Definition
- AIDS (Acquired Immunodeficiency Syndrome) is a recently recognized condition characterized by a defect in natural immunity against disease. Acquired refers to the fact that the disease is not inherited or genetic but develops as result of a virus. Immuno refers to the bodys immunologic system and deficiency indicates that the immune system is underfunctioning resulting in a group of signs and symptoms that occur together called syndrome.
Epidemiology
he !"# estimated that $.% million and & million children had AIDS and about $$ million people 'ere infected 'ith "I( 'orld'ide. AIDS 'as the leading cause of death among Americans $% ) ** years old. he ratio of men to 'omen 'ho are infected is estimated to be +,&- but the number of infected 'omen is gro'ing faster than the number of infected men. Asia has the lo'est number of cases .-%+&. America has the highest ./&-01+ and in 2SA alone */-0%& are affected. - 3is4 5roups, &. "omose6uals $. Intravenous drug users .. 7ise6uals *. 7lood transfusion %. #rgan transplantation +. Dialysis recipients /. "emophiliacs 1. 8eople 'ith heterose6ual contact 'ith partners 'ho are infected 'ith AIDS 9. ransmission from mother to baby &0. "eath care professionals : laboratory 'or4ers
Etiology
;tiologic Agent, "I( &&. Subfamily, <entivirus &$. =amily, "uman retrovirus - 3etrovirus ) it depends upon unique enzyme called 3everse ranscriptase (3>A directed D>A polymerase)- to replicate 'ith the host. here are * recognized "uman retrovirus a. "uman lymphotropic virus " <(?I @ 'hich is associated 'ith lymphoma. " <(?II@ provirus in circulating cells of the monocyte A macrophage. b. "uman Immunodeficiency viruses "I(?I @ classic AIDS virus @ much more closely related phylogenetically to the simian immunodeficiency virus (SI() found @ most common type "I(?II @ has *0B nucleotide sequence homology 'ith "I(?I - Codes of ransmission, "orizontal &.. Se6ual contact &*. ;6posure to infected blood or other blood products &%. Intravenous drug usersAneedle sharing (ertical &. 8eri?natally from the mother to the neonate -
$ "I( has been isolated from blood- semen- vaginal secretions- saliva- tearsbreast mil4- cerebrospinal fluid- amniotic fluid : urine : is li4ely to be isolated from other body fluids- secretions : e6cretions. "o'ever- epidemiologic evidence has implicated only blood- semen- vaginal secretions : possibly breast mil4 in transmission. here is no evidence of transmission by Dcausal contactE through the use of shared food- to'el- cups- razors- toothbrushes or even 4issing.
Clini-al Manifestations
. A+ A- te $I! synd.ome 'app.o/+ 012,312( Symptoms usually persist for & ) $ '4s : gradually subside as immune response to "I(. #pportunistic infections have been reported during this stage of infectionpresumably as a result of the transient immunosuppression. ypical clinical findings, &+. 5eneral =ever 8haryngitis <ymphadenopathy "eadache 3etro?orbital pain Arthralgias A myalgias <ethargyAmalaise !eight lossAanore6ia >auseaAvomitingAdiarrhea &/. >europathic Ceningitis ;ncephalitis 8eripheral neuropathy Cyelopathy &1. Dermatologic ;rythematous maculopapular rash Cucocutaneous ulceration 4+ Asymptomati- stage&Clini-al %aten-y he initial symptoms may be associated 'ith the first manifestation of an opportunistic disease ;6periences varying degrees of intermittent symptoms such as malaiselethargy- 'ea4ness- anore6ia- and persistent generalized lymphadenopathy "igh ris4 opportunistic : clinically apparent disease C+ Ea.ly Symptomati- Disease 'ARC o. AIDS Related Comple/( Flinical characteristics are the ff. &. 5eneralized lymphadenopathy (J&cm) ;6tra?inguinal sitesH J. monthsH idiopathic ;arliest symptoms ff. Acute syndrome $. #ral lesions a. hrush o !hite- cheesy e6udate ) erythematous mucosa o Soft palate are mostly affected b. #ral hairy leu4opla4ia o =ilamentous 'hite lesion (lateral borders of the tongue) c. Aphthous ulcers of the posterior oropharyn6 o 8ainful- interference s'allo'ing .. 3eactivation Dherpes zosterE or DshinglesE (&0?$0B) &st clinical indication of immunodeficiency % years follo'ing primary infection *. hrombocytopenia (.BH platelet &%0-000) 7leeding gums- e6tremity petechiae- easy bruisability D+ AIDS 'F ll 4lo5n( #pportunistic infection disease 'ould set in li4e 8neumocystis Farinii8neumonia- 7- Maposis Sarcoma : the li4e
