AIDS : CART – HAART – ART Intensified and Peripheral Neuropathy affecting tall persons

AIDS : CART – HAART – ART Intensified and Peripheral Neuropathy affecting tall persons

31-03-2013 : AIDS : CART – HAART – ART Intensified !!!

*Combination antiretroviral therapy (CART), also referred to as highly active antiretroviral therapy (HAART), is the cornerstone of management of patients with HIV infection

*Currently – four categories:

• -inhibit the viral reverse transcriptaseenzyme (nucleoside and nucleotide reverse transcriptase inhibitors; nonnucleoside reverse transcriptase inhibitors)
• -inhibit the viral protease enzyme (protease inhibitors)
• -inhibit the viral integrase enzyme (integrase inhibitors)
• -interfere with viral entry (fusion inhibitors; CCR5 antagonists)

*Elvitegravir – New integrase inhibitor(18th edition)

Indications for the Initiation of Antiretroviral Therapy in Patients with HIV Infection

• I. Acute infection syndrome
• II. Chronic infection
  • A. Symptomatic disease (including HIV-associated nephropathy)
  • B. Asymptomatic diseases
    • 1. CD4+ T cell count <500/MICRO L(18TH EDITION)(IT WAS less than 350micro/l in 17th edition)
    • 2. Pregnancy
• III. Postexposure prophylaxis

POZITIVE PEARL-HAART

• * The risk of HIV infection following a percutaneous exposure to HIV-contaminated blood is ~0.3%, and after a mucous membrane exposure, ~0.09%.

29-03-2013 : When tall stature became a disadvantage in HIV!!! Peripheral Neuropathy in AIDS

When tall stature became a disadvantage in HIV!!!

HIV-Peripheral neuropathy

• Peripheral neuropathies are common in patients with HIV infection.
• Early in the course of HIV infection, an acute inflammatory demyelinating polyneuropathy resembling Guillain-Barré syndrome may occur
• In other patients, a progressive or relapsing-remitting inflammatory neuropathy resembling chronic inflammatory demyelinating polyneuropathy (CIDP)
• Patients commonly present with progressive weakness, areflexia, and minimal sensory changes.
• CSF examination reveals a mononuclear pleocytosis, and peripheral nerve biopsy demonstrates a perivascular infiltrate suggesting an autoimmune etiology.
• Plasma exchange or IVIg has been tried.
• The most common peripheral neuropathy in patients with HIV infection is a distal sensory polyneuropathy (DSPN) also referred to as painful sensory neuropathy (HIV-SN), predominantly sensory neuropathy, or distal symmetric peripheral neuropathy.
• This condition may be a direct consequence of HIV infection or a side effect of dideoxynucleoside therapy.
• It is more common in taller individuals, older individuals, and those with lower CD4 counts. (18th edition)
• When due to dideoxynucleoside therapy, patients with lower extremity peripheral neuropathy may complain of a sensation that they are walking on ice.
• Other entities in the differential diagnosis of peripheral neuropathy include diabetes mellitus, vitamin B12 deficiency, and side effects from metronidazole or dapsone.

This message is from “OPERATION HARRI CAPSULE” 3 (OHC 3) : A crash course for AIIMS/PGI – May 2013 [Based on 18th Edition of Harrison] Date: 12.4.13 to 23.4.13 [12 days] Time: 8 am to 8 pm Venue: Egmore, Chennai. For Details, click here