General Illness Information
Medical Term: HIV, Human Immunodeficiency Virus Infection
Description: A chronic infection with a variable course (about 10 years from the time of infection for 50% of persons to develop AIDS).
HIV infects cells with CD4 receptors, most notably the CD4 lymphocytes (also called T4 or T helper cells).
Infection causes cell death and a decline in immune function resulting in opportunistic infections, malignancies, and neurologic problems.
Causes: It is caused by the Human immunodeficiency virus, a retrovirus.
- Avoid unscreened blood products;
- avoid unprotected sexual intercourse;
- use condoms;
- avoid injection drug abuse;
- avoid contact with body fluids of persons infected with HIV;
- treat all needle-stick injuries.
Signs & Symptoms
- Acute infection: Mononucleosis-like syndrome with fever, rash, myalgia, and malaise a self-limited syndrome occurring about 6-8 weeks postinfection, associated with the development of HIV antibody;
- Asymptomatic infection: Follows initial infection; variable duration;
- Persistent generalized lymph node enlargement.
- Fever lasting more than one month, involuntary weight loss of more than ten percent baseline weight, persistent diarrhea, skin rash, severe chronic fatigue;
- Dementia, myelopathy or peripheral neuropathy not explained by other illness.
Secondary infectious disease:
- Pneumocystis carinii pneumonia; chronic cryptosporidial diarrhea; cerebral toxoplasmosis; extra-intestinal Strongyloides; isosporiasis; esophageal, bronchial/pulmonary candidiasis; cryptococcosis; histoplasmosis; coccidioidomycosis; disseminated mycobacterial disease; cytomegalovirus disease; chronic mucocutaneous or disseminated herpes simplex; progressive multifocal leukoencephalopathy;
- Oral hairy leukoplakia, dermatomal zoster, nocardioses, tuberculosis (pulmonary), recurrent salmonella bacteremia, oral candidiasis.
- Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and primary brain lymphoma, invasive cervical cancer.
- Multiple sexual partners;
- Exposure of hospital workers and laboratory technicians to blood, feces and urine of HIV positive patients. Greatest risk is with an accidental needle injury;
- Infants born to mothers with HIV infection;
- Intravenous drug abuse;
- Multiple transfusions (before 1985).
Diagnosis & Treatment
First Screening test:
- ELISA (Blood test);
- Sensitivity and specificity > 98%;
- Reported as reactive or non-reactive. Reactive tests should be repeated;
- Confirm repeatedly reactive tests by another test (most commonly the Western Blot).
- CBC with differential and platelets; ; CD4 absolute count and %lymphocytes CD4; hepatitis B ; chest x-ray; TB test with control; HIV-1 RNA viralÂ load; toxoplasmosis IgG, CMV IgG, Pap smears in females.
- Consultation with an experienced HIV expert is strongly encouraged.
Nucleoside reverse transcriptase inhibitors:
- Abacavir (ABC, Ziagen), Didanosine (ddI, Videx), Lamivudine (3TC, Epivir), Stavudine (d4T, Zerit), Zalcitabine (ddC, Hivid), Zidovudine (AZT, Retrovir)
- Amprenavir (Agenerase), Indinavir (Crixivan), Nelfinavir (Viracept), Ritonavir (Norvir), Saquinavir (Fortovase)
Non-nucleoside reverse transcriptase inhibitors:
- Delaviridine (Rescriptor), Efavirenz (Sustiva), Nevirapine (Viramune). Current standard requires the use of 3 drugs to attempt to prevent the resistance.
These drugs have significant risk of toxicity, and significant drug interactions. Regular expert supervision is necessary.
No restrictions. Regular exercise is encouraged.
No restrictions. Good nutrition is encouraged. Vitamin supplementation is advised.
- Opportunistic infections;
- Neuropsychiatric symptoms;
- HIV-associated malignancies;
- Medication side-effects.
- When untreated, HIV infection leads to AIDS. The life expectancy is then two to three years;
- AIDS defining opportunistic infections usually do not develop until CD4 count drops to less than 200;
- Potent antiretroviral regimens may delay or reverse immune dysfunction.