HIV

General Features in HIV

• Weight loss more than 10%.

• Fever more than 1 month.
• Diarrhoea more than 1 month.
• Neuralgia, arthralgia, headache.
• Lymphadenopathy.
• Cutaneous rashes, dermatitis, fungal ( Candida), bacterial, viral (herpes simplex 1 and 2) infection.
• Dental infection, gingivitis, candidiasis of oral cavity and oesophagus.
• Varicella zoster infection.
• Opportunistic infections.
• Poor healing after surgery, trauma, infection with more complications.

CLINICAL CLASSIFICATION OF HIV INFECTION

• Acute infection
• Asymptomatic but positive HIV
• Persistent generalised lymphadenopathy
• AIDS (HIV related diseases)
o Constitutional diseases like weight loss, fever, diarrhoea
o Neurological diseases, dementia, neuropathy, myelopathy
o Opportunistic infections
o Malignancies. Kaposi's sarcoma, non-Hodgkin's lymphomas, primary cerebral lymphomas
o Other diseases attributable to HIV infection

Tests for HIV

 ELISA test (screening test).

 Western blot test (diagnostic test).
 Polymerase chain reaction {PCR).
 Anti-HIV antibody detection.
 Viraemia quantification-to start treatment and to see the response of antiviral drugs (useful
if it is within 0.5 log 10).
 CD4+ count - Normal value >500/mm3. Values between 200-500/mm3 is seen in Kaposi
sarcoma, Candida infection, Mycobacterium tuberculosis. Values between 50-200/mm3 is
seen in Pneumocystis carinii and Toxoplasma infections. Values< 50/mm3 is seen in atypical
mycobacteria, cytomegalovirus, lymphomas.

After HIV infection, there is a time gap for the patient to become reactive to tests. This time gap is called
as "Window period". This period is variable. But during this period, the individual is infective.
Mode of Transmission

 Sexual intercourse- vaginal or anal.

 Needle pricks-using unsterilised needles for injections, in IV drug abusers, careless handling.
 Mother to child-during birth through vaginal secretion, transplacental, through breast milk.
 Blood transfusions, organ transplantations.

HIV mainly harbours in semen, genital secretions, blood, pus, sputum, saliva and other body fluids.

Management

Investigations

 Tests for HIV

 Tests for specific and opportunistic infections.
 Tests relevant for associated tumours.

Treatment

 Antiviral therapy: ,
o Nucleoside reverse transcriptase inhibitor (NRTI): Zidovudine, didanosine, abacavir,
lamivudine, stavudine.
o Non-nucleoside reverse transcriptase inhibitor (NNRTI) : Nevirapine, delavirdine. ,
Protease inhibitors: Ritonavir, indinavir, amprenavir.
 Treatment of opportunistic infections.
 Treatment of tumours
 lmmunotherapy: , Alpha and gamma interferons. ,. Interleukins.
 Bone marrow transplantation.
 Anti-CD3 or IL-2 after HAART (Highly Active Anti-Retroviral Therapy).
 Psychotherapy
 Counselling of HIV patients and their families.
 Life-expectancy after initial HIV infection is 8-1 O years.

Prevention

Continues to be our best weapon in combating the menace of HIV infection.

• Safe sex- Condom usage reduces the risk of transmission.

• Health education.
• Use of disposable needles to prevent infections.

HIV, hospital and surgeon

• Isolation per se of HIV patient is not required.

• Proper care should be taken to prevent transmission of the virus.
• Open wounds, disposal of excreta, fluids, discharge, pus and other infective materials should be
taken care of properly.
• Risk of HIV infection through needle prick is very less (0.03%).
• Following measures should be taken while managing HIV patients:
o Wearing double gloves.
o Wearing proper spectacles (as HIV can get transmitted through eyes directly).
o Wearing proper head mask, theatre shoes, apron.
o Measures to prevent spread of infection from patient to patient in the hospital.
o Disposal of needles through a sharp disposing container.
• Disinfection
o Autoclave is ideal.
o Boiling.
o Sodium hypochlorite solution.
o 2% glutaraldehyde solution.

UNIVERSAL PRECAUTIONS FOR HIV:

 Care in handling sharp objects like needles, blades

 All cuts and abrasions in an HIV patient should be covered with a waterproof dressing
 Minimal parenteral injections
 Equipments and areas which are contaminated with secretions should be wiped with sodium
hypochlorite solution or 2% glutaraldehyde
 Contaminated gloves, cottons should be incinerated
 Equipments should be disinfected with glutaraldehyde
 Disposable equipments (drapes, scalpels, etc.) should be used whenever possible
 Walls and floor should be cleaned properly with soap water
 Separate operation theatre and staff to do surgeries to HIV patients is justifiable
 Avoid shaving whenever possible before surgery in HIV patients
 All people inside the theatre should wear disposable gowns, plastic aprons, goggles, overshoes
and gloves
 Surgeons, assistants and scrub nurse should wear in addition double gloves
 Suction bottle should be half-filled with freshly prepared glutaraldehyde solution
 Spilled body fluids should be diluted with glutaraldehyde
 Accidental puncture area in surgeon or scrub nurse should be immediately washed with soap
and water thoroughly
 Theatre should be fumigated after surgery to HIV patient