Presentation3

Diagnostic of
HIV infection
HIV counselling and
testing
Universal
• HIV testing is done with a screening test and a
confirmatory test. Determine and SD-Bioline done
in tandem and showing both a positive result.
• Components or characteristics of quality HIV
testing.
1. Consent Opt in and opt out.
2. Counselling. Pre and post-test.
3. Confidential
4. Correct results
5. care
• HIV testing is the gateway to HIV-related services.
• HIV testing should be done following consent, pre
and post-test counseling with confidentiality
delivering correct results, and referring the patient
for relevant care services.
• Relevance of early HIV testing.
1. Care as prevention. Undetectable equals
untransmittable.
2. HIV prevention services. VMMC, Prep, condoms, STD,
family planning...
• Implication of late or advanced HIV diagnosis
1. Same-day initiation or rapid initiation could be
associated with increased morbidity and mortality
2. Invest in ruling out and treating opportunistic
infections and or co-morbid conditions before ART
initiation
3. Treatment preparation is not always adequate IN same
day iintiation
• HIV testing is the gateway to HIV-related services.
• HIV testing should be done following consent, pre
and post-test counseling with confidentiality
delivering correct results, and referring the patient
for relevant care services.
• Relevance of early HIV testing and treatment
1. Care as prevention. Undetectable equals
untransmittable.
2. HIV prevention services. VMMC, Prep, condoms, STD,
family planning...
• Diagnosis of HIV infection is of part amount
importance since pediatrics are not immunologically
mature.
• It is called early infant diagnosis (EID)and relies on a
qualitative and or quantitative test identifying the
viral HIV RNA.
• This is done in the following cascade.
• At birth, six weeks, 6months, 9 months, 12months,
18 months and 24 months.
• Note that the test at 12, 18, and 24 months is
preceded by a serology test which advises on the
pertinence Nucleic acid test.
• Diagnosis of HIV infection is of part amount
importance since pediatrics are not immunologically
mature.
• It is called early infant diagnosis EID)and relies on a
qualitative and or quantitative test identifying the
viral HIV RNA.
• This is done in the following cascade.
• Other means of diagnostic
1. DNA PCR
2. RNA PCR
3. P24
• This is relevant in the following situations
• Diagnostic of HIV infection in the window period
• Diagnostic of infection in paediatrics
• Classification of HIV infection by WHO clinical stage.
• Definition
It is a WHO-developed case definition for HIV surveillance and
clinical staging and immunological classification of HIV-related
disease in adults and children.
• Relevance
It empowers clinicians to utilize clinical parameters when assessing
a patient’s disease status in a resource-limited setting.
Now it constitutes a baseline clinical assessment advising on the next scientific step
to engage.
• Limitations and remedial

Cases classified as mild and moderate immunosuppression may be severely
immunosuppressed.
• Cd4 cell count is an objective test aiding in
classifying the severity of the HIV infection.
Severe infection is defined as a state with CD4 below
200Cell/uL
• WHO clinical stages
1. Stage one
• Asymptomatic
• Generalizes or peripheral adenopathy (opened-minded by invoking
other diagnostics)
2. Stage two
• Unexplained weight loss of less than 10% of body weight( moderate)
• Recurrent respiratory tract infections ( sinusitis, tonsilitis, otitis media,
pharyngitis)
• Herpes zoster
• Angular cheilitis
• Recurrent oral ulceration
• Papular pruritic eruption
• Fungal nail infections
• Seborrhoeic dermatitis
3. Stage three
1. Unexplained weight loss of more than 10% body weight
( severe weight loss)
2. Unexplained chronic diarrhoea for longer than one month
3. Unexplained persistent fever ( intermittent or continuous for
more than a month)
4. Persistent oral candidiasis
5. Oral hairy leukoplakia
6. Pulmonary tuberculosis
7. Severe bacterial infections
8. Acute necrotizing ulcerative stomatitis , gingivitis or
periodontitis
9. Unexplained anaemia, neutropaenia and or
thrombocytopaenia
• 4 Stage four
1. HIV waisting syndrom
2. Pneumocystis (jirovecii)pneumonia
• 3 Recurrent revere bacterial infection
• 4 Chronic herpes simplex infection( oro-labial, genital or
ano-rectal of more than one month or visceral of any site.
• 5 Oesophageal candidiasis ( tracheal, bronchi or the lungs
• 6 Extra- pulmonary tubercolosis
• 7 Kaposis Sarcoma
• 8 Cytomegalovirus infection ( retinitis or other organs)
• 9 HIV encephalopathy
• 10 Extrapulmonary cryptococcosis , including meningigtis.
• 11 Progressive multifocal leukoencephalopathy
• 12 Chronic cryptosporidiosis
• 13 Chronic isosporiasis
• 14 Disseminated mycosis ( extra-pulmonary histoplasmosis,
coccidioidomycosis)
• 15 Lymphoma( cerebral or B cell non- Hodgkin)
• 16 Symptomatic HIV associated nephropathy or
cardiomyopathy
• 17 Recurrent septicaemia
• 18 Invasive cervical carcinoma
• 19 Atypical disseminated leishmaniasis
• Management of antiretroviral therapy and
management of opportunistic infections
1. Asymptomatic
2. Generalizes or peripheral adenopathy (opened-
minded by invoking other diagnostics)
• Good history taking
• Physical examination
• Laboratory investigation
• DDx of generalized adenopathies
WHO stage 2
Oral thrush.
Clinical presentation
Management
Angular Cheilitis/
Management
• Onychomicosis
• Microsporidum
• AHD concept
Definition
AHD for adults, adolescents, and children older than five years
denotes severe immunosuppression. WHO clinical stages 3 and
4, CD4 count of less than 200 cells/ul. Patients or Roc younger
than 5 are classified as AHD
Suspected in the following situations:

1. HIV-positive adult or adolescent who is acutely ill or
seriously sick ( RR>or =30 breath/min, HR > or = 120
beats/min, 39 degrees Celsius, unable to walk unaided.
2. HIV-positive patients who have an unsuppressed VL
3. HIV positive patients who have defaulted ARV
• Relevance of AHD concept
1. Significant number( 19%) of newly diagnosed

with HIV have AHD.
2. Significant rate(10%) of treatment interruption

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Diagnostic of

• Limitations and remedial

Suspected in the following situations:

1. Significant number( 19%) of newly diagnosed

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