“COULD IT BE HIV?????"
Who is suppose to take this lecture ?
• “ Truly speaking, all HIV patients come with
diagnosis to me, so I don’t have to think about
“Could it be HIV?”- Dr Sanjay Pujari
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COULD IT BE HIV?
Dr Madhu OswalSamvad HIV AIDS Helpline
“India has 23 lakh estimated HIV infected people. But 10 lakh ( 40%) people with HIV don't know their status” – Dr B B Rewari from National AIDS Control Organization
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Who will diagnose HIV infection in these 10 lakh people?
We as general practitioners are front line warriors- the first contact point. So we are best placed to suspect and diagnose HIV
infection.
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And it’s not so difficult
• Knowledge about clinical manifestation of HIV
• High index of clinical suspicion
• Comfort in taking sexual history and speaking about HIV
• “The fire in the belly”
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Whom should we offer HIV test?
• STDs and their partners• Tuberculosis• Herpes zoster• HBV and HCV• Young patient with stroke• ANC• MSM,FSW, IVDUs• Single migrant, long distance truckers• H/o high risk sexual behavior.
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Whom should we offer HIV test?
• Partners and children of known HIV positive person
• Any one who “comes” for an HIV TEST!!!!!!(Find the hidden clues- feeling weak,
loosing weight, anxiety, cannot sleep, etc)• Age, gender, occupation, status , religion-HIV
does not discriminate. So why we should?
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When will we suspect HIV infection in our practice?
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Acute Primary HIV Syndrome- “A Flu like illness”
– Fever– Pharyngitis– Rash “ erythematous maculopapular truncal eruption”– Fatigue– Generalized lymphadenopathy– Headaches, malaise, anorexia– Myalgias/ arthralgias
– Sudden onset, lasting from 3-14 days– H/o unprotected exposure in past 2 to 3 weeks
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Rash of Acute Primary HIV Syndrome
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Why we miss Acute Primary HIV Syndrome?
• Wide range in clinical manifestations• Non-specific signs & symptoms• Lack of clinical suspicion • Asking difficult questions: You need to elicit
exposure history!• Fail to understand diagnostic criteria
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Timeline of Events
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Viral Set point
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Diagnostic Tests for Acute Primary HIV infection
• Acute or Primary HIV Infection– Negative ELISA + positive HIV viral RNA
• Early HIV Infection– Positive ELISA + indeterminate Western Blot
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Herpes Zoster
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Herpes zoster
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Herpes Simplex Virus
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Extensive Herpes Simplex
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Molluscum Contagiosum
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Extensive tinea
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Tinea Barbae
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Onychomycosis
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Cryptococcosis
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Impetigo
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Drug reactions
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Ichthyosis
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Psoriasis
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Candidiasis
Erythematous Candidiasis Hyperplastic candidiasis
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Candidiasis
Angular Cheilitis Thrush
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Oral Hairy Leukoplakia
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Major Apthous Ulcer
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Necrotizing Gingivitis
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Hyperpigmented Nails
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Genital Warts
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Herpes Simplex
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Tubercular lymphadenopathy
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Bacterial Pneumonia
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Pneumocystis J Pneumonia(PCP)
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Tuberculosis
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Pleural Effusion
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Space occupying lesion
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Abdominal Tuberculosis
• Mesenteric nodes• Spleenic abscess• Hepato-
splenomegaly• Ascitis
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In heamogram report
•Unexplained Anemia•Thrombocytopenia (ITP)•Unexplained neutropenia
Stage I
• Acute HIV Primary HIV Syndrome• ASYMTOMATIC
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Stage II: EARLY SYMPTOMATIC STAGE CD4 > 500
• PGL-no treatment• TB• HZ• Headaches• Vaginal candidiasis-recurrent
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Stage III: SYMPTOMATIC HIV DISEASE CD4- (500-200)
• Many skin or oral lesions e.g. Herpes zoster, mild oral or vaginal candidiasis, seborrhoeic dermatitis, oral hairy leukoplakia,itchy folliculitis, apthous ulcer, etc.
• Recurrent diarrhea. • Recurrent fever• Bacterial infections like impetigo, pneumonitis, sinusitis, etc.• Tuberculosis• Herpes zoster
In this the diseases are those which we see in those with normal immunity, but are more frequent.
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• Severe Wt loss • Wasting syndrome• Chronic diarrhea• Fever> 1 month• Cough > 1 month• Skin infections• CNS infections• Recurrent pneumonias
Stage IV LATE SYMPTOMATIC DISESASE CD4 < 200
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Stage IV LATE SYMPTOMATIC DISESASE CD4 < 200
Malignancies • Ca. Cervix• Ca rectum
Non-Hodgkin’s and Hodgkin’s Lymphoma,• Primary CNS Lymphoma• Kaposi's sarcoma
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Stage IV LATE SYMPTOMATIC DISESASE CD4 < 200Gastro-intestinal diseases
• Oesophageal candidiasis• Diarrhea due to Isospora, cryptosporidium and
microsporidium • Abdominal tuberculosis• MAC
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Stage IV LATE SYMPTOMATIC DISESASE CD4 < 200
Neurological diseases• Tubercular meningitis• Toxoplasmosis• Progressive Multifocal Leucoencephalopathy (PML)• HIV associated dementia • Cryptococcal meningitis• Primary CNS Lymphoma• Peripheral neuropathy
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Stage IV LATE SYMPTOMATIC DISEASES CD4 < 200Pulmonary Complications
• Pulmonary tuberculosis• Recurrent pneumonias• Pneumocystis Carinii Pneumonia• Lymphoma• Histoplasmosis• Aspergillosis• Cryotoccocosis• M. Kansassi• MAC• CMV
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Facial Lipoatrophy
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© ITECH, 2006
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Lipodystrophy
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