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HIV Structure | Medical Science Optional Notes for UPSC PDF Download
Introduction
- Lentivirus
- Ranges in size from 80 to 110 nm
- Comprises Envelope and Nucleocapsid
- Envelope features gpl20 and gp41
- Nucleocapsid contains two identical copies of single-stranded RNA (ss) and viral enzymes
- Structural genes include Gag-p24, Pol-RT, protease, Integrase, Env-gpl20, gp-41, along with nonstructural genes Tat, Nef, Vpu, Vpr, Vpx, Rev, Vif
- Serotyping for HIV-1 and HIV-2
- HIV-1 subtypes (M, N, O, P) with M being predominant worldwide
- HIV-2 subtypes (A-H) with Group A being more prevalent
WHO-HIV clinical Staging in Adults
Clinical Stage 1:
- Asymptomatic
- Persistent generalized lymphadenopathy
Clinical Stage 2:
- Moderate unexplained weight loss (<10% of presumed or measured body weight)
- Recurrent respiratory tract infections (sinusitis, tonsillitis, otitis media, pharyngitis)
- Herpes zoster
- Angular cheilitis
- Recurrent oral ulceration
- Papular pruritic eruption
- Fungal nail infections
- Seborrheic dermatitis
Clinical Stage 3:
- Unexplained severe weight loss (>10% of presumed or measured body weight)
- Unexplained chronic diarrhea for longer than 1 month
- Unexplained persistent fever (intermittent or constant for longer than 1 month)
- Persistent oral candidiasis
- Oral hairy leukoplakia
- Pulmonary tuberculosis
- Severe bacterial infections (such as pneumonia, empyema, pyomyositis, bone or joint infection, meningitis, bacteremia)
- Acute necrotizing ulcerative stomatitis, gingivitis, or periodontitis
- Unexplained anemia (<8 g/dl), neutropenia (<0.5 x 109/L), and/or chronic thrombocytopenia (<50 x 109/L)
[Question: 939228]
Clinical Stage 4:
- HIV wasting syndrome
- Pneumocystis (jirovecii) pneumonia
- Recurrent severe bacterial pneumonia
- Chronic herpes simplex infection (orolabial, genital, or anorectal for more than 1 month's duration or visceral at any site)
- Esophageal candidiasis (or candidiasis of trachea, bronchi, or lungs)
- Extra-pulmonary tuberculosis
- Kaposi sarcoma
- Cytomegalovirus infection (retinitis or infection of other organs)
- Central nervous system toxoplasmosis
- HIV encephalopathy
- Extra-pulmonary cryptococcosis, including meningitis
- Disseminated non-tuberculous mycobacterial infection
- Progressive multifocal leukoencephalopathy
- Chronic cryptosporidiosis
- Chronic isosporiasis
- Disseminated mycosis (extra-pulmonary histoplasmosis, coccidioidomycosis)
- Lymphoma (cerebral or B-cell non-Hodgkin)
- Symptomatic HIV-associated nephropathy or cardiomyopathy
- Recurrent septicemia (including non-typhoid Salmonella)
- Invasive cervical carcinoma
- Atypical disseminated leishmaniasis
HIV -Modes of Transmission
Lab Diagnosis of HIV
Question for HIV Structure
Try yourself:
In the NACO testing strategy for HIV diagnosis, which strategy is implemented for the diagnosis of asymptomatic HIV patients, antenatal screening, and screening of patients awaiting surgeries?View Solution
Serological Diagnosis
Serological Diagnosis of HIV
Serologic Tests in the Diagnosis of HIV-1 or HIV-2 Infection.
NACO Testing Strategy for HIV Diagnosis
In resource-poor countries, confirming HIV screening test results through PCR or western blot is impractical due to the expense and limited availability of these assays. The National AIDS Control Organization (NACO) in India has devised a strategic plan for HIV diagnosis.
