HIV/AIDS, Causes, sign & symptoms with active management

WHO And other medical research said that estimated that there are 33.4 million people worldwide living with HIV/AIDS, with 2.7 million new HIV infections per year and 2.0 million annual deaths due to AIDS.
At the top of 2010, there have been 3.4 million children living with HIV around the world. An estimated 390,000 children became newly infected with HIV in 2010.
Introduction

A clinical entity characterized by profound loss of immune functions associated with a depletion of CD4 helper T lymphocytes was recognized between 1981-1985. It was named Acquired Immuno Deficiency Syndrome (AIDS). It was found that this syndrome is caused by infection with HIV.

Definition of HIV Aids:

The communicable disease of the system caused by a person’s immunodeficiency virus (HIV). AIDS is characterized by a decrease in the number of helper T cells, which causes a severe immunodeficiency that leaves the body vulnerable to a spread of probably fatal infections.
A disease of the system characterized by increased susceptibility to opportunistic infections, as pneumocystis carinii pneumonia and candidiasis, to certain cancers, as Kaposi’s sarcoma, and to neurological disorders caused by a retrovirus.

Mode of transmission

The transmission of HIV occurs in two ways:

Horizontal (Responsible for 10-15% cases)
Sexual intercourse
Needlestick injury
Contaminated blood and blood products
Vertical (Responsible for 90% cases)
In utero (30-35%)
During delivery (60-65%)
Breastfeeding (1-3%)

Mother to child transmission is the most significant mode of transmission of HIV infection in children below 15 years. It accounts for 90% of cases of infection. The vertical transmission, from mother to child, occurs in utero (30-35% cases), during delivery (60-65%), and through breastfeeding (1-3%). Horizontal transmission accounts for only 10-15% of HIV cases in children.
Pathogenesis

The average incubation period for the development of clinically apparent AIDS is 2-5 years. HIV causes immunologic abnormalities including lymphocytic dysfunction and a reduction in the number of T helper cells in adults. In children under 12 years, disturbance in B cells may precede failure of T cell-mediated immunity. Depletion of CD4+ lymphocytes in blood and lymph nodes is the hallmark of AIDS. The early decline of CD4+ cells is noticed within 1-3 weeks after infection, associated with viremia. A vigorous cellular and humoral response follow, evoked by CD8+ cytotoxic T cells, natural killer cells, and antibody-dependent cell-mediated cytotoxicity, resulting in a decline in viremia. Then follows a long asymptomatic period. As time passes, there is a steady decline in the number of CD4+ T cells. When the counts fall below 200-400/ml, the opportunistic infection may occur and ultimately the immune system is unable to cope up. Death may occur due to infection, malignancy, or cachexia.

CLINICAL MANIFESTATIONS:

Major sign:

 Weight loss or abnormality slow growth
 Chronic diarrhea of more than 1-month duration
 Prolonged fever of more than 1-month duration
Minor signs:
 Generalized lymphadenopathy
 Oropharyngeal candidiasis
 Repeated common infections
 Persistent cough
 Generalized Dermatitis
 Confirmed maternal HIV infection

Differences in pediatric and adult HIV–infection:

 The overall progression of the disease is more rapid in children
 The immune system is more immature than adults.
 CD4+ counts
 Recurrent invasive bacterial infections are more common in children
 Disseminated CMV, Candida, Herpes Simplex, and Varicella Zoster are more common
 LIP occur almost exclusively in children
 CNS infections are common
 Peripheral neuropathy, Myopathy is rare in children.

CLINICAL STAGING SYSTEM

CLINICAL STAGE I:
 Asymptomatic
 General Lymphadenopathy

CLINICAL STAGE II

 Diarrhea >30 days
 Severe persistent or recurrent diarrhea outside the time of life. Weight loss
 failure to thrive
 Persistent fever >30 days
 The recurrent severe bacterial infection aside from Septicemia or Meningitis. (e.g. Osteomylitis, Abscess, Bacterial Pneumonia-non tubercular)
 Unexplained hepatosplenomegaly
 Popular pruritic eruptions
 Extensive wart viral infection
 Extensive molluscum
 Recurrent oral ulcerations
 Fungal nail infections
 Linear Gingival Erythema (LGE)
 Unexplained persistent parotid enlargement
 Herpes zoster
 Recurrent or chronic upper tract infections (otitis media, otorrhoea, sinusitis, Tonsillitis).

CLINICAL STAGE III

 Unexplained moderate malnutrition not adequately responding to plain therapy
 Unexplained persistent diarrhea (>14 days)
 Unexplained persistent fever (>37.5’c intermittent or constant, for extended than 1 month)
 Persistent Oral Candidiasis (after first 6-8 weeks of life)
 Oral hairy leukoplakia
 Pulmonary TB
 Lymph node TB
 Severe recurrent bacterial Pneumonia
 Acute Necrotizing Ulcerative Gingivitis/ peridontitis
 Symptomatic Lymphoid Interstitial Pneumonitis (LIP)
 Chronic HIV-associated lung disease, including bronchiectasis
 Unexplained anemia ( 1500 cells/mm3 (20%)
>6 years CD4 > 550 cells/mm3

Recommended ART consistent with NACO for youngsters

Under the national program, CD4 counts are going to be done to screen the medical eligibility for ART. However, where CD4 count isn’t available, there should be no delay in offering ART-based clinical staging.

IMMUNIZATION
HIV-exposed children should be immunized consistent with the routine national immunization schedule with the subsequent notes:
 BCG shouldn’t tend in symptomatic HIV- infected children.
 Hib vaccine should tend to all or any who are confirmed HIV-infected on the idea of two
 Positive DNA PCR tests were done at 6 weeks aged.
 Additional vaccines like
 Pneumococcal,
 Varicella, hepatitis A, Influenza Virus, etc. could also be given as necessary.
 Vitamin A supplementation should be as per the UIP schedule.