HIV, AIDS

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.

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