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Human Immunodeficiency Virus
The Human Immunodeficiency Virus (HIV) is a deadly virus. Once you are infected with this virus you are sooner or later going to develop AIDS 'Aquired Immunodeficiency syndrome'. There is at present no cure for this disease. It is spread from one person to another via blood, semen, and vaginal fluids. Once you become infected, the virus attacks and gradually weakens your body's Immune System which is the defense mechanism against infections which our body is exposed at every minute of our life. Thus this reduced defense system of our body makes it possible for unusual diseases and cancers to take hold in our body.
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HIV infection and AIDS are caused by infection with the human immunodeficiency virus (HIV). HIV infects CD4+ cells,also known as T-helper cells or Helper T Lymphocytes, which are part of the body's immune system. There are mainly two types of HIV virus, HIV-1 and HIV-2. HIV-1 causes most of the infection all over the world. How the disease is spread HIV is spread when blood, semen, or vaginal fluids from an infected person enter another person's body, usually in one of the following ways:
Sexual Contact: any type of sexual contact - anal, vagina, or oral. Drug addicts sharing needles. Tattooing and body piercing by un sterilized needles. Getting injected by un sterilized needles by quacks (especially in the underdeveloped countries.) Accidental needle pricks to health workers or doctors. Unsafe Blood or blood products. Born to HIV positive mother. Pregnant female can transmit the virus to the newborn during pregnancy or during delivery or when she feeds her baby breast milk.
After years of scrutiny, there is no evidence that HIV is transmitted by casual contact or that the virus can be spread by insects, such as by a mosquito bite
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AIDS is diagnosed when an HIV-infected person has --
A CD4+ cell count below 200 cells per microliter of blood.
Specific opportunistic infections and/or cancers
About 60% of HIV-positive adults who do not receive treatment develop AIDS after 12 or 13 years .This time period is too variable. Many with positive HIV develop opportunistic infections early and succumb to such infections.
Homosexuals, those who inject drugs and those with promiscuous lifestyle form a big part of HIV infections. Those visiting sex workers are at a very high risk. Truck drivers especially in the developing countries like India are a major part of infected population and are taking a big part in the spread of this infection back to their family when they happen to visit home.
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Clinical Features & Symptoms
A wide variety of symptoms can be expected in patients infected with HIV. Combination of various indicators can help in diagnosing this disease. A high degree of suspicion can help in diagnosing many patients in their early stage.
Fatigue
Weight loss
Fevers
Night sweats
Swollen lymph nodes in neck, armpits, and groin
Sinus fullness and drainage
Pain when swallowing
Mouth sores
Dry cough
Shortness of breath
Diarrhea or other bowel changes
Personality changes
Difficulty concentrating
Confusion
Tingling, numbness, and weakness in the limbs
Dry skin
Nail changes
Recurrent Herpes Simplex
HIV infection may be suspected when a woman has the following:
Recurrent vaginal yeast infections (more than 3 infections per year.)
Recurrent Pelvic Inflammatory disease.
Abnormal Pap test
HIV may be suspected in a child who has the following:
Persistent yeast infection of the mouth (thrush)
Recurrent bacterial infections
Delays in growth or development
Swollen lymph nodes in neck, armpits, and groin
Enlargement of the liver and spleen
Almost all of these symptoms can be caused by other illnesses.
AIDS is diagnosed when an HIV-infected person has a CD4+ cell count below 200 cells per microliter of blood and specific opportunistic infections and/or cancers.
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Primary Infection The initial infection with HIV is a subclinical type of infection and may not be of much consequence. A small part of the infected may develop within 2-3 weeks Rash, Fever and Lymphadenopathy. Some get pharyngitis, erythematous maculopapular rash, arthralgia, myalgia, retro orbital headache, malaise, diarrhea and vomiting. Opportunistic infections are not seen at this stage. A large majority remain a symptomatic. After a long incubation period varying from 1 to 12 years (usually 5-7 years) majority of the HIV infected develop frank clinical problems. The clinical picture is also too variable and depends from patient's level of immune system.
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Many develop serious opportunistic infections especially Pn.carrini pneumonia and Kaposi's sarcoma. Kaposi's sarcoma is a cancer of the walls of the blood vessels or lymphatic system. It usually appears as pink-to-purple spots on the skin. It can also occur internally. Kaposi's sarcoma can be fatal if it develops in certain sites such as the lungs.
Some HIV infected develop symptoms like diarrhoea, weight loss, candidiasis, fever and leucopaenia. Brain involvement occurs in a large number of infected patients. This can be in the form of Dementia, Psychosis, Encephalitis, Multiple cerebral abscess, Cerebral toxoplasmosis, Herpes encephalitis, Cerebral lymphomas, Kaposi's sarcoma, Stroke, Mylopathy, Neuropathy, Fungal infection. The diverse nature of the neurological complications underlines the importance of considering HIV infection in any neurological patient.
In Africa majority of patients present with severe weight loss. Multiple parasite infection is very common in african patients and thus diarrhoea is also very common.
Thrombocytopaenic purpura may be isolated manifestation of HIV infection.
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Investigations
Two tests are used to diagnose HIV infection. They detect antibodies to HIV.
ELISA ( Enzyme-linked immunosorbent assay. If it is negative, no further tests are needed.
Western Blot Assay. It is used to confirm a positive ELISA test.
It can take up to 6 months, usually 3 months from the time of exposure to HIV until antibodies can be detected. During this period the person can spread infection to others.
