This Could Happen to YOU!
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Transcript of This Could Happen to YOU!
This Could Happen to YOU!
Robert R. Tight, MD FACPBradley Kasson, DDS
Roger SchobingerDakota AIDS Education and Training Center
What is HIV?
• Human: Infecting human beings
• Immunodeficiency: Decrease or weakness in the body’s ability to fight off infections and illnesses
• Virus: A pathogen having the ability to replicate only inside a living cell
Types of HIV Virus• HIV 1
– Most common in sub-Saharan Africa and throughout the world
– Groups M, N, and O– Pandemic dominated by Group M
Group M comprised of subtypes A - J
• HIV 2– Most often found in West Central Africa, parts
of Europe and India
What is AIDS?• Acquired: To come into possession of
something new • Immune Deficiency: Decrease or weakness in
the body’s ability to fight off infections and illnesses
• Syndrome: A group of signs and symptoms that occur together and characterize a particular abnormality
AIDS is the final stage of the disease caused by infection with a type of virus called HIV.
HIV vs. AIDS
• HIV is the virus that causes AIDS• Not everyone who is infected with HIV has
AIDS• Everyone with AIDS is infected with HIV• AIDS is result of the progression of HIV
Infection• Anyone infected with HIV, although
healthy, can still transmit the virus to another person
How is HIV Transmitted?• Unprotected sexual
contact with an infected partner
• Exposure of broken skin or wound to infected blood or body fluids
• Transfusion with HIV-infected blood
• Injection with contaminated objects
• Mother to child during pregnancy, birth or breastfeeding
Basic Terms
• Antigen: A substance which is recognized as foreign by the immune system. Antigens can be part of an organism or virus, e.g., envelope, core (p24) and triggers antibody production.
• Antibody: A protein (immunoglobulin) made by the body’s immune system to recognize and attack foreign substances
Testing for Viral Infection and Immune Response
• Viral infection– Viral Load– p24 Antigen
• Immune response– Antibody (IgG, IgM)– Cellular response (CD4)
Window Period
• Time from initial infection with HIV until antibodies are detected by a single test
• Usually 3-8 weeks before antibodies are detected
• May test false-negative for HIV antibodies during this time period
• Can still pass the virus to others during this period
Disease Progression
• Severity of illness is determined by amount of virus in the body (increasing viral load) and the degree of immune suppression (decreasing CD4+ counts)
• As the CD4 count declines, the immune function decreases.
WHO HIV/AIDS Classification System
Stage I
Asymptomatic
Stage IIMinor
Symptoms
Stage IIIModerate
Symptoms
Stage IV
AIDS
Can Disease Progression Be Delayed?
• Prevention and early treatment of opportunistic infections (OIs)
• Antiretroviral therapy• Positive living
HCW HIV PEP Risk Stratification
• Highest risk: larger volume of blood (e.g., deep injury, large diameter hollow needle) and blood containing high titer of HIV (e.g., source patient with acute retroviral illness or end-stage AIDS)
• No increased risk (e.g., solid suture needle from asymptomatic source patient)
• No known risk (e.g., urine, saliva, tears)• Source patient unknown or HIV status
unknown: decide on case-by-case basis, in consultation
HCW HIV PEP• Basic (2 drug) regimen
– Combivir® (ZDV/3TC) 1 tab bid or– Truvada® (TDF/FTC) 1 tab daily
• Expanded regimen: Kaletra® (LPV/r)2 tabs bid
• Initiate promptly: 1-2hr/<72hr/?longer• Duration: 4 wks BUAD:initial(3d), then 2
wksx2– initial supply packet– 2 wks supply at a time– start on basis of preliminary +– stop if confirmatory test is negative
• 24 hours PEP line: 1-888-448-4911
Kahn JO, Walker BD. N Engl J Med. 1998;339:33-39.
