Comprehensive Patient Management - BDS - 611

HIV
:Definition
HIV affects specific cells of the immune system, called CD4 cells, or T cells. Over time, if left untreated, HIV can destroy so many of
these cells that the body cant fight off infections and disease.
However, with proper medical care, HIV can be controlled.
Treatment for HIV is called antiretroviral therapy or ART. It involves
taking a combination of HIV medicines (called an HIV regimen)
.every day
- Asymptomatic stage, which averages 8 to 10 years (this period is
affected by the nature of the virus, the host immune reaction, or
external factors that may delay or accelerate the process).

:Brief Epidemiology
new HIV cases (2,956 in Saudi nationals and 7,261 in non- 10,217
Saudis) were reported. Africans of Sub-Saharan Africa origin
accounting for 3,982/7,261 (53%) of non-Saudi cases constituted:
Ethiopians (2,271), Nigerians (1,048), and Sudanese nationals (663).

The overall average annual incidence was <4 cases per 100,000;
1.5 cases per 100,000 for Saudis (range 0.52.5), and 13.2 per
100,000 for non-Saudis (range 5.719.0). Notifications increased
yearly from 2000 for both groups until a plateau was reached in
.2006 at 1,390 new cases

Etiological Factors:

By having sex.

From blood transfusions.

By sharing needles.

During pregnancy or delivery or through breastfeeding.

Classification and Clinical Staging of

HIV/AIDS:
Species

Virulence

Infectivity

Prevalence

HIV-1

High

High

Global

HIV-2

Lower

Low

West Africa

Clinical Stage

Clinical Conditions or Symptoms

Primary HIV
Infection

Asymptomatic

Acute retroviral syndrome

Asymptomatic

Persistent generalized lymphadenopathy

Clinical Stage
1

Clinical Stage
2

Moderate unexplained weight loss (<10% of presumed or measured bod

weight)

Recurrent respiratory infections (sinusitis, tonsillitis, otitis media, and

pharyngitis)

Herpes zoster

Angular cheilitis

Recurrent oral ulceration

Papular pruritic eruptions

Seborrheic dermatitis

Fungal nail infections

Unexplained severe weight loss (>10% of presumed or measured body

Clinical Stage
3

weight)

Unexplained chronic diarrhea for >1 month

Unexplained persistent fever for >1 month (>37.6C, intermittent or

constant)

Persistent oral candidiasis (thrush)

Oral hairy leukoplakia

Pulmonary tuberculosis (current)

Severe presumed bacterial infections (e.g., pneumonia, empyema,

pyomyositis, bone or joint infection, meningitis, bacteremia)

Acute necrotizing ulcerative stomatitis, gingivitis, or periodontitis

Unexplained anemia (hemoglobin <8 g/dL)

Neutropenia (neutrophils <500 cells/L)

Chronic thrombocytopenia (platelets <50,000 cells/L)

HIV wasting syndrome, as defined by the CDC (see Table 1, above)

Pneumocystis pneumonia

Recurrent severe bacterial pneumonia

Chronic herpes simplex infection (orolabial, genital, or anorectal site for >

Clinical Stage
4

month or visceral herpes at any site)

Esophageal candidiasis (or candidiasis of trachea, bronchi, or lungs)

Extrapulmonary tuberculosis

Kaposi sarcoma

Cytomegalovirus infection (retinitis or infection of other organs)

Central nervous system toxoplasmosis

HIV encephalopathy

Cryptococcosis, extrapulmonary (including meningitis)

Disseminated nontuberculosis mycobacteria infection

Progressive multifocal leukoencephalopathy

Candida of the trachea, bronchi, or lungs

Chronic cryptosporidiosis (with diarrhea)

Chronic isosporiasis

Disseminated mycosis (e.g., histoplasmosis, coccidioidomycosis,

penicilliosis)

Recurrent nontyphoidal Salmonella bacteremia

Lymphoma (cerebral or B-cell non-Hodgkin)

Invasive cervical carcinoma

Atypical disseminated leishmaniasis

Symptomatic HIV-associated nephropathy

Symptomatic HIV-associated cardiomyopathy

Reactivation of American trypanosomiasis (meningoencephalitis or

myocarditis)

Human Immunodeficiency Virus

:(HIV)
enzymes needed for the development of the virion :reverse transcriptase : generate complementary DNA(cDNA)
from an RNA template.
proteases : enzyme that performs proteolysis, that is,
begins protein catabolism
ribonuclease : catalyzes the degradation of RNA into smaller
components.
integrase : enables HIV genetic material to be integrated into the
DNA of the infected cell.

Transmission of HIV:

Clinical Manifestations of HIV/AIDS:

-

Acute viral syndrome (typically develops within 1 to 6 weeks

after exposure). The symptoms bear some resemblance to

those of Mononucleosis( generalized lymphadenopathy, sore

throat, fever, maculopapular rash, headache, myalgia,
arthralgia, diarrhea..etc). the acute viral syndrome clears
within a few weeks. Followed by the asymptomatic phase.

