AIDS OVERVIEW

DEFINITION

Acquired Immunodeficiency Syndrome (AIDS) is a group of symtomps due to deficiency of immune system which is cause by Human immunodeficiency syndrome.

HIV infection is mainly via three ways which involve body fluid:

1. Sexual transmision
2. Blood or blood products transmission, for example in organ transplantation
3. Transplacental transmission: the fetus is infected by HIV and by perinatal infection.

CLINICAL SIGNS AND SYMTOMS

Almost every patient who is infected by HIV will progress to symptoms related to HIV and AIDS when they are not  adequately treated

Constitutional Symptoms

This group is commonly known as AIDS related complex. The Patient experiences at least two symptoms which last for three months or more. The symptoms are:

1. Constant fever of 37⁰C or more
2. Weight Loss 0f 10% or more
3. Inflammation of lymph nodes (two or more extra inguinal nodes)
4. Diarrhea of unknown origin                              
5. Excessive sweating at night

 Neurological Symptoms

This stadium gives various neurological symptoms like muscle weakness, dysphasia, balance disorder, disorientaton, hallucination, dementia, psychosis and even coma (sign of cerebral inflammation)

Infection symptoms

Opportunistic infection is a condition whereby immunity is very weak which leads to incapability to fight infection :

1. Pneumocystic carinii pneumonia (PCP)
2. Tuberculosis
3. Toxoplasmosis
4. Mucocutaneus infection

Tumor symptoms

Tumor commonly found in AIDS patients; Kaposi sarcoma and Non-Hodgkin lymphoma maligna.

DIAGNOSIS

WHO has announced the criteria for diagnosis if there is no serology or HIV antigen examination

Adults. AIDS is suspected if there are at least two major symptoms and one minor symptoms and no other immunosupression factors are present, such as cancer, severe malnutrition or others.

Major symptoms:

• Weight loss of more than 10% of the initial body weight
• Chronic diarrhea more than one month
• Fever more than one month

Minor symptoms :

• Cough more than one month
• Pruritus dermatitis
• Recurrent common infection (e.g herpes zoster)
• Oropharingeal candidiasis
• Progressive chronic herpes simplex infection
• Lymphadenopathy generalisata

Presence of kaposi sarcoma or cryptococcal meningitis are sufficient to establish diagnosis of AIDS.

Children

AIDS is established if there are two major symptoms and two minor symptoms and no other immunosupression factors are present, such as cancer, severe malnutrition or others.

Major symptoms:

1. Weight loss or abnormal growth
2. Chronic diarrhea more than one month
3. Fever more than one month

Minor symptoms

1. Lymphadenopathy generalisata
2. Oropharyngeal candidiasis
3. Cough more than one month
4. Pruritus dermatitis
5. Reccurent common infection (e.g herpes zoster)
6. Confirmation of HIV in the mother is considered as minor symtoms.

In areas whereby laboratory examination is already available, diagnosis is establised based on the examination to serum or other body fluid (e.g serebrospinal fluid) with three principles of ELISA. Currently, there are tree methods of ELISA, they are:

• Indirect ELISA
• Competitive ELISA
• “sandwich” ELISA or agglutination.

The HIV antigen used for this examination is prepared from cloning or synthesis of viral polypeptide. False-negative result is very rare. False-negative can be found if antibody titer is not detected during window period whereby the titer is actually detected after 4-12 weeks after infection. False-negative can aso be found in patients with low immunity. Serology test for anti HIV can also be carried out withWestern Blot to detect specific antibodies to HIV antigen. Laboratory examination for children under 18 months-old is better to use virology test (p24, PCR DNA or RNA) since anti HIV is not yet detected. Children above 18 months-old can use ELISA with three methods but they have to be free from breastfeeding for at least 6 weeks.