Introduction to Clinical HIV

1. Introduction to Clinical HIV Joe Caperna, MD University of California, San Diego Presented @ Provincial Hospital, PE,South Africa 2 Feb 2009

2. ObjectivesAt end of session, participants will be able to: 1) Describe HIV, as a retrovirus, and understand the basics of its life cycle Define AIDS, as a case-based definition

3. Objectives--At end of session, participants will be able to: 3) Compare and contrast staging of HIV and definition of AIDS: South African Guidelines South African HIV Clinicians Society WHO CDC 4) Be able to explain HIV and AIDS to a patient, with emphasis on culturally sensitive & useful terms

4. AIDS-AdultsCDC The 1993 AIDS Surveillance Case Definition of the U.S. Centers for Disease Control and Prevention

5. The 1993 AIDS Surveillance Case Definition of the U.S. Centers for Disease Control and Prevention A diagnosis of AIDS is made whenever a person is HIV-positive and: 1) he or she has a CD4+ cell count below 200 cells per microliter OR 2) his or her CD4+ cells account for fewer than 14 percent of all lymphocytes OR 3) that person has been diagnosed with one or more of the AIDS-defining illnesses listed below.

6. AIDS-Defining Illnesses Candidiasis of bronchi, trachea, or lungs (see Fungal Infections) Candidiasis, esophageal (see Fungal Infections) Cervical cancer, invasive--HPV Coccidioidomycosis, disseminated (see Fungal Infections) Cryptococcosis, extrapulmonary (see Fungal Infections) Cryptosporidiosis, chronic intestinal (>1 month duration) (see Enteric Diseases) Cytomegalovirus disease (other than liver, spleen, or lymph nodes) Cytomegalovirus retinitis (with loss of vision) Encephalopathy, HIV-related� (see Dementia) Herpes simplex: chronic ulcer(s) (>1 month duration) or bronchitis, pneumonitis, or esophagitis Histoplasmosis, disseminated (see Fungal Infections) Isosporiasis, chronic intestinal (>1 month duration) (see Enteric Diseases) Kaposi's sarcoma, HHV8 Lymphoma, Burkitt's, EBV Lymphoma, immunoblastic Lymphoma, primary, of brain (primary central nervous system lymphoma) Mycobacterium avium complex or disease caused by M. Kansasii, disseminated Disease caused by Mycobacterium tuberculosis, any site (pulmonary� or extrapulmonary�) (see Tuberculosis) Disease caused by Mycobacterium, other species or unidentified species, disseminated Pneumocystis carinii pneumonia (aka jiroveci) Pneumonia, recurrent� (see Bacterial Infections) Progressive multifocal leukoencephalopathy Salmonella septicemia, recurrent (see Bacterial Infections) Toxoplasmosis of brain (encephalitis) Wasting syndrome caused by HIV infection�

7. AIDS-AdultsWHO 2006 Update All conditions listed in 1993 CDC MMWR Plus: Symptomatic HIV-associated Nephropathy Symptomatic HIV-associated Cardiomyopthy Atypical disseminated Leishmaniasis NOT: Pulmonary TB, only extrapulmonary TB

8. AIDS-AdultsSouth Africa 2004 ARV Guidelines �WHO Stage 4 Disease�

9. What is HIV? What is AIDS? How do you describe HIV and AIDS in Xhosa? Germ: Ngculasi CD4: isoldati, or amajoni

10. Practice speaking to patients Role play with other member of the class Emphasize the importance of being consistent about a few basic terms used with all patients, then tailer or modify the message to each individual patient and his/her needs.

11. First, we will review WHO guidelines of when to start therapy: