Hiv
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HIV/AIDS IN PREGNANCY INTRODUCTION HIV-Human Immunodeficiency Virus AIDS- Acquired immunodeficiency Syndrome CD4 cells
EPIDEMIOLOGY Affects all age groups Reproductive age group Affects both sexes Female / male 55:45 AIDS– 4th commonest cause of death worldwide 40 million people living with HIV/AIDS – About 18 million women & 3 million children
IN NIGERIA Prevalence is 5.2% (5-6 million people) No state or community is spared by this epidemic Ranges from 1.2% in Osun state to 12% in Cross River State 13 States & FCT- prevalence over 5% Rivers State -9% UPTH antenatal patients - 8-10%
TRANSMISSION 3 MAJOR MODES OF TRANSMISSION 1- SEXUAL INTERCOURSE -(80%) Homosexual, Heterosexual > in Dev. Countries 2-TRANSFUSSION OF BLOOD & COMPONENTS (10%) 3-MOTHER TO CHILD TRANSMISSIOM - MTCT (5-10%)
FACTORS AFFECTING MTCT Maternal Viral Load Stage of Maternal Disease Stage of Pregnancy 1st<2nd<3rd trimester Mode of Delivery Duration of Rupture of Membranes Prematurity Breastfeeding
PATHOPHYSIOLOGY INCUBATION PERIOD Generally, 2-3 months 6 months in some individuals 1 month with current Anti HIV assays Asymptomatic Period 2-10 years, may be shorter, depending on; -Virulence of organism -Viral load -Viral resistance
Pathophysiology Contd. HIV –RNA retroviruses 2 serotypes; HIV 1 & HIV 2 HIV 1 more widespread & more virulent HIV 2 milder & commoner in West Africa HIV primarily affects CD4 T-lymphocytes HIV membrane protein gp 120 + CD4 receptors Infected cell+reverse transcriptase =Proviral DNA Viral replication = gradual depletion of CD4 count Absence of ART= devp. of disease manifestations
EFFECTS OF HIV/AIDS ON PREGNANCY More marked in developing countries; These include; Spontaneus abortion Ectopic pregnancy Maternal infections Vaginal candidiasis Preterm labour & low birth weight IUGR Stillbirth Anaemia
EFFECTS OF PREGNANCY ON HIV/AIDS
Little or no effect on the asymptomatic in early stages of HIV disease More rapid progression in late HIV/AIDS
CLINICAL PRESENTATION Broad spectrum of illness in severity & diversity Primary infection associated with a brief illness about the time sero-conversion Symptoms include; Fever Malaise Headache Arthralgia Maculopapular rash Tender lymphadenopathy Diarrhoea Mouth ulcers Followed by an asymptomatic phase (2-10 YEARS)
Clinical presentation Symptomatic phase; Weght loss - 10% of body weight Fever of 1 month duration Diarrhoea of 1month duration Herpes zooster Lymphadenopathy Dermatitis Oral hairy leucoplacia This phase termed – AIDS RELATED COMPLEX
FULL BLOWN AIDS Occurrence of opportunistic infections Tuberculosis Pneumocystic carini pneumonia Cerebral toxoplasmosis Cryptococcal meningitis AIDS dementia Diarrhoea & wasting syndrome Oesophageal candidiasis Cytomegalovirus retinitis Malignancies like; Kaposi’s sarcoma Non Hodgson’s lymphoma Mycobactrium avium intra celulare complex infections (mac)
INVESTIGATIONS GENERAL; FBC
E/U/Cr URINALYSIS & URINE M/C/S CXR LFT Pap smear SPECIFIC; HIV SEROLOGY TEST (ELISA) VIRAL LOAD CD4 COUNT CD8 COUNT WESTERN BLOT (CONFIRMATORY) POLYMERASE CHAIN REACTION especially in children
THANK YOU
EPIDEMIOLOGY Affects all age groups Reproductive age group Affects both sexes Female / male 55:45 AIDS– 4th commonest cause of death worldwide 40 million people living with HIV/AIDS – About 18 million women & 3 million children
IN NIGERIA Prevalence is 5.2% (5-6 million people) No state or community is spared by this epidemic Ranges from 1.2% in Osun state to 12% in Cross River State 13 States & FCT- prevalence over 5% Rivers State -9% UPTH antenatal patients - 8-10%
TRANSMISSION 3 MAJOR MODES OF TRANSMISSION 1- SEXUAL INTERCOURSE -(80%) Homosexual, Heterosexual > in Dev. Countries 2-TRANSFUSSION OF BLOOD & COMPONENTS (10%) 3-MOTHER TO CHILD TRANSMISSIOM - MTCT (5-10%)
FACTORS AFFECTING MTCT Maternal Viral Load Stage of Maternal Disease Stage of Pregnancy 1st<2nd<3rd trimester Mode of Delivery Duration of Rupture of Membranes Prematurity Breastfeeding
PATHOPHYSIOLOGY INCUBATION PERIOD Generally, 2-3 months 6 months in some individuals 1 month with current Anti HIV assays Asymptomatic Period 2-10 years, may be shorter, depending on; -Virulence of organism -Viral load -Viral resistance
Pathophysiology Contd. HIV –RNA retroviruses 2 serotypes; HIV 1 & HIV 2 HIV 1 more widespread & more virulent HIV 2 milder & commoner in West Africa HIV primarily affects CD4 T-lymphocytes HIV membrane protein gp 120 + CD4 receptors Infected cell+reverse transcriptase =Proviral DNA Viral replication = gradual depletion of CD4 count Absence of ART= devp. of disease manifestations
EFFECTS OF HIV/AIDS ON PREGNANCY More marked in developing countries; These include; Spontaneus abortion Ectopic pregnancy Maternal infections Vaginal candidiasis Preterm labour & low birth weight IUGR Stillbirth Anaemia
EFFECTS OF PREGNANCY ON HIV/AIDS
Little or no effect on the asymptomatic in early stages of HIV disease More rapid progression in late HIV/AIDS
CLINICAL PRESENTATION Broad spectrum of illness in severity & diversity Primary infection associated with a brief illness about the time sero-conversion Symptoms include; Fever Malaise Headache Arthralgia Maculopapular rash Tender lymphadenopathy Diarrhoea Mouth ulcers Followed by an asymptomatic phase (2-10 YEARS)
Clinical presentation Symptomatic phase; Weght loss - 10% of body weight Fever of 1 month duration Diarrhoea of 1month duration Herpes zooster Lymphadenopathy Dermatitis Oral hairy leucoplacia This phase termed – AIDS RELATED COMPLEX
FULL BLOWN AIDS Occurrence of opportunistic infections Tuberculosis Pneumocystic carini pneumonia Cerebral toxoplasmosis Cryptococcal meningitis AIDS dementia Diarrhoea & wasting syndrome Oesophageal candidiasis Cytomegalovirus retinitis Malignancies like; Kaposi’s sarcoma Non Hodgson’s lymphoma Mycobactrium avium intra celulare complex infections (mac)
INVESTIGATIONS GENERAL; FBC
E/U/Cr URINALYSIS & URINE M/C/S CXR LFT Pap smear SPECIFIC; HIV SEROLOGY TEST (ELISA) VIRAL LOAD CD4 COUNT CD8 COUNT WESTERN BLOT (CONFIRMATORY) POLYMERASE CHAIN REACTION especially in children
THANK YOU
