HIV - clinical pics

Question 1

From HIV to AIDS- what happens when you get infected

Answer 1

AIDS stand for: Acquired Immuno Deficiency Syndrome (syndrome means a sets of signs and symptoms build a distinct clinical picture)

Primary infection = CD4 T cell count is high. Virus starts replicating, (Acute HIV syndrome) and CD4 T cells die. Then CD4 T cells respond, virus count goes down. But in 5-10 years, virus count increases back again, and T cells go down again.
CD4 cells drop so low, to below 200-100, and then you get Constitutional symptoms = tiredness, loss of weight, then you get opportunistic infections and die.

First CD4 cell numbers drop when they go towards to virus and trying to help infection (redistribution), then you see a real loss in CD4 T cell number (they are destroyed).
After the therapy, again you see a redistribution, then a real gain (number of CD4 cells formed outnumber the ones that are lost).

Question 2

Immune disturbances in HIV infection

Answer 2

CD4 T cells die
CTL response goes down
T cell repertoire goes down
IgGs increase
Cytokines increase (Interleukins, TNFalpha)

Question 3

Aspecific clinical symptoms

Answer 3

Occur due to HIV replication.
called B symptoms, because these symptoms are seen in some B cell deficiencies such as lymphomas. In HIV, also similar responses are seen, can be seen in other infections too.
Weight loss, fever, sweat

Question 4

Opportunistic infections HIV patients get

Answer 4

Stomatitis (mouth infection) by HSV
Herpes normally gives cold sores outside the mouth in immunocompetent people, but in immunocompromised people it covers inside the mouth, leading to ulcers.

Oral Hairy Leukoplakia by EBV - tongue
Epstein Barr is also a member of Herpesvirus family, and this is a premalignant condition, if you don’t treat it, it can transform into a tongue carcinoma.

Esophagitis by Candida - esophagus
This esophagitis only occurs when a patient is severely immunocompromised.

PCP infection on lung
Filled lungs, fluid. This happens when a patient has CD4 T cell number less than 200, can be treated but can be deadly as well.

Kaposi sarcoma on chest
, caused by another Herpesvirus. With only HIV therapy few ones can probably be solved, and spots will gradually go away.
a lot more extensive = systemic chemo required.
Close up picture looks like a mole, but it’s not a circle, edges aren’t sharp, and it follows the skin lines, (usually not seen in normal moles since they aren’t epithelia) it’s an epithelia sarcoma.

CMV retinitis
Surrounding the retina there’s redness, inflammation (yellow parts) around the vessels. Very common in patients with CD4 levels are lower than 50, so they are severely immunocompromised. Treatment is HIV treatment + virus targeting drugs.

Toxoplasmosis
Brain lesion.
Cat litter box, cat feces. Also from raw meat. Pregnant woman shouldn’t change a litter box since baby can get it, their immune system isn’t good.
In AIDS, this type of lesions is occurring mainly due to Toxoplasma infections or CNS lymphomas.

Ulcerative gingivitis
Teeth decay, gum problem. Happening due to bacterial overgrowth, common in immunocompromised people. Also common in people that uses meth lmao. (meth mouth)

Varicella zoster
Groups of blisters filled with fluid, surrounding the chest wall. Another herpes infection on skin. Multidermatomal infection, very common in AIDS patients. since they extend from the spine midline. (not only on sides) Only happens when immunocompromised.

TB
Leads to collapsed spine. Makes getting TB much easier if you have HIV, from %10 lifetime chance to %10 yearly chance.

Herpes and TB is important.
Without HIV treatment, patients die in 6 months around %50 from all those events occurring due to immunocompromise.