General Illness Information
Common Name:
HIV, AIDS
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.
Prevention:
- 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
Early:
- 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.
Other diseases:
- 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 manifestations:
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.
Secondary cancers:
- Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and primary brain lymphoma, invasive cervical cancer.
Risk Factors
- 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).
Other investigations:
- CBC with differential and platelets; ; CD4 absolute count and %lymphocytes CD4; hepatitis B ; chest x-ray; TB test with control; HIV-1 RNA viral load; toxoplasmosis IgG, CMV IgG, Pap smears in females.
General Measures:
- Consultation with an experienced HIV expert is strongly encouraged.
Medications:
Nucleoside reverse transcriptase inhibitors:
- Abacavir (ABC, Ziagen), Didanosine (ddI, Videx), Lamivudine (3TC, Epivir), Stavudine (d4T, Zerit), Zalcitabine (ddC, Hivid), Zidovudine (AZT, Retrovir)
Protease inhibitors:
- 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.
Activity:
No restrictions. Regular exercise is encouraged.
Diet:
No restrictions. Good nutrition is encouraged. Vitamin supplementation is advised.
Possible Complications:
- Opportunistic infections;
- Neuropsychiatric symptoms;
- HIV-associated malignancies;
- Medication side-effects.
Prognosis
- 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.
Posted by RxMed