Haart HIV And Aids in ENT

DNB ENT Theory Question - What is HAART HIV? Classify the drugs used in treatment of HIV. What are their merits and demerits? Ear, Nose, Throat manifestation of Haemato-Oncological disorders and HIV. What are the Head and Neck manifestations of AIDS in ENT? (10) Dec 2014 (2+4+4) Dec 2015, June 2018, Dec 2018 Staging of HIV and Aids Staging of hiv and aids HAART HIV AND AIDS IN ENT Common Manifestations of HIV in Head and Neck. Common Manifestations of HIV in Head and Neck. The use of multiple drugs that act on different viral targets is known as highly active antiretroviral therapy (HAART) ANTIRETROVIRAL THERAPY Principles of therapy - • Specific combination of drug to be used. • 3 drugs( never 2 or 1 drug because of resistance) • Once therapy is started it must be continued. • Adherence is critically important. • When patient skips the doses ? Viral resistance develops ? CD4 count falls ? Increased risk of disease progression. General goals of ART • To prolong survival • To decrease morbidity. • To help to maintain family unit. Specific goals of ART • To suppress HIV replication. • To reduce plasma viral load to below undetectable levels for maximum duration. • To improve immune status. • To reduce opportunistic infections. Drawbacks • Cannot eradicate HIV. • Mutations in HIV can develop resistance. • Combination therapy has limitations: ? Toxicity ? Interactions ? Penetration Antiretroviral therapy • Nucleoside analog reverse transcriptase inhibitors(NRTI) • Non-nucleoside analog reverse transcriptase inhibitors(NNRTI) • Protease inhibitors • Entry inhibitors. and Integrase inhibitors NRTIs Nucleoside RTIs• -Zidovudine (AZT, ZDV)• -Didanosine(ddl)• -Stavudine(d4T)• -Lamivudine(3TC)• -Abacavir(ABC) NNRTIs • Nevirapine(NVP)• Efavirenz(EFV)• Delaviridine (rarely used) Protease inhibitors • Saquinavir(SQV)• Lopinavir(LPV)• Nelfinavir(NFV)• Indinavir(IDV)• Amprenavir(AMP)• Atazanavir(ATZ)• Tipranavir(TPV)• Ritonavir Entry inhibitors • Enfuviritide(T-20) Combination of drugs used • 2 NRTIs plus 1 NNRTI• 2 NRTIs plus 1 PI( often boosted with low dose Ritonavir)• Actual combinations are important as some are antagonistics. eg; Stavudine andZidovudine.• Some have serious combined toxicity eg; stavudine and Didanosine RECOMMENDATIONS FOR INITIATING ART If CD4 counts are available; Document baseline CD4 count & offer ART to patients with • WHO stage IV Diseases, irrespective of CD4 count, • WHO stage III Disease, with consideration of CD4 < 350/mm3 to assist decision-making • WHO stage I or II disease, with CD4 count < 200/mm3 If CD4 counts not available; Offer ART to patients with: • WHO stage IV disease, irrespective of total leucocyte count • WHO stage III disease, irrespective of total leucocyte count • WHO stage II disease, with total leucocyte count < 1400/mm3 Head and neck manifestations of AIDS DERMATOLOGIC Molluscum contagiosum -pearly umbilicate papules; usually 2-5 mm, occasionally giant; predilection for eyelids -tx: surgical excision, curettage or cryotherapy -complics: frequent recurrence following treatment; can cause functional problems if extensively involving and treated in eyelid areas Bacillary angiomatosis -subcutaneous nodules or friable papules; multiple organ involvement; negative cultures; classic histopathologic appearance -tx: erythromycin, 500 mg qid or rifampin 600 mg qd -if unrecognized and untreated, can have multisystem involvement and possibly death Cutaneous Cryptococcus -most common dermatologic condition associated with HIV -pustular or granulomatous lesions; histopathologic or culture identification -tx: search for systemic infection, and treat systematically with amphotericin B and/or flucytosine -complications: cryptococcal meningitis associated with 30% mortality rate even when treated. Seborrheic dermatitis -white scaly plaques or patches with or without erythema and inflammation -tx: hydrocortisone cream; ketoconazole cream -complics: can become secondarily infected with S. aureus Herpes zoster/Ramsay Hunt -typical dermatomal distribution -tx: oral acyclovir, 800 mg 5 times/day; analgesic -complics: often produces permanent cranial nerve palsy; systemic disease associated with high morbidity Kaposi sarcoma -violaceous papular or ulcerated skin lesions, often multiple; can be associated with regional adenopathy and mucosal lesions -tx: low-dose XRT, systemic (vincristine or vinblastine), or intralesional (vinblastine) chemotherapy -complics: secondary infection produces severe symptoms; occasionally causes airway obstruction or other functional problems OTOLOGIC -primary dermatologic conditions affecting EAC: KS and seborrheic dermatitis -serous and acute otitis media most common otologic conditions -ETD to nasopharyngeal lymphoid hypertrophy -Staphylococcus and Pseudomonas in acute or chronic OM is more common -P. carinii and Candida have been cultured in middle ear aspirates of AIDS patients -mild to moderate SNHL often reported: viral infection suspected NOSE AND PARANASAL SINUSES -can be sites of herpetic lesions, KS and NHL -recurrent and chronic sinusitis -persistent low-grade viral or bacterial infection of OMC -usual pathogens: Staphylococcus species, S. pneumoniae, H. influenzae and anaerobic bacteria -Pseudomonas aeruginosa implicated in 20%. tx /w clindamycin and ciprofloxacin -invasive fungal sinusitis must be suspected in individuals with pain out of proportion to findings on examination despite being on empiric antibiotics ORAL CAVITY AND PHARYNX -Oral candidiasis:-most common oral lesion in AIDS-pseudomembranous plaques with underlying red inflamed mucosal surface-tx: topical antifungal: nystatin tid or clotrimazole;systemic antifungal: ketoconazole 200 mg qd or fluconazole-can produce severe local symptoms; candida esophagitis must be considered -Herpetic stomatitis:-ulcerative, punched-out lesions occurring on any mucosal surface-tx: oral acyclovir, 200 mg 5 times/day; topical analgesics -Aphthous ulcers:-usually single, but may be multiple; usually on mobile mucosal surface; may become extremely large “giant apththous ulcers”-tx: topical analgesics; topical steroids in Orabase; occasionally intralesional or systemic steroids-can produce severe debilitating symptoms resulting in nutritional imbalance -Hairy leukoplakia:-whitish thickening of mucosa on lateral tongue; often has corrugated appearance-usually asymptomatic-EBV present in epithelium-tx: none necessary; treat candidal superinfection when present; acyclovir may be beneficial Adverse reactions of HAART Adverse reactions of HAART NRTI NNRTI Adverse reactions of HAART NNRTI Adverse reactions of HAART Protease inhibitor Adverse reactions of HAART Protease inhibitor

HAART HIV AND AIDS IN ENT

Common Manifestations of HIV in Head and Neck.

The use of multiple drugs that act on different viral targets is known as highly active antiretroviral therapy (HAART)

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