Oral Lesions in HIV/AIDS:

classification of the oral manifestations
divided into three
(1)
(2)
(3)

Strongly associated
Less commonly associated
Seen in HIV infection

Group 1

Group 2

Group 3

lesions strongly

lesions less commonly

lesions seen in HIV

associated with HIV

associated with HIV

infection

infection

infection

Bacterial infections

Bacterial infections

Candidosis

Erythematous

Pseudomembrano
us

Mycobacterium

avium-intracellulare

Mycobacterium

Actinomyces
israelii

Escherichia coli

Klebsiella

tuberculosis
pneumonia

Hairy leukoplakia

Melanotic
hyperpigmentation

Cat-scratch disease

Group 1

Group 2

Group 3

lesions strongly

lesions less commonly

lesions seen in HIV

associated with HIV

associated with HIV

infection

infection

infection

Kaposis sarcoma

Necrotizing (ulcerative)

Drug-reactions

stomatitis (Figure
(Figure55)

Ulcerative

erythema
multiforme

lichenoid

toxic
epidermolysis

Non-Hodgkins

Salivary gland diseases

lymphoma

Epithelioid (bacillary)
angiomatosis

Dry mouth due to

decreased salivary
flow rate

Unilateral or
bilateral swelling of
major salivary
glands

Periodontal disease

Thrombocytopenic purpura

Fungal infections other

than candida

Linear gingival
erythema

Cryptococcus

Group 1

Group 2

Group 3

lesions strongly

lesions less commonly

lesions seen in HIV

associated with HIV

associated with HIV

infection

infection

infection

Necrotizing

neoformans

gingivitis

Necrotizing

Geotrichum
candidum

periodontitis

Histoplasma
capsulatum

Mucoraceae
(mucormycosis,
zygomycosis)

Aspergillus
flavus

Ulceration NOS (not

Neurological

otherwise specified)

disturbances

Facial palsy

Trigeminal
neuralgia

Viral infections

Herpes simplex
virus

Viral infections

Cytomegaloviru
s

Group 1

Group 2

Group 3

lesions strongly

lesions less commonly

lesions seen in HIV

associated with HIV

associated with HIV

infection

infection

infection

Human
papillomavirus

Molluscum
contagiosum

lesions

Condyloma
acuminatum

Focal
epithelial
hyperplasia

Verruca
vulgaris

Varicella zoster virus

Herpes
zoster

Varicella

Laboratory Tests in HIV Disease:

CD4/T-cell count: A normal CD4 cell count is more than 500

cells per cubic millimeter (mm3) of blood. If you have a CD4
count of fewer than 200/mm3, you will be diagnosed as
having AIDS
.

CD4 Percentage: This measures how many of your white

blood cells are actually CD4 cells. This measurement is more
stable than CD4 counts over a long period of time.

Viral Load (VL): This test measures the amount of HIV in

your blood.

Complete Blood Count (CBC): This is a measure of the

concentration of red blood cells, white blood cells, and platelets
in a sample of your blood.

Serum Chemistry Panel: This test helps provide information

about your body's metabolism. It gives your doctor information
about how your kidneys and liver are working.
Why its important: Some HIV medications can have serious
side effects, and this test helps your healthcare provider to
monitor the impact of your medications on your bodys ability to
function normally.

Sexually Transmitted Disease (STD) Screening: These

screening tests check forsyphilis, gonorrhea and chlamydia.

PAP Smear (Cervical and Anal): This is a screening test for

abnormal cells that could become cancerous. It involves using a
swab to take cell samples directly from the cervix and anus.
Why its important: For women living with HIV, abnormal cell
growth in the cervix is common, and abnormal anal cells are
common for both men and women who are HIV-positive. These
abnormal cells may become cancerous if they arent treated.

Antiretroviral and other

Medications for the treatment of
HIV/AIDS:
-

Nucleoside reverse-transcriptase inhibitors

Nucleotide reverse-transcriptase inhibitors
Nonnucleoside reverse-transcriptase inhibitors
Protease inhibitors
Fusion inhibitors
Integrase inhibitors
CCR5 inhibitors

Occupational Exposure Risk and

Post Exposure Prophylaxis in Dental
Practice:
-

Percutaneous, mucous membrane and cutaneous exposures to

contaminated body fluids constitute possible sources of viral
exposure in many health-care settings.
Factors Influencing Occupational Risk of Bloodborne Virus
Infection
Prevalence of infection among patients
Type of exposure and type of virus
Nature and frequency of blood exposures

Preventing Transmission of Blood-borne Viruses in Healthcare

Settings
Treat all patients as potentially infectious
Use barriers to prevent blood/body fluid contact
Prevent percutaneous injuries
Eliminating unnecessary needle use.
Using devices with safety features.
Developing safe work practices for handling needles and
other sharp devices.
Safely disposing of sharps and blood-contaminated
materials.

References:-

PLoS One. 2012; 7(9): e45919.,Published online 2012 Sep

26. doi: 10.1371/journal.pone.0045919, HIV Case Notification Rates in the Kingdom of Saudi
Arabia over the Past Decade (20002009). Mohammed A. A. l. Mazroa,1 Ibrahim A.
Kabbash,1,2 Sanaa M. Felemban,3 Gwen M. Stephens,3,4 Raafat F. Al-Hakeem,3 Alimuddin I.
Zumla,5 and Ziad A. Memish3,*. Erica Villa, Editor.

http://www.klass.org.my/en/newsroom/global/ashm/dentists_and_hiv_may2011.pdf

https://www.aids.gov/hiv-aids-basics/hiv-aids-101/what-is-hiv-aids/

http://www.who.int/occupational_health/activities/5pepguid.pdf

Ann Med Health Sci Res. 2014 Jul-Aug; 4(Suppl 2): S94S98.doi: 10.4103/21419248.138020Dental Practice, Human Immunodeficiency Virus Transmission and Occupational
Risks: Views from a Teaching Hospital in Nigeria

http://aidsetc.org/guide/hiv-classification-cdc-and-who-staging-systems

https://www.aids.gov/hiv-aids-basics/hiv-aids-101/how-you-get-hiv-aids/index.html