Clinical Progression Of Hiv Infection

Clinical progression of HIV infection Solehah Jeffrey 0610108

Outline 1. 2. 3. 4.

5. 6.

Overview Primary infection/ seroconversion Clinical latency/intermediate stage Acquired immunodeficiency syndrome (AIDS) Summary References

Overview

Overview 

Start with CD4 of 1000cells/ml blood

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In HIV infected persons, the CD4 count declines by about 10cells/ml blood/year initially

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However, towards the end, the CD4 count declines by 30-60cells/ml blood/year

How does HIV infection progresses? Primary infection/seroconversi on Clinical latency/intermediate stage AIDS

Primary infection/ seroconversion 

The incubation periods is 2-4 weeks. Silent both clinically and serologically



Symptomatic in 70 %-80% of cases

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Occurs 6-8 weeks after exposure

Primary infection/ seroconversion 

Symptoms include        

Fever Arthralgia/ Myalgia Headache Photophobia Lethargy Sore throat with cervical lymphadenopathy Mucosal ulcers Occasionally –a transient faint pink maculopapular rash.

Rash of acute HIV infection

Primary infection/ seroconversion Symptomatic recovery occurs after 1-3 weeks 

and recovery is usually complete Parallel to return of CD4 count and fall in the viral load

How does HIV infection progresses? Primary infection/seroconversion

Clinical latency/intermediate stage AIDS

Clinical latency/ intermediate stage

Early Immune deficiency (CD4>500) and

Intermediate Immune Deficiency (CD4 200-500)

Early Immune deficiency  Prolonged asymptomatic period (8-10 years) (CD4>500) 

Active viral replication takes place within lymphoid tissue

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Sustained viraemia with decline in CD4 count

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Generally good immune response

Serocon Early version (CD4>500)

CD4 CELL COUNT

PGL Polymyositis Recurrent vaginal candidiasis

500

200

100 50

Intermediate CD4 <500>200

Advanced CD4<200

Early Immune deficiency  Persistent generalized lymphadenopathy (CD4>500) (PGL) 

 

Lymphadenopathy(<1cm) at two or more extrainguinal sites for more than 3 months in the absence of causes other than HIV infection. Usually symmetical, firm, mobile and non-tender. May disappear with disease progression

Intermediate Immune Deficiency (CD4 200-500) 

Signs and symptoms of immunocompromised



Risk of opportunistic infection and malignancy

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Develop constitutional symptoms such as fever, weight loss, and night sweats

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Skin and mucosal surfaces are first affected

Serocon Early version (CD4>500)

Intermediate CD4 <500>200

CD4 CELL COUNT

Acute primary infection PGL Polymyositis Recurrent vaginal candidiasis

500

200

100 50

Pulmonary tuberculosis Herpes zoster Oropharyngeal candidiasis Oral hairy leukoplakia Salmonellosis Kaposi’s sarcoma HIV associated ITP Cervival intraepithelial neoplasia II-III Lymphoid interstitial pneumonitis(LIP)

Advanced CD4<200

How does HIV infection progresses? Primary infection/seroconversion Clinical latency/intermediate stage

AIDS

Acquired Immunodeficiency Syndromes(AIDS) 

Diagnosis:   

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Having a CD4 count of less than 200 Serologic evidence of HIV infection One of the AIDS-defining opportunistic infections

Develops for a median of 2 years followed by death

Serocon Early version (CD4>500)

Intermediate CD4 <500>200

Advanced CD4<200

CD4 CELL COUNT

Acute primary infection PGL Polymyositis Recurrent vaginal candidiasis

500

200

100 50

Pulmonary tuberculosis Herpes zoster Oropharyngeal candidiasis Oral hairy leukoplakia Salmonellosis Kaposi’s sarcoma HIV associated ITP Cervival intraepithelial neoplasia II-III Lymphoid interstitial pneumonitis(LIP)

PCP Chronic mucocutaneous herpes simplex Chronic cryptosporidial diarrhoea Microsporidium Oesophageal candidiasis Miliary or extrapulmonary tuberculosis HIV-asociated wasting Peripheral neuropathy Cerebral toxoplasmosis Cryptococcal meningitis Non-Hodgkin Lymphoma MAI CMV

Acquired Immunodeficiency Syndromes(AIDS)

Summary 1000 900 800

CD4 counts

700 600

Primary Infection

CD4

Clinical latency/ Intermediate stage

500 400 300 200 100

AIDS-defining illness

0 Years : mean survival ~ 10 yrs.

References 



Clinical Medicine, Kumar & Clark, sixth edtion, 2005, Elsevier Clinical microbiology, Gladwin & Trattler, second edition, 1999

THANK YOU

Symptomatic HIV infection As viral load rises, the CD4 count falls Clinical picture is a result of

   

Direct HIV effects Immunosuppression

Clinical consequence depends on three factors

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1.

2. 3.

The microbial exposure of the patient throughout life The pathogenicity of organisms encountered Degree of immunosuppression of the host

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What are the stages of HIV disease? 

The Centers for Disease Control (CDC) has a disease classification system based on immune function and clinical status.

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Each patient is classified with a number which is reflective of CD4 count, and a letter reflective of clinical status.

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This provides clinical and prognostic information of the patients.

CDC Classification of HIV Infection A CD4 Cell Categories Asymptomatic (cells/mm3) OR Acute seroconver sion illness OR PGL

B HIV related conditions (Not A or C)

C AIDS Indicator Condition

> 500

A1

B1

C1

200-499

A2

B2

C2

< 200

A3

B3

C3

CORRELATION BETWEEN CD4 COUNT AND HIV–ASSOCIATED DISEASES >500cells/mm3 Acute primary infection Progressive generalised lymphadeno Pathy(PGL) Recurrent vaginal candidiasis 200-500 cells/mm3 Pulmonary tuberculosis Herpes zoster Oropharyngeal candidiasis Oral hairy leukoplakia Salmonellosis Kaposi’s sarcoma HIV associated ITP Cervival intraepithelial neoplasia II-III Lymphoid interstitial pneumonitis(LIP)

<200cells/mm3 Pneumocystis carinii pneumonia Chronic mucocutaneous herpes simplex Chronic cryptosporidial diarrhoea Microsporidium Oesophageal candidiasis Miliary or extrapulmonary tuberculosis HIV-asociated wasting Peripheral neuropathy <100cells/mm3 Cerebral toxoplasmosis Cryptococcal meningitis Non-Hodgkin’s lymphoma Primary cerebral lymphoma HIV-associated dementia Progressive multifocal leucoencephalopathy <50 cells/mm3 Disseminated Mycobacterium avium intracellulare(MA!) CMV retinitis