Clinical progression of

HIV infection

Solehah Jeffrey
0610108
Outline

1. Overview
2. Primary infection/ seroconversion
3. Clinical latency/intermediate stage
4. Acquired immunodeficiency syndrome
(AIDS)
5. Summary
6. References
Overview
 Overview

 Start with CD4 of 1000cells/ml blood

 In HIV infected persons, the CD4 count

declines by about 10cells/ml blood/year
initially

 However, towards the end, the CD4 count

declines by 30-60cells/ml blood/year
 How does HIV infection
progresses?
Primary
infection/seroconversi
on
Clinical
latency/intermediate
stage

AIDS
 Primary infection/
seroconversion

 The incubation periods is 2-4 weeks. Silent

both clinically and serologically

 Symptomatic in 70 %-80% of cases

 Occurs 6-8 weeks after exposure

 Primary infection/
seroconversion
 Symptoms include
 Fever
 Arthralgia/ Myalgia
 Headache
 Photophobia
 Lethargy
 Sore throat with cervical lymphadenopathy
 Mucosal ulcers
 Occasionally –a transient faint pink
maculopapular rash.
Rash of acute HIV infection
 Primary infection/
seroconversion
Symptomatic recovery occurs after 1-3 weeks
and recovery is usually complete
 Parallel to return of CD4 count and fall in the
viral load
 How does HIV infection
progresses?
Primary
infection/seroconversion

Clinical
latency/intermediate stage
AIDS
 Clinical latency/
intermediate stage
Early Immune deficiency
(CD4>500)
and

Intermediate Immune
Deficiency (CD4 200-500)
 Early Immune
deficiency
(CD4>500)
 Prolonged asymptomatic period (8-10 years)

 Active viral replication takes place within

lymphoid tissue

 Sustained viraemia with decline in CD4 count

 Generally good immune response

 Serocon Early Intermediate Advanced
version (CD4>500) CD4 <500>200 CD4<200

PGL
Polymyositis
Recurrent vaginal
candidiasis
CD4 CELL COUNT

500

200

100

50
 Early Immune
deficiency
(CD4>500)
 Persistent generalized lymphadenopathy

(PGL)

 Lymphadenopathy(<1cm) at two or more

extrainguinal sites for more than 3 months in the
absence of causes other than HIV infection.
 Usually symmetical, firm, mobile and non-tender.
 May disappear with disease progression
 Intermediate Immune
Deficiency (CD4
200-500)
 Signs and symptoms of immunocompromised

 Risk of opportunistic infection and malignancy

 Develop constitutional symptoms such as fever,

weight loss, and night sweats

 Skin and mucosal surfaces are first affected

 Serocon Early Intermediate Advanced
version (CD4>500) CD4 <500>200 CD4<200

Acute primary infection

PGL
Polymyositis
Recurrent vaginal
candidiasis
CD4 CELL COUNT

Pulmonary tuberculosis
500 Herpes zoster
Oropharyngeal candidiasis
Oral hairy leukoplakia
Salmonellosis
Kaposi’s sarcoma
HIV associated ITP
Cervival intraepithelial neoplasia
II-III
Lymphoid interstitial
200 pneumonitis(LIP)

100

50
How does HIV infection
progresses?
Primary
infection/seroconversion

Clinical
latency/intermediate
stage

AIDS
 Acquired
Immunodeficiency
Syndromes(AIDS)
 Diagnosis:
 Having a CD4 count of less than 200
 Serologic evidence of HIV infection
 One of the AIDS-defining opportunistic infections

 Develops for a median of 2 years followed by

death
 Serocon Early Intermediate Advanced
version (CD4>500) CD4 <500>200 CD4<200

Acute primary infection

PGL
Polymyositis
Recurrent vaginal
candidiasis
Pulmonary tuberculosis PCP
CD4 CELL COUNT

Herpes zoster Chronic

500 Oropharyngeal candidiasis mucocutaneous
Oral hairy leukoplakia herpes simplex
Salmonellosis Chronic
Kaposi’s sarcoma cryptosporidial
HIV associated ITP diarrhoea
Cervival intraepithelial neoplasia Microsporidium
II-III Oesophageal
Lymphoid interstitial candidiasis
pneumonitis(LIP)
200 Miliary or
extrapulmonary
tuberculosis
HIV-asociated
wasting
Peripheral
neuropathy
100
Cerebral toxoplasmosis
Cryptococcal meningitis
Non-Hodgkin Lymphoma
50
MAI
CMV
Acquired Immunodeficiency
Syndromes(AIDS)
 Summary
1000
CD4
900 Primary
Infection
800 Clinical
700 latency/
Intermediate
600 stage
CD4 counts

500
400
300
200 AIDS-defining
illness
100
0

Years : mean survival ~ 10 yrs.

References

 Clinical Medicine, Kumar & Clark, sixth

edtion, 2005, Elsevier
 Clinical microbiology, Gladwin & Trattler,
second edition, 1999
THANK YOU
Symptomatic HIV infection
 As viral load rises, the CD4 count falls
 Clinical picture is a result of
 Direct HIV effects
 Immunosuppression
 Clinical consequence depends on three
factors
1. The microbial exposure of the patient throughout
life
2. The pathogenicity of organisms encountered
3. Degree of immunosuppression of the host
 What are the stages of HIV disease?
 The Centers for Disease Control (CDC) has a
disease classification system based on immune
function and clinical status.

 Each patient is classified with a number which is

reflective of CD4 count, and a letter reflective of
clinical status.

 This provides clinical and prognostic information

of the patients.
 CDC Classification of
HIV Infection

A B C
CD4 Cell
Categories Asymptomatic HIV related AIDS
(cells/mm3) OR Acute conditions Indicator
seroconver (Not A or C) Condition
sion illness
OR PGL
> 500 A1 B1 C1

200-499 A2 B2 C2

< 200 A3 B3 C3
CORRELATION BETWEEN CD4
COUNT AND HIV–ASSOCIATED
DISEASES
>500cells/mm3
Acute primary infection
Progressive generalised lymphadeno
Pathy(PGL)
Recurrent vaginal candidiasis
<200cells/mm3
Pneumocystis carinii pneumonia
Chronic mucocutaneous herpes simplex
Chronic cryptosporidial diarrhoea
Microsporidium
Oesophageal candidiasis
Miliary or extrapulmonary tuberculosis
HIV-asociated wasting
Peripheral neuropathy

200-500 cells/mm3 <100cells/mm3

Pulmonary tuberculosis Cerebral toxoplasmosis
Herpes zoster Cryptococcal meningitis
Oropharyngeal candidiasis Non-Hodgkin’s lymphoma
Oral hairy leukoplakia Primary cerebral lymphoma
Salmonellosis HIV-associated dementia
Kaposi’s sarcoma Progressive multifocal
HIV associated ITP leucoencephalopathy
Cervival intraepithelial neoplasia II-III
Lymphoid interstitial <50 cells/mm3
pneumonitis(LIP) Disseminated Mycobacterium avium
intracellulare(MA!)
CMV retinitis