Clinical Presentation and Diagnosis of TB and HIV in Adults Lecture Notes 2024 PDF

Clinical Presentation and diagnosis of TB and HIV in adults Dr SA van Blydenstein Pulmonology Chris Hani Baragwanath Academic Hospital  Introduction and epidemiology of HIV South Africa has the largest number of people living with HIV (PLWH) of an...

Clinical Presentation and diagnosis of TB and HIV in adults Dr SA van Blydenstein Pulmonology Chris Hani Baragwanath Academic Hospital  Introduction and epidemiology of HIV South Africa has the largest number of people living with HIV (PLWH) of any country in the world. Prevalence of around 8 million Incidence 7/1000 among 15-49 year old ¼ women of reproductive age (15–49 years) are living with HIV Vertical transmission rate in the country is 3.5% High rate of sexual violence - individuals may be exposed to a high risk of HIV transmission due to sexual transmission risk and sexual violence-related injury. Half of new infections occur among young key populations –behaviours and potential sexual violence and who also experience barriers to effective prevention services men who have sex with men transgender women people who sell sex people who inject drugs Horak J, Venter WDF, Wattrus C, Papavarnavas N, Howell P, Sorour G, et al. Southern African HIV Clinicians Society 2023 Guideline for post-exposure prophylaxis: Updated recommendations. South Afr J HIV Med. 2023 Sep 28;24(1):10. Definition and transmission HIV (Human Immunodeficiency Virus) is a retrovirus that attacks the immune system, leading to acquired immunodeficiency syndrome (AIDS) if untreated. Primary modes of transmission unprotected sexual intercourse sharing of needles mother to child during childbirth or breastfeeding (WHO, 2021) SA HIV guidelines emphasize early diagnosis and immediate initiation of antiretroviral therapy (ART) to improve health outcomes (South African National Department of Health, 2021). Clinical presentation of HIV Acute HIV infection: include fever, rash, sore throat, and swollen lymph nodes (can mimic other viral infections) Chronic HIV infection: As HIV progresses, individuals may experience persistent fever, weight loss, oral thrush, and chronic diarrhea. Advanced stages are characterized by opportunistic infections and malignancies HIV-associated conditions and opportunistic infections - tuberculosis (TB), cryptococcal meningitis, and Kaposi's sarcoma (WHO, 2021) Chronic HIV infection: stages and clinical manifestations Conditions typically associated with CD4 counts: CD4 count >500 cells/mm³: Generally asymptomatic, mild infections possible CD4 count 200-500 cells/mm³: Increased risk of bacterial infections (e.g., pneumonia), oral candidiasis, and herpes zoster. CD4 count