AC Q UIRED IMMUNODEFICIENCY SYNDROME
ETIOLOGY:
Human Immunodeficiency Virus (HIV) Infection
CLINICAL FINDINGS
- Systemic complaints/ Symptoms
- Many individuals with HIV infection remain asymptomatic for years without antiretroviral therapy (ART/ARV) à approximate 10 years between exposure of HIV and developmen of AIDS
- A combination of complains base on opportunistic infection
- Fever à persistent fever
- Night sweats
- Weight loss à antipyretics to prevent dehydration
- Anorexiaà nausea à vomiting
- Diarrhea
- Signs
- Physical examination may be entirely normal
- Abnormal findings range from completely nonspesific to highly spesific for HIV infection
- Opportunistic infections
- Sinopulmonary disease
- Central nervous system disease
- Peripheral nervous system
- Rheumatologic manifestation
- Myopathy
- Retinitis
- Oral lesions
- Gastrointestinal manifestations
- Endocrinologic manifestation à hypogonadism
- Skin manifestations
- HIV-related malignancies
- Gynecologic manifestations
- Inflammatory Reactions (Immune reconstitution Syndrome = IRIS)
TREATMENT
There are 4 catagories:
A. Opportunistic infections & malignancies
B. Antiretroviral treatment
- Nucleoside reverse transcriptase inhibitors (NRTI)
- Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
- Nucleotide reverse transcriptase inhibitors
- Protease inhibitors (PIs)
- Entry inhibitor
C. Hematopoietic stimulating factors
- Erythropoietin (Epoetin alfa):
- HIV infected patients with anemia
- Anemia secondary to zidovudine
- Human G-CSF (filgrastim) and granulocyte – macrophage colony-stimulating factor (GM-CSF [sargramostim]) to increase the neutrophil counts of HIV-infected patients
D. Prophylaxis of opportunistic infections
Management of opportunistic infections
E. Supportive therapy
- Sympthomatic
- Fluid and electrolite
- Anti depressant
To slow AIDS wasting
- Fever control
- Food supplementation with hight-caloric drinks
- Total parentral nutrition (NTN)
- Progestational agent: megestrol acetate
- Antiemetic agent: dromabinol à marjuana
- Growth hormone
- Anabolic steroidà testosteron for 2-4 weeks
- Nausea à weight loss à metoclopramide, dromabinol
- Antideppresant
Prognosis
- W ith improvements in therapy, patients are living longer after the diagnosis of AIDS. This has resulted in dramatic decreases in AIDS deaths. Despite new therapeutic options, people continue to die from HIV infection.
- Depend on:
– The stage of HIV/AIDS (I, II, III, IV)
– The Adherence of ARV
– The number of CD4 count
