Clinical manifestations in HClinical manifestations in HIVinfectionIVinfection

新光醫院黃建賢

AIDSAIDS

These early signs and symptoms may be oral, dermatological, lymphatic or systemic with genital/anal or other manifestations.

Signs and symptomsSigns and symptoms

Signs and symptoms include : – herpes zoster, thrush, recurrent vaginal c

andidiasis, cervical dysplasia, cervical cancer, persistent generalized lymphadenopathy (PGL), anemia, thrombocytopenia, fevers, night sweats, weight loss and minor infections.

台灣地區感染人類免疫缺乏病毒者依檢體來源統計表民國 73年 ~91年

檢體來源 檢體件數 感染者數

陽性率( 十萬分之

一 )

發病數

陽性率( 十萬分之

一 )

本署指定醫院 2,388,838 2965 124.92

990 41.71

捐血中心篩檢 19,388,969 419 2.16 53 0.27

役男體檢 2,326,026 97 4.17 15 0.64

監所收容人員篩檢 769,431 98 12.74 17 2.21

其他 2,681,624 856 32.46

206 7.81

篩檢件數 27,554,888 4435 16.13

1281 4.66

Oral CandidiasisOral Candidiasis

PCPPCP

SyphilisSyphilis

MeningitisMeningitis

Name: 許 XAge: 35 Y/O. Sex: male.C.C: Headache for 1 week.P.E.: no meningeal sign.PHx:

– HIV (+) one month ago.– Sexual exposure at Thailand 3 years ago.

MeningitisMeningitis

Lab:– WBC: 3400. N/L: 74/15. Hgb: 9.8.– Brain CT: negative.– CSF: Protein: 126. Sugar: 42. Lactate: 20.2.– Indian ink: many cryptococcus.– Cryptococcal Ag: >1024.– Culture: Cryptococcus.

Dx: Cryptococcal meningitis. Tx: AmpB 50 mg qd

CMV retinitisCMV retinitis

Name: 張 X X Age: 54 Y/O Sex: female C. C.:

– Blurred vision for 3 months. PHx:

– AIDS diagnosed 8 months ago.– Hx of oral candidiasis, HSV infection with oral ul

cer, PCP pneumonia, Herpes-Zoster infection in recent one year.

CMV retinitisCMV retinitis

Lab data:– WBC: 4200. Hgb: 8.3. N/L: 86/4.– Urine virus culture: CMV.

Dx: AIDS with CMV retinitis.Tx:

– Ganciclovir 250 mg iv q12h for 3 weeks.– Fever subsided and visual acuity improve

d one week later.

PCPPCP

Name: 劉 X XAge: 25 Y/O. Sex: maleC.C.:

– Dry cough for 2 + months.– Fever & SOB for 13 days.

PHx: – Stay at USA form 1978 - 1988.

PCPPCP

Lab:– WBC: 11600. Hgb: 12.4. Plat: 440,000.– HIV (+) ( ELISA & Western blot ).– CD4: 50.– ABG: FiO2 90%. PaO2 : 51.6.– Toluidine blue stain : positive for PCP.

Dx: AIDS with PCP Tx: AZT + Bactrium.

– 1 year later : C/O chest pain.– UGI endoscopy: esophageal candiasis.

PCPPCP

Name: 甘 X X Age: 62 Y/O. Sex: maleC.C.:

– cough & SOB for 2months.P.E:

– oral candidiasis.– Chest: bil basal rales.

PHx: Bisexual for many years.

PCPPCP

Lab data:– WBC:21900. N/L: 88/12.– ABG: PaO2 : 64.3. ( FiO2 : 30 %).– HIV (+).

Ga scan: diffuse Ga uptake in both lung.

Bronchoscopy: PCP.

Anemia in HIV infection Anemia in HIV infection and AIDSand AIDS

multifactorial. Mild anemia can occur during primary infec

tion normocytic andnormochromic with no spec

ific diagnostic features. may be associated neutropenia, thrombocy

topenia, and atypical lymphocytes early lymphopenia is followed by lymphocy

tosis.

AnemiaAnemia

By the time of diagnosis, anemia is often present

3.2% to 36.9% Anemia in HIV : predictive of shorter survival Anemia in HIV : opportunistic infections

Sullivan PS; Blood 1998, 91:301-308. Spino C J; Acquir Immune Defic Syndr Hum Retrovirol 1997,

15: 346-355. Hoots WK; J Acquir Immune Defic Syndr Hum Retrovirol 199

8, 18: 349-357. Moore RD; J Acquir Immune Defic Syndr Hum Retrovirol 199

8, 19: 29-33.

Causes of anemiaCauses of anemia

HIV infection of hematopoietic stem cells and bone marrow stromal cells

opportunistic infection Autoimmune hemolytic anemia Drug toxicity Direct or indirect effect of HIV-related lympho

ma Unknown mechanisms; thrombotic microangi

opathy including hemolytic uremic syndrome and thrombotic thrombocytopenic purpura

Anemia in HIV infectionAnemia in HIV infection

蔡 X XC.C.: cough for 1 monthCXR: Atypical lung infectionP.H.: sexual exposure Tailand 7 yearLab.:

– WBC: 6900 B6S83L6M4AL1– PLT194000– Hb 8 Ht 24.2 MCV 92.2

Molluscum contagiosumMolluscum contagiosum蔡 X XC.C.: chronic skin lesions 1 year

– Follow up at OPD 14 times– STS-RPR and TPHA positive at outer Lab.

P.H.: Herpes zosterP.E.: oral candidiasisBiopsy by Dermatologist:

– Molluscum contagiosum

Peri-anal abscessPeri-anal abscess王 X XFever one weekLAB

– WBC 21500 B2S83L9M5 – PLT 17800 Hb 15

Dx.: F.U.O. at ERP.H.: repeat proctatitis

Rectal ulcerRectal ulcer

孫 X XFever and frequent stoolLab:

– WBC2700 B5S20L46M20P.H.:

– Sexual exposure at Tailand Sigmoidscope:

– Rectal ulcer r/o AIDS, r/o CMV