Exposure to HIV atmucosal surface (sex)
Virus collected by dendritic cells, carried to lymph node
HIV replicates in CD4 cells, released into blood
Virus spreads to other organs
Day 0
Day 0-2
Day 4-11
Day 11 on
HCW HIV PEP Monitoring
• Anti-HIV: baseline, 6 and 12 wks, 6 (and 12 mo. if source + HCV/HIV)
• CBC, basic panel; UA: baseline, 2, 4 wks
• Baseline pregnancy test
This Could Happen to YOU!
Robert R. Tight, MD FACPBradley Kasson, DDS
Roger SchobingerDakota AIDS Education and Training Center
Oral Manifestations of HIV
Bradley M Kasson, DDS
Consultant for Infection Control Office of Dentistry, Washington DC
Chief, Dental Service VA Medical Center, Fargo
Dakota AIDS Education and Training Center
Oral Manifestations of HIV
No identified unique oral lesion specific to HIV
Seldom manifest with CD4 >400
Some predict progression to AIDS
Some meet criteria for AIDS diagnosisCasiglia JM, Mirowski GW, Oral Manifestations of Systemic Diseases. eMedicine. Oct 2006
Predictive Value CD4+ < 200
Major Aphthous Stomatitis 100%NUP 95.1%Intraoral Kaposi’s Sarcoma93.6%HSV (long standing) 87.0%Oral Hairy Leukoplakia 70.3%Oral Candidiasis 69.9%
Dental Management of the HIV-Infected Patient Supplement to JADA , December 1995
Candidiasis 90% of HIV patients*
• Pseudomembranous
• Erythematous
• Angular Cheilitis
• Hyperplastic
*Casiglia JM, Mirowski GW, Oral Manifestations of Systemic Diseases. eMedicine. Oct 2006
Angular Cheilitis (Candida)
Pseudomembranous Candidiasis
Pseudomembranous Candidiasis
Pseudomembranous Candidiasis
Pseudomembranous Candidiasis: Wikipedia
Erythematous Candidiasis 33yo
Erythematous Candidiasis
Hyperplastic Candidiasis
HIV Oral Candidiasis Treatment• Nystatin not first choice
• Increasing resistance to azoles– Fluconazole– Itraconazole– Ketaconazole
• Clinical recovery precedes mycologic elimination
• Treat the removable denture– Clean & disinfect daily
Casiglia JM, Mirowski GW, Oral Manifestations of Systemic Diseases. eMedicine. Oct 2006
Necrotizing Ulcerative Periodontitis
Necrotizing Ulcerative Periodontitis
Necrotizing Ulcerative Gingivitis
Necrotizing Ulcerative Gingivitispost chlorhexidine therapy
NUG/NUP Treatment
• Debridement, usually with local anesthesia– Oral hygiene instruction
• Chlorhexidine gluconate– Apply with toothbrush, if possible
• Follow-up cleaning– Oral hygiene instruction
• Regular dental cleanings– Oral hygiene instruction
Oral Hairy Leukoplakia (OHL)Cardiac Transplant
Oral Hairy Leukoplakia (OHL)33yo
Oral Hairy Leukoplakia (OHL)21 yo
OHL• Most specific oral manifestation of HIV*
• Usually no treatment indicated– Usually responds to acyclovir– High recurrence rate
• If symptomatic, usually indicates Candida superinfection*
*Casiglia JM, Mirowski GW, Oral Manifestations of Systemic Diseases. eMedicine. Oct 2006
Aphthous Stomatitis
RAS Treatment Recommendations, Barron
• Topical is tx of 1st choice– Amlexanox (Aphthasol) most extensively studied and most cost effective of topicals
• Inhibits inflammatory mediators
• Levamisole– “…may prove to be the safest & most effective systemic agent for maintaining
remission…”– Normalize CD4/CD8 ratio
• Systemic corticosteroids– Major RAS or esophageal/GI involvement
• Thalidomide– Limited to patients with severe RAS as alternative to systemic corticosteroids for
esophageal/GI involvement– Significant adverse effects– Normalize CD4/CD8 ratio, inhibit cytokines & TNF
Barron RW. Treatment strategies for recurrent oral aphthous ulcers. Am J Health-Syst Phar 58(1):41-52,2001