- Depending on the specific situation or condition for which the test is conducted, a positive result from the initial screening test should either be accepted as is or confirmed by one or two additional screening tests.
- The first screening test should prioritize high sensitivity, while the second and third screening tests should prioritize high specificity.
- The three screening tests should employ different principles or different antigens, and it is essential not to reuse the same kit.
- Supplemental or confirmatory tests should be reserved for cases where the screening test(s) yield equivocal or intermediate results.
There are four strategic plans/algorithms outlined by NACO:
1. Strategy I:
- Applied to blood donors in blood banks.
- Involves a single test.
2. Strategy II (a):
- Implemented for seroprevalence or epidemiological purposes.
- Requires two tests.
3. Strategy II (b):
- Utilized for the diagnosis of HIV/AIDS in symptomatic patients.
- Involves two tests.
4. Strategy III:
- Employed for the diagnosis of asymptomatic HIV patients, antenatal screening, and screening of patients awaiting surgeries.
- Involves three tests.
[Question: 939229]
Strategy I
Use test of high sensitivity
A blood unit that tests positive should be discarded. In the event that the donor has consented to be notified of their result, it becomes a diagnostic matter, requiring the use of strategies II and III following appropriate counseling. The donor should then be referred to an Integrated Counseling and Testing Center (ICTC) for result confirmation.
Strategy II A
Used in Sentinel surveillance
Strategy II B
Used for diagnosis in symptomatic patients
Strategy III
Used for diagnosis in asymptomatic patients
Test 1-High sensitivity Test 2 and 3-High specificity
If results remain negative despite repeated testing, conduct PCR testing (if facilities are available) and refer the case to the National Viral Reference Laboratory (NVRL)
Dermatological Manifestations of HIV
More than 90% of individuals with HIV infection experience dermatologic issues.
Non-Neoplastic:
- Seborrheic dermatitis is observed in 50% of HIV patients and is exacerbated by concurrent Pityrosporum infection, a yeastlike fungus.
- Folliculitis is present in nearly 20% of HIV cases.
- Eosinophilic pustular folliculitis manifests as multiple urticarial perifollicular papules that may merge into plaque-like lesions, accompanied by elevated serum IgE levels.
- Prurigo nodularis (PN) is a skin condition characterized by hard, itchy nodules.
- Norwegian scabies is a severe form with hyperkeratotic psoriasiform lesions.
- Guttate psoriasis transforms preexisting psoriasis and becomes refractory to treatment.
- Reactivation of Herpes Zoster is observed in 10-20% of HIV patients, with clinical manifestations indicative of immunologic compromise but less severe than in other immunodeficient conditions.
- Recurrent reactivation of Herpes simplex infection presents as beefy red lesions, intensely painful, and often occurring high in the gluteal cleft.
- Diffuse skin eruptions due to molluscum contagiosum.
- Cutaneous drug reactions, including erythroderma, Stevens-Johnson syndrome, and toxic epidermal necrolysis, as reactions to drugs such as sulfa drugs, nonnucleoside reverse transcriptase inhibitors, abacavir, amprenavir, darunavir, fosamprenavir, and tipranavir.
Neoplastic:
- Kaposi's Sarcoma: The initial lesion may appear on the skin, oral mucosa, or sun-exposed areas, particularly following trauma (Koebner phenomenon).
HIV-Repeats
- Describe the mode of transmission of Human Immunodeficiency Virus and outline preventive measures to curb its spread (1994).
- Explore the various modes of HIV/AIDS transmission prevalent in India (1997).
- Provide details on drug treatment, including names, doses, and toxicity, for managing HIV infection (2003).
- Identify common dermatological lesions associated with AIDS (2006).
- Enumerate significant parasitic and fungal opportunistic infections occurring during HIV infection. Discuss current strategies for HIV testing, monitoring progress, and briefly outline recommended treatment (2011).
- Delve into the laboratory diagnosis of AIDS (2012).
