This slides describe the etiology,structure of HIV,clinical features,diagnosis and management of AIDS.

1. ACQUIRED IMMUNODEFICENCY SYNDROME
Melbia
Shiny

2. CONTENTS
 Introduction
 History
 Etiology
 Structure
 Pathogenesis
 Modes of spread
 Clinical features
 Lab diagnosis
 Management

3. INTRODUCTION
 AIDS is defined as a disease indicative of a
defect in cell mediated immunity occuring in
a person with no known cause for
immunodeficiency other than the presence of
HIV.(WHO )
 HIV is a lentivirus (retro virus).
 Retro virus – both mutation & latency.

4. HISTORY
 Sushrutha - 800 BC
 1981 – los Angeles (homosexuals).
 1983 - HIV described (Robert Gallo & luc
Montagnier).
 1985 - Antibody test.
 1986 - India’s first case in Chennai.
 1987 - AIDS control program launched.

5. ETIOLOGY

6. STRUCTURE OF VIRUS

7. HIV GENOME

8. SUBTYPES OF HIV 1 - VIRUS

9. PATHOGENESIS

13. TRANSMISSION
 Sexual contact.
 Passage of virus from infected mothers to
newborn.
 Through blood and parenteral innoculation.

14. CLINICAL FEATURES
 Initial viral transmission.
 Acute retroviral syndrome.
 Recovery and seroconversion within first six
weeks.
 Asymptomatic chronic HIV infection.
 Symptomatic HIV infection - AIDS related
complex (ARC).
 AIDS for 1 to 2 yrs before death.

15. WHO CRITERIA FOR HIV INFECTION

18. STAGES OF DISEASE

20. ORAL MANIFESTATIONS
 WHO and EC clearing House revised the
classification of oral lesions into :
 Group I – lesions strongly associated with
HIV infection.
 Group II – lesions commonly associated with
HIV infection.
 Group III – lesions uncommonly associated
with HIV infection.

21. GROUP I LESIONS
 Candidiasis - erythematous,
pseudomembranous.
 Hairy leukoplakia.
 Kaposi’s sarcoma.
 Non hodgkin’s lymphoma.
 Periodontal disease – linear gingival
erythema,
necrotizing ulcerative gingivitis
/periodontitis

23. KAPOSI’S SARCOMA

25. GROUP II LESIONS
 Bacterial infections.
 Melanotic hyperpigmentation .
 Necrotizing stomatitis.
 Salivary gland disease.
 Thrombocytopenic purpura.
 Ulcerations not otherwise specified.
 Viral infections – HSV, HPV,VZV

28. GROUP III
 Bacterial infections.
 Cat scratch disease.
 Drug reactions.
 Bacillary epithelioid angiomatosis.
 Fungal infections other than candidiasis.
 Neurological disturbances.
 Recurrent apthous ulcerations
 Viral infections.

29. DIAGNOSTIC TESTS
 ELISA test (enzyme linked immunosorbent
assay) – screening.

31.  Western blot test – confirmatory test.
 Nine antibodies are detected .
 Antibody (gp 160,gp 120,gp 41) , Antibody
(p24,p17,p55),Antibody from polymerase
region(p31,p51,p66).
 Symptomatic stage – presence of gp41 with
one band from any two region.

32.  Lane1: Positive Control
 Lane 2: Negative Control
 Sample A: Negative
 Sample B: Indeterminate
 Sample C: Positive

33. Viral load testing:
 Amount of HIV virus in the body.
 Progression of HIV infection.
 PCR & bDNA.
 Report – no. of HIV copies in 1 ml of blood.
 High viral load & low viral load.

34.  Antibody test – DOT test
 & Med mira
Reveal G 2 rapid HIV 1 antibody test.
 Indirect immunofluorescence.
 Absolute CD4 + T cell lymphocyte count.

35.  Ora quick- sensitivity is 99.6%
 - specificity is 100%
 - performance low.
 - rapid test.

37. MANAGEMENT

38. MANAGEMENT
 Managing immunosuppression and
opportunistic infections.
 Targeted at the virus itself.
 Interferon
Antiviral,antiproliferative ,immunomodulator.
 Thymic replacement therapy
Transplantation of fetal thymic epithelium ,
thymic hormone.

39.  Lymphokines and cytokines.
 Bone marrow transplantation.
 Monoclonal antibody therapy.
 Intravenous immunoglobulin therapy.
 Virus adsorption inhibitors.
 Viral coreceptor antagonists.
 Antiretroviral therapy.

