Presented in Association of Physicians of India National Conference, held at Varanasi January 2003, Published in Journal of Association of Physicians of India, December 2002.

CLINICAL PROFILE OF HIV INFECTION

A Krishna Prasad, VR Srinivasan, Murali Mohan Rao Vuda, AMVR Narendra and Vikas Mathur.

Nizam’s Institute of Medical Sciences, Hyderabad.

Aim: Study of clinical profile of HIV infection.

Material and Methods: Total 200 case records of HIV infected patients were collected and analyzed retrospectively. All were proved by Western blot (WB) test and had their CD4 counts (cells/ml).

Results: Age varied from 6 to 68 years with a mean of 33. Males were 151 and females 49. Unprotected sexual behavior was noted in 43 cases. 20 patients took blood transfusions in the past. 22 had HIV positive spouses.

42 were asymptomatic and 158 symptomatic. Maximum had symptoms from 1-6 months. Commonest symptom was fever (in 108). Other symptoms noted in order of frequency loss of weight (88), loss of appetite (78), organomegaly (75), respiratory symptoms (59), weakness (46) and chronic diarrhoea (30). Lynphadenopathy was seen in 75, hepatomegaly in 19 and spleenomegaly in 19 cases.

193 patients had WB positive for HIV1, 6 for HIV2 and 1 case for both. CD4 count <50 in 34, 50-200 in 73, 200-500 in 56 and >500 in 37. Viral RNA load was done in 75 (copies <20000/ml in 17 and >20000 in 58).

Anemia was noted in 138 cases, leukopenia 17, thrombocytopenia 14 and pancytopenia in 4. Bone marrow study showed tuberculous granulomas in 1, NHL in 1, reactive myeloid hyperplasia in 2 and hypoplastic anemia in 1. Cholestatic hepatitis was seen in 1case.

Coexisting tuberculous infection was seen in 63 cases (pulmonary 28, plural 9, lymphnodal 24, pericardial 4, abdominal 1, cerebral 3, esophageal 1 and cold abscesses 2). Opportunistic infections seen were Herpes zoster (2), toxoplasmois (3), Pneumocystis carinii pneumonia (8) and chicken pox (1). Associated problems like Addison’s disease in 2, HBV in 4 and UTI in 5 were noted.

Neurological problems noted were Bell’s palsy(3), cranial nerve palsies(1), myelopathy(2) and vision loss(1). Skin ulcer seen in 1, generalized itching in 2 and multiple abscesses in 8 (liver 5, spleen 1, face 1, illeopsoas 1).

55 patients could not afford treatment and 10 were under observation. 135 were on HAART management. 26 patients were on follow up and quality of life improved in all. Adverse drug reactions were seen in 16. Mortality was seen in 2 and 1 LAMA.

Conclusions: 1.HIV is becoming the commonest infection in our population.

2.Majority of patients are not in a position to afford diagnosis and treatment.

3.HAART strategy is improving the quality of life.