CASE PRESENTATION a HIV infection @ by @ Nagaraju BHuman Immunodeficiency Virus (HIV) © Etiologic agent of Acquired Immunodeficiency Syndrome (AIDS). © Discovered independently by Luc Montagnier of France and Robert Gallo of the US in 1983-84. o Former names of the virus include: » Human T cell lymphotrophic virus (HTLV-II) » Lymphadenopathy associated virus (LAV) « AIDS associated retrovirus (ARV) HOW THE HIV VIRUS CAN ENTER THE BODY Semen Surface of Vicgtreal Plesich the skin ood a Blood vesseis Breast Mitk cme = The [HV virus may penetrate through the outer membrane of fragite skirt (eg, the walt of the vagina} and inte the bloodstream. The virus may enter the body through a cul. sore, scratch. oF needle puncture, and (ravet Guo the bloodstrearn. The virus may also penetrate through small microscopic tears in the shir,Primary HIV Syndrome o Symptoms are relatively nonspecific. o HIV antibody test often negative but becomes positive within 3 to 6 months, this process is known as seroconversion. o Large amount of HIV in the peripheral blood. o Primary HIV can be diagnosed using viral load titer assay or other tests. o Primary HIV syndrome resolves itself and HIV infected person remains asymptomatic for a prolonged period of time, often years.Clinical Latency Period oHIV continues to reproduce, CD4 count gradually declines from its normal value of 500-1200. o Once CD4 count drops below 500, HIV infected person at risk for opportunistic infections. o The following diseases are predictive of the progression to AIDS: * persistent herpes-zoster infection (shingles) oral candidiasis (thrush) * oral hairy leukoplakia ° Kaposi's sarcoma (KS)AIDS o CD4 count drops below 200 person is considered to have advanced HIV disease o If preventative medications not started the HIV infected person is now at risk for: Pneumocystis carinii pneumonia (PCP) cryptococcal meningitis. toxoplasmosis 0 If CD4 count drops below 50: Mycobacterium avium Cytomegalovirus infections lymphoma dementia Most deaths occur with CD4 counts below 50.Other Opportunistic Infections Respiratory system « Pneumocystis Carinii Pneumonia (PCP) « Tuberculosis (TB) * Kaposi's Sarcoma (KS) Gastro-intestinal system +» Cryptosporidiosis » Candida = Cytomegolavirus (CMV) = Isosporiasis + Kaposi's Sarcoma Central/peripheral Nervous system Cytomegolavirus Toxoplasmosis Cryptococcosis Non Hodgkin's lymphoma Varicella Zoster Herpes simplex Skin Herpes simple si's sarcoma . tanoane ZosterLABORATORY DIAGNOSIS OF HIV INFECTION Methods utilized to detect: « Antibody [ELISA/ Dot-Blot/Western Blot] * Antigen [P24 HIV! PCR] « Viral nucleic acid [Viral isolation/ Viral load] + Virus in culture Strategies to prevent the spread of HIV Social mobilization Improving treatment of STDs using the syndromic management approach Work place programs Community and home based care Practical strategies for reducing mother to child (MTC) transmissionDRUGS USED IN THE TREATMENT OF HIV INFECTIONRole of Pharmacist: o In Prevention, promotion of safe and healthy sexual behavior o Improve the management and control of STIs o Reduce mother to child transmission o Provide appropriate post exposure services o Improve voluntary testing and counseling. o Treatment and care: o In counseling, Providing information to the patients regarding disease, medication, diet and life style modifications and assisting the patients in clarifying the doubts and in taking suitable decisions with respect to the management of the disease. o Human legal rights o Monitoring, surveillance and researchPatient Name IP No DOA DOD Department Age Sex -XXXX -58800/664767 - 07/11/14 - 09/11/14 - Med/V - 20years - MaleUBJECTIVE Chief complaint/ History of Presenting illness: *clo vomiting, headache, fever for 3 days. *no| h/o chills, rigors, burning micturition, loose stools, pain abdomen. Previous history: * Admitted with similar complaints in KIMSH on 11/10/2014 & DAMA on the same day. Past” ion History with Allergy: *Nothi ignificant. '@Personal history: Family history: Diet- Mixed Appetite- Average Sleep- Normal B&B- Normal Habits- Occasionally smokes OBJECTIVE Physical examination : A 20 year old male conscious, cooperative, well-oriented to time, place and person. Vital signs: BP- 120/78 mmHg PR- 72 bp RR- {8epm Temp - 100. No f/h with similar complaintsPE), IE. CE) Cl], LE. EG] Systems:- P/A- — RS NAD cvs CNS Provisional diagnosis : Enteric feverLABORATORY INVESTIGATIONS: O7/11/14 Hb (g/dl) 10.8 12-16 TLC (cells/emm) 6160 4000-11000 DLC N(%) 76.9 40-75 L(%) 16.7 20-45 E (%) 1.0 46 M (%) 52 2-10 B (%) 0.2 0-1 Platelets (cells/emm) 2.02 1.5-4.0 lakhiemm ESR 36 0-20mmV/hr Widal Negative Hivas2 Reative Urine complete: 08/11/14 CD4 101 ‘Normal Western Blott CONFIRMEDOn dated: 08/11/14, Patient referred to NACO center for further evaluation and treatment. ASSESMENT Based on the subjective & objective evidence the patient was diagnosed to have infection with HIV.TREATMENT CHART Inj. Febrinit Paracetamol 150mg 4508) 7H ont Inj. Ondemit+ DNS Ondaselran+ Dextrose 4mg+S00m! sos. WM efit Normal Saline Tab. Clarbid500 Clarithromycin 600mg. tod Wi ont Cap. Unidel50 Tramadol 60mg thsod = 7/41 efit Tab. Lamidura00 | Lamivudine 300m thsed — “B/it oft Tab. Tenovir300 Tenotovir 300mg thsod 8/11 ont Tab. Efavir600 Efavirenz’ ‘600m3 tod (My “6/14 ony MEDICINE ON DISCHARGE Tab Lazid-E kit Lamivudine 150mg tod Tab Dolo650 Paracetamol isos,PLAN Suggestion to Physician- * Plasma concentrations decreased by Efavirenz, if clarithromycin added. No dose adjustment of Efavirenz is recommended when given with Clarithromycin. Alternatives to Clarithromycin, other macrolide antibiotics such as Azithromycin, Erythromycin should be considered.Advice to patient- + Adhere to medication. + Regular follow-up. - Bring partner to be screened and treated, if any. + Consume nutritious food, fruits & vegetables. - Don’t donate blood and organs of your body. - Avoid sex and use condom for masturbation even.