41.  R 5 antagonist:
Maraviroc
 Integrase strand transfer inhibitors
Raltegravir
Elvitegravir
 Highly active antiretroviral therapy (HAART).
* 1 NNRTI + 2 NRTI.
* 1 or 2 PI + 2 NRTI.
* Triple NRTI.

43.  Adverse effects:
 IRIS (Immune reconstitution inflammatory
syndrome).
 Other side effects – bone marrow
suppression,bleeding disorder,liver and renal
toxicity,hypersensitivityreactions and severe
form of erythema multiforme.

45.  FUNGAL DISEASE:
Candida albicans
 Nystatin tablets
 Mycostatin pastille
 Mycelex (clotrimazole) – 10 mg troche
 Nizoral (ketoconazole).
 Miconazole mucoadhesive buccal tablets- 50
mg

46.  BACTERIAL DISEASE:
Linear erythematous banding
 Irrigation with 10 % povidone iodine solution.
 Prophlaxis
 Antifungal therapy.
 125 chlorhexidine gluconate.
 Frequent systemic follow up.

47. Necrotizing ulcerative gingivitis /periodontitis:
 Irrigation with 1% povidone iodine.
 Debridement of necrotic gingival tissue
scaling ,root planing
 Antibiotic therapy
 Hydrogen peroxide mouth rinse.
 12% chlorhexidine gluconate rinse.
 Frequent systemic follow up..

48.  NEOPLASIA:
 Kaposi’s sarcoma
 Chemotherapy – vinblastin sulfate ( 0.1 ml of
0.2 mg/ml solution for each 0.5 cm lesion.0.2
intralesionally after LA.
 Localized radiation therapy.
 Sodium tetradecyl sulfate (sotradecol) –
intralesional.
 Co2 laser.

49. APTHOUS ULCER:
Lidex (fluocinonide) ointment 0.05% /clobetasol
ointment.
Dexamethasone 0.5mg /5ml – swish around mouth
for one minute.
Prednisone – 10 mg tablets six times for 1week.
Thalidomide - 200mg every 12 hrs for 5 days.
Tetracycline oral suspension – 125 mg/5ml swis+h
& expectorate.
Levamisol – 50 mg every 8 hrs for 3 days.

50.  Viral infections
 HSV - Acyclovir 200 mg for 4-5 times/day
 VZV – acyclovir 200/800 mg
 CMV – ganciclovir iv.
 HPV – surgical excision
- cryotherapy
-co2 laser.
- electrocoagulation.

51. HIV VACCINE
 Prophylactic vaccine
*Recombinant subunit protein.
*Synthetic peptides.
*Recombinant viral vectors.
*DNA vaccines.
 Therapeutic vaccine

52.  Derma Vir – dendritic cell based therapeutic
vaccination.
 Gene therapy to eliminate CCR5 coreceptor
in derived T /stem cell with new technology
such as zinc finger nucleases.


53. UNIVERSAL PRECAUTIONS
 Hand washing.
 Barrier protection – gloves,masks,gowns,eye
protectors.
 Careful handling of sharp objects.
 Proper sterilization & disinfection.
 Proper disposal of used instruments.
 Proper disposal of infected wastes.

54.  Sterilization - autoclave at 121 degree , 15
Ibs for 15 to 20 min.
 Flamming – for knives & other piercing
instruments.
 Boiling & chemicals – inactivates HIV .
 Modification in dental care and procedures.

55.  Pre exposure prophylaxis
 Combination of tenofir disoproxil fumarate
(TDF) and emtricitabine – Truvada.

56. CONCLUSION
 Immune activation which is decreased but
not abolished by ART is responsible for the
pathogenesis of vascular disease the risk of
which is increased in HIV.
 Improved understanding of virus latency and
reservoirs might result in cure.
 Effective vaccine remains elusive despite 2
decades of effort.

57. BIBLIOGRAPHY
1)Differential diagnosis of oral and maxillofaciallesions.Norman K
Wood,Paul W Goaz.
2)Burket’s oral medicine.Micheal Glick.
3)Textbook of oral medicine,Oral diagnosis and Oral
radiology.Ongole,Praveen.
4)Oral manifestations in HIV infection.JIAOMR.
5)Human immunodeficiency virus vaccine an update.JOMFP 2013.
6)The end of AIDS :HIV infection as a chronic disease.Steven G
Deeks et al.
7)HIV infection ,epidemiology,pathogenesis,treatment and
prevention.Gary Maartens et al.
8)Dental clinics of north america.clinical approach to oral mucosal
disorders part 1.

58. +