HIV infection is diagnosed only after 2 or more positive ELISA tests are confirmed by a positive Western blot assay.
Laboratory Tests for HIV Infection
Rapid progressors About 5% to 10% of people who are infected with HIV are "rapid progressors." They develop AIDS within about 3 years if they do not receive treatment.
Nonprogressors and HIV-resistant people Some people never become infected with HIV despite years of exposure to the virus (for example, they may have repeated, unprotected sex with an infected person). These people are said to be HIV-resistant.
At least 5% of HIV-positive people are described as "nonprogressors." These people have lived with the infection for 10 to 15 years but they have stayed healthy and do not have declining CD4+ cell counts.
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Laboratory Tests for HIV Infection
Laboratory tests for detecting HIV infection are of three types Screening tests Supplemental tests Confirmatory tests Screening tests - are designed to detect Antibodies against HIV. they are of three types. ELISA - enzyme linked immunosorbent assay test Rapid Tests Simple Tests
ELISA technology is based on antigen-antibody and enzyme substrate reactions.
Rapid Tests - Dot Blot and Latex Agglutination Tests
Simple Tests - Particle Agglutination tests.
Both Simple and Rapid Tests do not need costly equipments.
Strategies employed for HIV screening.
Strategy I Used for blood transfusion safety. The serum of the donor is tested by one of the techniques E/R/S (ELISA, Rapid, Simple Tests) If reactive it is taken as Positive and if non reactive its taken as negative.
Stategy II If the serum is reactive with one of the E/R/S it is tested with a second E/R/S based on a different antigen or on different test principle. If the second test is reactive it is reported as positive. If it turns out to be non reactive it is reported as negative.
Strategy III If the serum sample is found to be reactive with two E/R/S tests, it is retested with a third E/R/S, again with a different antigen or a different test principle.
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Supplemental Tests - Western Blot test, Immunofluorescent tests. These are used to validate results obtained by the screening tests. Western Blot test is highly sensitive test. Like ELISA it may not be positive in the initial 3-4 wks. of infection.
Confirmatory Tests - aim at demonstration of Viral Antigen(P24), isolation of HIV and detection of viral nucleic acid. These are done in the reference centres and are time consuming and very costly. The confirmatory tests can diagnose HIV infection even during the initial two to three weeks - the window period, in which both the screening and the supplemental tests fail to diagnose the infection.
Elisa (Enzyme Linked Immunosorbent Assays)
ELISA is the most commonly used test to screen for HIV infection. It detects antibodies to HIV. ELISA may not be sensitive during the initial 3-4 wks of infection because the HIV specific antibodies become positive about 22 to 27 days after acute infection.
False positive tests may occur in multiparous women, recent recipients of Influenza or Hepatitis B vaccines or multiple transfusions, those with hematological malignancies, multiple myeloma, primary biliary cirrhrosis or alcoholic hepatitis.
False negative ELISA occurs in very early or late in the course of HIV disease when antibody production is low.
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Predictors of HIV Disease Progression
The median time from the acquisition of infection and the development of AIDS is variable and depends on many factors. It is usually 10-12 years. Without therapy the CD4+ declines by 40-80 cells / mm³ each year.
Among the predictors of disease progression are :
Transfusion recipients often progress faster to AIDS as compared to Haemophilics. The rapidity of progression of infection increases if the infection is acquired after the age of 35 years. Higher viral load is associated with faster disease progression. CD4 cell count provide crucial information as to the degree of immunodeficiency. Combined plasma viral load and CD4 count estimation provides best estimation of disease progression in an individual.
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There have been anecdotal reports that the number of individuals being diagnosed with HIV in the UK when they already have severe immune suppression has increased in recent years. Patients who have a low CD4 cell count at the time of their HIV diagnosis are at higher risk of disease progression and are less likely to experience the same degree of immunological and virological benefit from HAART. There are also concerns individuals who have very low CD4 cell counts at the time of their HIV diagnosis make a greater demand on clinical services.
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SNAKE BITE
Types of Poisonous Snakes Poisonous Snakes are of Three types:
Cobra & Krait - these secrete Neurotoxic venom and cause Paralysis.
Viper - these secrete Haemotoxic venom and cause Haemolysis and Haemorrhage.
Sea Snakes - secrete myotoxic venom and cause Muscular pain.
Symptoms due to Snake bite
Cobra or Krait Mild Local symptoms -- burning, redness, swelling, superficial necrosis. Marked Neurotoxic effects. Earliest symptom - Ptosis - inability to keep Eyes open. Giddiness, Lethargy, Muscle weakness. Spreading Paralysis - causing difficulty in speaking and breathing, Salivation, Vomiting. Frothing around mouth. Viper - Haemotoxic venom is very painful Severe Local symptoms -- Intense Pain, Inflammation, Ozing of haemolytic blood. Marked Vasculotoxic effects. Bleeding from mucous membrane of the Mouth, Anus, Nose and haemorrhages under the skin. Because of local damage to circulatory cells, hemotoxic venom spreads more slowly and has a slower action than the neurotoxins. Vascular Collapse - Cold Skin, Rapid feeble Pulse, Dilated Pupils insensitive to light, Gradual loss of consciousness.
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Sea Snakes No Local symptoms. Severe Pain while moving Neck, Trunk and Limbs. A few hours later urine turns Brown to Black due to the presence of muscle protein Myoglobin.