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Clinical Care of HIV, AIDS and Opportunistic Infections

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Describe the natural history of HIV and AIDS in adolescents and adults ... WHO Immunological Classification of HIV Infection. CD4 cells 500. CD4 cells. 499-350 ... – PowerPoint PPT presentation

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Title: Clinical Care of HIV, AIDS and Opportunistic Infections


1
Unit 1 Natural History of HIV Disease and
Overview of Opportunistic Infections
  • Clinical Care of HIV, AIDS and Opportunistic
    Infections

2
Learning Objectives
  • Participants will be able to
  • Describe the natural history of HIV and AIDS in
    adolescents and adults
  • Use the 2006 WHO clinical staging of HIV
  • Explain the meaning of opportunistic infection
    or disease
  • Explain how CD4 lymphocyte count results are used
    in developing a differential diagnosis

3
Definitions
  • HIV
  • Human Immunodeficiency Virus
  • Two types HIV-1, HIV-2.
  • HIV-1 is the cause of the world-wide pandemic
  • Multiple HIV-1 subtypes or clades
  • Clades C and A are most common in southern Africa
  • Clinical meaning - Can refer to persons with
    asymptomatic infection or symptomatic disease.
  • HIV/AIDS
  • Used by MOHSS to describe the epidemic as a
    whole WHO is moving away from this term

4
Definitions (2)
  • AIDS
  • Acquired Immunodeficiency Syndrome
  • Although used by the public to encompass the
    whole epidemic, in the clinical sense it refers
    only to the most severe manifestation of
    infection with HIV
  • Defined by the presence of life-threatening
    AIDS-defining conditions due to HIV-induced
    severe immunosuppression
  • Opportunistic infections
  • Some malignancies

5
Definitions (3)
  • 2006 WHO definitions
  • Advanced HIV infection (most relevant for patient
    management)
  • WHO Clinical Stage 3 or 4
  • OR
  • CD4 count lt 350 cells/mm3
  • AIDS
  • WHO Clinical Stage 4
  • OR
  • CD4 count lt 200 cells/mm3

6
Question 1
  • How long do people live after they acquire HIV
    infection, without HAART?
  • How long does it take for a person with HIV to
    develop AIDS?

7
CD4 Count, Viral Load and Clinical Course of
Untreated HIV Infection in Adults
Plasma HIV RNA
8
Natural History High Viral Load Rapid Progressor
Normal
CD4 cells gt 500
High Viral Load
CD4 cells lt 200
AIDS
Infection
2-3 years
9
Natural History Low Viral Load Long-Term
Non-Progressor
10
Question 2
  • What is the meaning of opportunistic infection
    or disease?

11
Opportunistic Disease or Infection
  • Strict meaning
  • An infection or disease that occurs only in
    persons with weakened immune systems
  • Common meaning
  • Any one of a number of infections or diseases
    that occur often in persons with HIV or AIDS

12
WHO, 2006. http//www.who.int
13
Natural History WHO Immunological Classification
of HIV Infection
No significant immunosuppression
CD4 cells gt 500
Mild immunosuppression
CD4 cells 499-350
Advanced immuno-suppression
CD4 cells 349-200
Severe immuno-suppression
CD4 cells lt 200
14
Question 3
  • How can you use CD4 lymphocyte count results in
    developing a differential diagnosis?

15
Relation Between CD4 Count and Types of Pathogens
CD4 cells gt 500
Usual pathogens
Usual pathogens disease more frequent or severe
CD4 cells 500-200
Opportunistic pathogens
CD4 cells lt 200
Severe opportunistic pathogens
CD4 cells lt 50
16
Examples of Pulmonary Pathogens
CD4 cell count Pathogen Examples
gt 500 Usual Bacterial pneumonia TB
500-200 Usual More frequent More severe Bacterial pneumonia TB
200-50 Opportunistic Pneumocystis TB
lt 50 Opportunistic MOTT or TB CMV Kaposis Sarcoma
17
Distribution of HIV Infected Persons and Levels
of Immunosuppression
18
Key Points
  • Persons with HIV may have normal immune function,
    or varying degrees of immunodeficiency
  • Knowledge of the degree of immunodeficiency in an
    HIV person helps determine which infections or
    diseases are most likely
  • The CD4 lymphocyte count, if available, helps
    determine the degree of immunodeficiency
  • Staging of HIV disease is based on clinical
    factors, not CD4 counts
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