Compli-ations
* he complications of "I(?related infections and neoplasms affect virtually every organ. he general approach to "I(?infected person 'ith symptoms is to evaluate the organ system involved- aiming to diagnose treatable conditions rapidly. Fertain infections may occur at any FD*G count- 'hile others rarely occur unless the FD*G lymphocyte count has dropped belo' a certain level. Abnormal findings range from completely non?specific to highly specific for "I( infection. A+ #yne-ologi- -ompli-ations6 (aginal candidiasis Fervical dysplasia >eoplasia 8elvic inflammatory disease 4+ $I!&.elated malignan-ies6 Maposis Sarcoma >on?"odg4ins carcinoma C+ Endo-.inologi- -ompli-ation6 Adrenal gland is the most commonly afflicted D+ S7in -ompli-ations6 (iral dermatitis 7acterial dermatitis =ungal dermatitis >eoplastic dermatitis >onspecific dermatitis E+ #ast.ointestinal -ompli-ations6 Fandidal esophagitis "epatic diseases 7iliary diseases ;nterocolitis #ther disorders 5astropathy Calabsorption F+ CNS -ompli-ations6 o6oplasmosis F>S lymphoma AIDS dementia comple6 Fryptococcal meningitis #+ Sinop lmona.y -ompli-ations6 8neumonia : other infectious pulmonary diseases >oninfectious pulmonary diseases Sinusitis $+ O.al lesions8 .etinitis8 myopathy8 and .he matologi- manifestations I+ Othe. systemi- -omplaints
Diagnosis
<icensed tests for diagnosing "I( infection, If one cannot afford !7A- confirm results by repeating ;<ISA after * ) &$ 'ee4s (. months) for seroconversion to occur. If still (G) then indicative of (G) "I( infection. A+ En9yme , %in7ed Imm noso.:ent Assay 'E%ISA( Standard screening test ;6tremely sensitive test Disadvantage, <o' specificity 4+ ;este.n 4lot Assay ';4A( Cost common confirmatory test ests for assessing disease progression, -
% FD*G ?cell count : 8lasma "I( 3>A assay are the most accurate assessment for disease progression : time of death A+ CD<= "&-ell Co nt 4+ p>< Antigen Capt .e Assay Simplest test C+ Plasma $I! RNA Assay Cost sensitive and reliable measurement of plasma viral load
P.ognosis
- =rom the time of seroconversion- &0?$0B of "I(?infected individuals 'ill progress to AIDS in . ) + years. - #nce the patient has constitutional symptoms- herpes zoster- thrush or a lo'ered FD*G lymphocyte count- chances are J*0B of progressing to AIDS after . years of follo'?up and J%0B after % years. - 8rognosis can be modified by antiretroviral therapy and general medical support.
+ $$. 8ulmonary test $.. 2; and <; instability test $*. 3#C $%. CC $+. Cotor and sensory tests - 2sual problems, $/. Impaired mobility $1. Difficulty 'ith self?care $9. Impaired cognition .0. 2ncontrolled pain - Fhec4 for deconditioning problems, Fontracture .&. Adhesions .$. Atrophy ... <#C .*. !ea4ness .%. Instabilities .+. ;demaAs'elling - Specific tests suitable for conditions A complications present should be done and performed for confirmation.
P" Management
- Cost important aspect of rehabilitation is to 4eep the patient as mobile as possible to prevent the complications often associated 'ith prolonged bed rest A+ "o imp.o@e f n-tion6 5ait and functional retraining 8revention of effects of deconditioning 2se of adaptive equipment and strategies 4+ Fo. impai.ed mo:ility8 diffi- lty 5ith self&-a.e8 impai.ed -ognition8 and n-ont.olled pain6 herapeutic e6ercises 5ait aids 7athroom and safety equipment #rthosis 8ain management !hirlpool treatment Assistance especially in areas of stair climbing- ambulation- bo'el management- and <; dressing C+ Fo. -an-e. pain and pain in patients 5ith $I!6 "eat modalities o Faution, may increase circulation to the involved area- possibly increasing the potential for metastatic spread. 2S over malignant tissues is contraindicated herapeutic heat and cold are used on non?cancer patients ;>S for reducing the dependence on opioid medications particularly in phantom pain- radiculopathy and incisional pain o Fonventional high frequency setting is most effective