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Dr. Amaj Saeed MB.CH.B MSc PhD Clinical virologist

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Presentation on theme: "Dr. Amaj Saeed MB.CH.B MSc PhD Clinical virologist"— Presentation transcript:

1 Dr. Amaj Saeed MB.CH.B MSc PhD Clinical virologist

2 4 th commonest cause of death 34.5 x 10 6 infections worldwide 24.5 x 10 6 in sub-Saharan Africa 33% 15 year olds infected in some African countries impact on social, civil and economic stability

3 Sexually- heterosexual - same sex Vertically- in utero - during delivery (15-40%) - breast milk (20%) Contaminated- IV drug misuse needles- needle stick injuries Blood products- transfusion/tissues factor VIII






9 Candidiasis of bronchi, trachea or lungs Candidiasis, oesophageal Cervical carcinoma, invasive Coccidioidomycocis, disseminated or extrapulmonary Cryptococcosis, extrapulmonary Cryptosporidiosis, chronic intestinal (1-month duration) Cytomegalovirus (CMV) disease (other than liver, spleen or nodes) CMV retinitis (with loss of vision) Encephalopathy, HIV-related Herpes simplex, chronic ulcers (1-month duration); or bronchitis, pneumonitis or oesophagitis Histoplasmosis, disseminated or extrapulmonary Isosporiasis; chronic intestinal (1-month durations) Kaposis sarcoma

10 Lymphoma, Burkitts Lymphoma, immunoblastic (or equivalent term) Lymphoma (primary) of brain Mycobacterium avium complex or M. kansasii, disseminated or extrapulmonary Mycobacterium tubereculosis, any site Mycobacterium, other species or unidentified species, disseminated or extrapulmonary Pneumocystis carinii pneumonia Pneumonia, recurrent Progressive multifocal leucoencephalopathy Salmonella septicaemia, recurrent Toxoplasmosis of brain Wasting syndrome, due to HIV

11 establish diagnosis - HIV antibody present (ELISA, Western blot) - determine VL (HIV RNA assays – bDNA, RT-PCR, NASBA) determine past exposure to OI - hepatitis A, B, C - CMV - toxoplasmosis exclude other active infection - syphilis, other STI - cervical cytology immune status - CD4/CD8 lymphocyte counts

12 low CD4 count high VL - > 10,000 copies/ml > 35 years low BMI (weight (kg) / height (m) 2 ) coinfection – CMV complicating systemic infections complicating malignancies eg. Lymphoma

13 mucocutaneous respiratory gastrointestinal neurological eye (retina) haematological

14 Bacteria Salmonella spp Mycobacterium tuberculosis M. avium-intracellulare Streptococcus pneumoniae Staphylococcus aureus Haemophilus influenzae Moraxella catarrhalis Rhodococcus equii Bartonella quintana Nocardia Viruses Cytomegalovirus Herpes simplex Varicella zoster Human papillomavirus Papovavirus

15 Fungi and yeasts Pneumocystis carinii Cryptococcus neoformans Candida spp Dermatophytes (Trichophyton) Aspergillus fumigatus Histoplasma capsulatum Coccidioides immitis Protozoa Toxoplasma gondii Cryptosporidium parvum Microsporidia spp Leishmania donovani Isospora belli

16 avoid exposure food protected sex CMV & blood products immunization hepatitis A & B chemoprophylaxis

17 Entry inhibtors

18 NRTI Nucleoside reverse transcriptase inhibitors – (nucleoside analogues NA) abacavir, didanosine, lamivudine, stavudine, zalcitabine, zidovudine NNRTI Non-nucleoside RTIs efavirenz, nevirapine Protease inhibitors (PIs) amprenavir, indinavir*, nelfinavir, ritonavir, saquinavir*, lopinavir* (* combined with ritonavir – boosted) Fusion inhibitors enfuvirtide (T-20)

19 A)NRTI x 2 + NNRTI OR B)NRTI x 2 + PI (boosted)

20 (A) zidovudine & lamivudine + efavirenz OR nevirapine (B) zidovudine & lamivudine + lopinavir/ritonavir (kaletra) OR atozanavir/ritonavir OR indinavir/ritonavir OR amprenavir/ritonavir

21 lipodystrophy increased fat deposits (abdomen, breast, buffalo hump) lipids, cholesterol and glucose mitochondrial toxicity lactic acid immune reconstitution flare in host response to OI eg. CMV, M. tuberculosis, HBV, VZ

22 pregnancy avoid vertical transmission (AZT, combination therapy) newborn treat vertical infection (AZT, combination therapy) post-exposure prophylaxis needle stick injuries in HCW (AZT, 3TC, indinavir) acute seroconversion illness HAART

23 Chemically inactivated whole virus vaccine (in effective) Recombinant DNA technology (expression of HIV env protein) Live attenuated HIV vaccine is under investigation (nef gene has been mutated) Prime boost approach : HIV env gene has been cloned in to harmless pox virus (canary pox), injection to the arm and subsequent replication of the pox virus DNA containing the HIV env gene prime the immune system, this will be followed by injection of recombinant env protein.

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