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Session Objectives

List the modes of HIV transmission

Discuss the pathogenesis and life cycle ofHIV

Describe the progression of HIV

Classify an HIV-infected patient according

to the WHO clinical stages

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Modes of HIV Transmission

Sharing Semen andVaginal Fluids

Sharing Needles& Syringes

Through InfectedBlood

During Pregnancyor Birth

Breast Feeding

I-TECH, 2005

Needle StickInjury

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Risk of HIV Transmission with SingleUnprotected Exposure

(Risk per 10,000 exposures)

Source: HIV Web Study, 2006

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How HIV Infects the Body

HIV makes contact with cells located within thegenital mucosa

Virus is carried to regional lymph nodes(1-2 Days)

Exponential viralreplication

Widespread systemicdissemination to the brain,

spleen, distant lymphnodes, etc. (5-11 Days)

Source: GHTM Fellowship Programme, 2006

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Life Cycle of HIV

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Stages of HIV InfectionViral transmission (2-3 wks)

Acute retroviral syndrome (2-3 wks)

Seroconversion (2-4 wks)

Asymptomatic chronic HIV infection (Avg. 8yrs)

Symptomatic HIV infection/AIDS (Avg. 1.3 yrs)

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Progression of HIV

Acute Seroconversion

Asymptomatic HIV (Clinical latency)

Symptomatic HIV Acquired Immune Deficiency Syndrome

(AIDS)

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Patterns of HIV Progression

Typical progressors

Rapid progressors

Slow progressors Long-term non-progressors

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I-TECH, 2005

Case Study 1

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and Staging of HIV 15

Case Study 2

I-TECH, 2005

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Case Study 3

I-TECH, 2005

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Case Study 4

I-TECH, 2005

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Indian Ink Staining ofCryptococcus in CSF

Case Study 7

I-TECH, 2005

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and Staging of HIV 22

Case Study 9

Courtesy of : GHTM, Chennai, 2006

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Case Study 10

37 year-old HIV-positive male Lost 9 kg in last 3 months (previously 75

kg)

Reports having a fever for the pastmonth

Goes to bed by late afternoon

Treated for pulmonary TB 5 months agoWhat is his WHO clinical stage?

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Case 11

34 year-old HIV positive male Suffers from bacterial sinusitis and a

fungal infection on his toes

Has no problem keeping up with hisusual activities and weight is stable

Treated for herpes zoster 4 years ago

What is his WHO Clinical Stage?

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Key Points

The most common mode of HIV transmission inIndia is sexual

Understanding the natural history of HIV is

important in predicting progress of the diseaseand determining when to begin ART

Clinical staging allows clinicians to reliablypredict in patients:

The risk for death and opportunistic infections

The need for disease prevention and ART