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
- * 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!!!
- 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.