HIV/AIDS AND COMMON OPPURTUNISTIC INFECTION /IRIS

HIV

What is HIV?

WHAT IS AIDS?

A-Acquired

I- Immuno

D- Defeciency

S-Syndrome

CD4 CELLS

What is oppurtunistic infection?

Oppurtunistic infection

CD4 cell

Natural history of HIV

COMMON OPPURTUNISTIC INFECTONPROTOZOA FUNGUS

Pneumocystis jiroveci toxoplasmosis

Candiasis Cryptosporiodiasis

Cryptococcus neoformans Isosporiasis

Common agents for OIsBACTERIA VIRUS

Streptococcal pneumonia Cytomegalo virus

Mycobacterial tuberculosis Varicella zooster

Mycobacterial avium complex

Human pappiloma virus

Salmonellois Molluscum contagiosum

Oral hairy leukoplakia

CD4 VS OPPURTUNISTIC INFECTIONCD4 LEVEL OPPURTUNISTIC INFECTIONS

<400 Herpes zooster, Tuberculoisis

<300 Oral candidiasis

<200 Pneumocystis carini, pneomonia, oesophageal candiasis

<100 MAC,Toxoplasmosis,Cryptococcus

<50 Cryptosporiadiasis

Tuberculosis Risk of TB increases with progressive

immuno-suppression

Risk of extra-pulmonary TB and disseminated TB increases

Non specific finding in CXR.

Pneumocystis jiroveci

Most common OIS in western world

Characterised by cough, shortness of breath

ORAL CANDIASIS

HERPES ZOOSTER

TUBERCULOSIS

KAPOSI SARCOMA

Primary and secondary prophylaxis for OIsorganism Condition Drugs

P.Jiroveci CD4 less than 500/mm3 WHO stage 2/3/4

Trimethoprim/sulfamethaxazole 1 tab od

M.Tuberculosis Mantoux >5mm Isoniazide 300 mg od for 6 months

Toxoplasma gondii CD4 count<100 TMP/Sulmethaxozole 1 tab od

Crytocococcus neoformans

CD4<100 Flucanazole 200 mg od

Mycobacterium avium complex

CD4<100/mm3 Azithromycin 1200 mg /wkly

IRIS

I-Immune

R-Reconstitution

I-Inflammatory

S-Syndrome

Immune reconstitution inflammatory syndrome

Collection of inflammatory disorders

with paradoxical worsening of preexisting infectious process

following initiation of HAART.

WHAT IS HAPPENING?

CHANCES OF IRIS ….

Level of CD4

Immune recovery following HAART

Leading pathogens in IRIS

Mycobacterium tuberculosis MAC Cytomegalovirus Cryptococcus Pneumocystis Herpes simplex Hepaatitis B

Management of IRIS

ART after 2 weeks of therapy of OIs.

Continuation of ART???

Anti-inflammatory agent.