HIV and Drug Abuse

Lesson 3:

HIV Diagnosis

16/10/2020
Lesson objectives
• Natural history of HIV disease
• Stages of HIV progression(HIV to AIDS)
• Clinical staging of AIDS
• HIV Diagnosis methods
 Acute Primary Infection
• Once HIV enters the body, the virus infects a large number of CD4+
T cells and replicates rapidly.
• During this acute phase of infection, the blood has a high number of HIV
copies (viral load) that spread throughout the body, seeding in various
organs, particularly the lymphoid organs such as the thymus, spleen,
and lymph nodes.
• During this phase, the virus may integrate and hide in the cell’s genetic
material. Shielded from the immune system, the virus lies dormant for
an extended period of time.
• In the acute phase of infection, up to 70 percent of HIV-infected people
suffer flu-like symptoms.
• Two to 4 weeks after exposure to the virus, the immune system fights
back with killer T cells (CD8+ T cells) and B-cell-produced antibodies. At
this point, HIV levels in the blood are dramatically reduced. At the same
time, CD4+ T cell counts rebound, and for some people the number
rises to its original level.
Natural History of HIV Infection
Categories of people
• Rapid Progressors
5– 10%, AIDS 1-2 years

•Intermediate Progressors
80-90%, Asymptomatic 5-8 years

• Slow Progressors
5-10%,Good immune responses
10-15 years, Rare
Stage 1 - Primary

• Short, flu-like illness - occurs one to six weeks

after infection
• no symptoms at all
• Infected person can infect other people
 Stage 2 - Asymptomatic
 On average lasts for on average of 8-10 years
 This stage is free from symptoms
 Few or no clinical manifestation- swollen glands
 The level of HIV in the blood drops to very low levels
 HIV antibodies are detectable in the blood
 During this period of the disease, the immune systems remains
competent at handling most infections with opportunistic
microbes
 Steady destruction of CD4+ T cells and steady decline of
circulating blood CD4+ T cells
 The chronic gradual loss of CD4+ T cells in untreated human
immunodeficiency virus (HIV) infection, and the consequent
adverse effects on both innate and adaptive immunity, lead to the
opportunistic infections and malignancies characteristic of
acquired immunodeficiency syndrome (AIDS).
Stage 3 - Symptomatic
 The symptoms are mild
 The immune system deteriorates
 emergence of opportunistic infections
and cancers
 Stage 4 - HIV  AIDS
 The immune system weakens
 The illnesses become more severe leading to an
AIDS diagnosis
 Acquired Immune Deficiency Syndrome:
 Catastrophic breakdown of host defenses, marked
increase in viremia and clinical disease.
 CD4+ cell count less than or equal to 200 per
microliter
 Clinical Features:
 Opportunistic infection
 Neoplasms
 CNS involvement
AIDS associated signs and
symptoms
Gastrointestinal: Cause most of illness and death of AIDS
patients.
Symptoms:
• Diarrhea
• Wasting (extreme weight loss)- more than 10% weight
• Abdominal pain
• Infections of the mouth and esophagus.
Pathogens: Fungus infections- Candida albicans,
cytomegalovirus(Virus infection),
AIDS associated signs and symptoms

2. Respiratory:
• 70% of AIDS patients develop serious respiratory problems.
Partial list of respiratory problems associated with
AIDS:
• Bronchitis
• Pneumonia
• Tuberculosis
• Lung cancer
• Sinusitis
• Pneumonitis
AIDS associated signs and symptoms

. Neurological(affecting the brain and nerves):

Opportunistic diseases and tumors of central
nervous system.
Symptoms many include: Headaches,
peripheral nerve problems, and AIDS dementia
complex (Memory loss, motor problems,
difficulty concentration, and paralysis).
AIDS associated signs and symptoms

.Skin Disorders: 90% of AIDS patients develop skin or

mucous membrane disorders.
• Kaposi’s sarcoma
• 1/3 male AIDS patients develop KS
• Most common type of cancer in AIDS patients
• Herpes zoster (shingles)
• Herpes simplex
• Thrush
• Invasive cervical carcinoma
5. Eye Infections: 50-75% patients develop eye
conditions.
• Conjunctivitis
• Dry eye syndrome
 Opportunistic infections
• Opportunistic infections are infections that take advantage of
a weakened immune system to cause more frequent or
severe illness
• Opportunistic infections cause the vast majority of the
morbidity and mortality associated with HIV
• Most are readily treatable and/or preventable
• Most of these treatments are simple, available and affordable
• Common opportunistic infections are;
• Candidiasis;
• caused by infection with a common (and usually harmless) type of fungus
called Candida. Infection with Candida, can affect the mouth, oesophagus,
Vagina, skin, nails, and mucous membranes throughout the body
• Oral trush- whitish substances in the mouth
• candidiasis is only considered an OI when it infects the esophagus
(swallowing tube) or lower respiratory tract, such as the trachea and
bronchi (breathing tube), or deeper lung tissue
Opportunistic infections
• Cancer:
• Cervical cancer-
• Kaposi’s sarcoma (KS)-appears as firm pink or
purple spots on the skin that can be raised or flat.
Can occur anywhere in the body
• Caused by a virus called Kaposi’s sarcoma herpesvirus
(KSHV) or human herpesvirus 8 (HHV-8)
• Lymphoma, multiple forms- cancer of the lymph
nodes and other lymphoid tissues in the body
Opportunistic infections
• Tuberculosis (TB)- Tuberculosis (TB) infection is caused
by the bacteria Mycobacterium tuberculosis.
• Encephalopathy, HIV-related- brain disorder is a result
of HIV infection
• Herpes simplex (HSV): Herpes simplex virus (HSV) is a
very common virus that for most people never causes
any major problems. HSV is usually acquired sexually
• Wasting syndrome due to HIV- Wasting is defined as the
involuntary loss of more than 10% of one’s body weight
while having experienced diarrhea or weakness and
fever for more than 30 days.
 HIV Disease
•Progression of HIV disease is measured by:
– CD4+ count
• Degree of immune suppression
• Lower CD4+ count means decreasing immunity
– Viral load
• Amount of virus in the blood
• Higher viral load means more immune suppression

•Severity of illness is determined by amount of virus in the body

(increasing viral load) and the degree of immune suppression
(decreasing CD4+ counts)
•Higher the viral load, the sooner immune suppression occurs
Diagnosis

• HIV infection- Laboratory diagnosis

• Various tests are done to make diagnosis
• Serology tests are most common
• Detecting antibodies
• AIDS- Clinical diagnosis + Laboratory
Thank You