Mohamed H. Dahir - Chairman Pharmaceutical Association of Somaliland
What do you know about Aids?
- Aids is caused by the human immunodeficiency Virus (HIV)
- HIV can be spread through sexual intercourse and by sharing needles, syringes and mixing bowls for injecting drugs
- It can also pass from mother to child during pregnancy, if the mother has the virus
Initial infection and Acute HIV syndrome
After initial infection with HIV-1 the virus finds its way to the lymphatic tissue where high level viral replication occurs. It takes about 1 to 3 weeks before the humoral and cell mediated immune responses are activated. The antibodies may require 4 to 12 weeks to become detectable in the serum (window period). As a result of immune response the viral replication decreases by 100 to 10í000 fold.
The primary HIV infection is usually asymptomatic. Symptoms like fever, malaise, myalgias, arthralgia, nausea, anorexia, headache, lymphadeno-pathy, pharyngitis may occur but most patients do not seek medical attention. Appearance of generalized morbiliform skin eruptions (most prominent on the trunk and face) are characteristic. Only in very rare cases the primary HIV infection is associated with immune deficiency. They are termed as "raped progressors".
Clinical staging of HIV infection
A fundamental feature of HIV disease is the ongoing Viral replication throughout the entire course of infection. HIV disease begins with "and ends with " terminal stage
STAGE 1: Acute infection or primary HIV or Sero Conversion
After an incubation period of 2-6 weeks, 50 percent of infected individuals suffer a flu like syndrome.
There may be high fever, lymph adenopathy, pharyngitis, arthralgia, myalgia and morbiliform rash. This flu like syndrome may last up to 2 weeks. Around 10 to 20% patients may suffer headache, meningoencephalitis peripheral neuropathies, myclopathy, Bellís palsy or GB syndrome. One may occasionally get oropharyngealcandideaseis. The other 50 percent may be free of symptoms.
STAGE 2: Early Stage HIV or Asymptomatic HIV Disease (CD4 count > 500/mm3)
This stage of asymptyomatic disease may last 8 to 10 years in the west but it is found to be a period of 5to 7 years in other countries.
This relatively asymptomatic period is punctuated by various dermatolgical condition like sebborrhic dermatitis, pruritis, cellutistis and sometimes oral hairy leucoplakea, latent herpes zoster may become reactivated. PGL may be seen in some cases. Laboratory data shows leucopenia, throm bocytopenia, elevated serum trransaminase levels etc.
STAGE 3: Intemediate HIV Infection (CD4 count 200-500/mm3)
As CD4 cells count falls, the complication of HIV begin to occur more and more frequently or worsen in severity. EX: recurrent HSV & HZV may occur.
STAGE 4: Latest stage HIV Disease (CD4 count 50-200/mm3)
According to revised CDC definition of AIDS, all patients in this group are now defined as having AIDS because all persons with CD4 count less than 200/mm3 are at strong risk of developing an AIDS defining opportunistic infection or malignancy. The most commonly noted opportunistic infections during this stage include pneumocystis carinii pneumonia, cerebral toxoplasmosis, variors diarrhoeal disorders (particularly cryptosporidium) recurrent multidermatomal Herpes zoster infection, cryptococcal meningitis severe oropharyngeal candidiasis. In many third world country, 60 percent of patients present with pulmonary or disseminated tuberculosis. Cases of mycobacterium avium complex have not been reported from these countries. PCP and daposis sarcoma, are seen around 4% cases only (compared to 50% in western countries).
Combination ARV therapy does not halt the rapid progress to some extent and aggressive nutritional counseling is warranted to maintain immune system function as well as delay development of AIDS wasting syndrome.
To be continue next week