection.

Want to check opportunistic infections such as sinusitis, oral thrus, CMV retinitis, toxoplasmosis, cryptococcal meningitis, Kaposi's sarcoma, psoriasis, seborrheic dermatitis, molluscum contagiosum, and herpes zoster.

Diagnostics:

The following tests are used to diagnose HIV

1) ELISA (Enzyme Linked Immuno Assay) and Western Blot test.

A positive ELISA should be followed by a Western Blot test, whichreact with 2 / 3 different antigens. And 'inacurate in the first 3-4 weeks after exposure to HIV.

2) PVL (plasma viral load): This test can be seen already 11 days. And 'the stage of disease by determining the CD4 cell counts and PVL.

Treatment:

-For patients & asymptomatic and CD4 cell counts above 350/mm3, you should not treat the patient!

-For asymptomatic patients, but CD4 cell counts less than 350/mm3 or PVL increased (30k copies/mm3 of B-DNA or PCR copies/mm3 50K)Give patients anti-retroviral therapy.

-3 Types of drugs are used: NRTIs (nucleoside reverse transcriptase inhibitor), PI (protease inhibitors), NNRTIs (nonnucleoside reverse transcriptase inhibitors).

Scheme a total of three drugs: two NRTIs (zidovudine + didanosine or zidovudine + lamivudine) + 1 PI (indinavir), or an NNRTI (efavirenz)

For pregnant women, C-section and zidovudine therapy can reduce accidents in children. Children have a positive test (immunoglobulins cross the placenta)and should ziduvidine for at least 4-6 weeks with repeat tests every month to two negative tests.

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