- Provide a detailed account of the laboratory diagnosis of AIDS (2016).
- Name two opportunistic fungal and two parasitic agents causing infections in an HIV patient. Describe the laboratory diagnosis of one of them (2017).
- Discuss the strategic plans formulated by NACO for diagnosing individuals exhibiting AIDS-indicative symptoms (2018).
The document HIV Structure | Medical Science Optional Notes for UPSC is a part of the UPSC Course Medical Science Optional Notes for UPSC.
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FAQs on HIV Structure - Medical Science Optional Notes for UPSC
| 1. What is WHO-HIV clinical staging in adults? |  |
Ans. WHO-HIV clinical staging in adults is a system used by the World Health Organization (WHO) to classify the progression of HIV infection in adults. It is based on the presence and severity of clinical symptoms and is divided into four stages. This staging system helps in determining the appropriate treatment and management strategies for individuals living with HIV.
| 2. What are the modes of transmission for HIV? | |
Ans. HIV can be transmitted through various modes, including:
1. Unprotected sexual intercourse: The most common mode of transmission is through unprotected vaginal, anal, or oral sex with an infected person.
2. Sharing contaminated needles or syringes: HIV can be transmitted through sharing needles or syringes contaminated with infected blood.
3. Mother-to-child transmission: HIV can be transmitted from an infected mother to her baby during pregnancy, childbirth, or breastfeeding.
4. Blood transfusion and organ transplantation: Although rare nowadays, HIV can be transmitted through transfusion of infected blood or transplantation of infected organs.
| 3. How is HIV diagnosed through serological testing? | |
Ans. Serological testing is commonly used to diagnose HIV. It involves detecting the presence of specific antibodies produced by the immune system in response to HIV infection. The two main types of serological tests used are:
1. Enzyme-linked immunosorbent assay (ELISA): This initial screening test detects HIV antibodies in the blood or oral fluid sample. If the ELISA test is positive, a confirmatory test is performed.
2. Western blot: This confirmatory test is used to confirm the presence of HIV antibodies detected by the ELISA test. It identifies specific proteins of HIV in the blood sample.
A positive result in both the ELISA and Western blot tests confirms HIV infection.
| 4. What is NACO's testing strategy for HIV diagnosis? | |
Ans. The National AIDS Control Organization (NACO) in India follows a testing strategy for HIV diagnosis known as "Three Test Strategy." It includes the following steps:
1. First-line testing: This involves conducting an initial screening test using a rapid diagnostic test (RDT), which detects HIV antibodies or antigens in the blood or oral fluid sample.
2. Second-line testing: If the first-line test is positive, a second confirmatory test is performed using another type of RDT or an ELISA test.
3. Third-line testing: In cases where the second-line test is positive, a third confirmatory test is conducted using the Western blot or another highly specific test to confirm the presence of HIV infection.
This strategy ensures accurate diagnosis and reduces the chances of false-positive or false-negative results.
| 5. What are the dermatological manifestations of HIV? | |
Ans. Dermatological manifestations are common in individuals living with HIV. Some of the dermatological conditions associated with HIV infection include:
1. Kaposi's sarcoma: This is a cancerous skin tumor that often appears as purplish or reddish patches or nodules on the skin.
2. Herpes simplex: HIV-infected individuals may experience more frequent and severe outbreaks of oral or genital herpes.
3. Candidiasis: It is a fungal infection that can cause oral thrush (white patches in the mouth) or genital yeast infections.
4. Seborrheic dermatitis: This condition causes itchy, flaky, and red skin, commonly affecting the scalp, face, and upper body.
5. Prurigo nodularis: It is characterized by intensely itchy nodules that often appear on the arms and legs.
These are just a few examples, and there are many other dermatological manifestations associated with HIV. Proper diagnosis and treatment of these conditions are important for the overall management of HIV-infected individuals.
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Nov 22, 2024 Last updated |
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