Author Topic: Human Immunodeficiency Virus Management  (Read 57 times)


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Human Immunodeficiency Virus Management
« on: November 29, 2017, 08:50:01 AM »
● The human immunodeficiency virus, type 1 (HIV) causes a chronic infection that culminates, usually after several years, in acquired immunodeficiency syndrome (AIDS).
● Acute infection occurs 2 to 6 weeks from the time of viral transmission. illustrates the kinetics of viral
load and immune response during the phases of HIV-1 infection.
● The acute infection most often is a mild, self-limited mononucleosis-like illness; pharyngitis, mucosal ulcerations
, rash , penile ulcer from sexual contact , splenomegaly, and lymphadenopathy commonly occur. Hepatitis and aseptic meningitis are occasionally seen.
● The p24 antigen and the HIV polymerase chain reaction (PCR) will be reactive ; positive HIV serology
usually first becomes positive 1 month later.

● CD4 cells subsequently decline an average of 75/mm3 per year, but the range is variable. Five percent of infected people are long-term nonprogressors; another 10% progress more rapidly.

● RNA retrovirus HIV-1 was probably derived from transmission of a simian immunodeficiency virus (SIV) from chimpanzees in Central Africa; a related virus HIV-2 was derived from an SIV found in Sooty Mangebey
monkeys from West Africa.
● HIV-1 is the predominant pathogenic retrovirus in human populations; HIV-2 has limited distribution (primarily in West Africa) and tends to be less rapidly immunosuppressive than HIV-1.
● Transmitted by sexual contact, shared needles, blood transfusion, or from mother to child during pregnancy, delivery, or breastfeeding.
● Primary target of infection: CD4 lymphocyte .
● Direct central nervous system (CNS) involvement: manifested as encephalitis , myelopathy, or neuropathy
in advanced cases
● Renal failure , rheumatologic disorders, thrombocytopenia, or cardiac abnormalities

● Acute infection: mononucleosis or other respiratory viral infections
● Late symptoms: similar to those produced by other wasting illnesses such as neoplasms, tuberculosis (TB), disseminated fungal infection, malabsorption, or depression
● HIV-related encephalopathy: confused with Alzheimer’s disease or other causes of chronic dementia; myelopathy and neuropathy possibly resembling other demyelinating diseases such as multiple sclerosis,

Three HIV viral antibody screening tests currently are in use:
● Bound anti-HIV antibody is detected by antihuman antibody labeled with an enzyme. The use of recombinant proteins has reduced false-positive results (specificity, 99.9%).
● A false-negative finding may result when measured in the acute infection period (sensitivity, 99.9%).
● New rapid serologic-screening assays
● HIV-antigen–coated gelatin or latex particle agglutination assays. The single-use test can be performed rapidly but may be less sensitive and specifi c than standard ELISA tests.
● A oral salivary test called OraSure (sensitivity, 99.9%) is sent to a reference laboratory after being inserted into the
mouth for 2 minutes.
● Western blot confirmatory test is performed when ELISA is positive.
● This test identifies specifi c viral antigens; it is positive when both core and envelope antigens are present.
● The result is indeterminate when either antigen is present; if unchanged when repeated in 6 months in more than
one laboratory, this is considered a false-positive result.

Management Strategies for the Asymptomatic Patient
● Initial testing: CD4 cell count and HIV viral load measured every 3 to 6 months to guide decisions regarding antiretroviral use and prophylaxis against PCP and MAC infection
● Other testing: identifi es previously acquired latent infections that may become reactivated because of loss of T cell
function but can be prevented by the use of specific agents
● Serology to Toxoplasma gondii (IgG):
● Clinical infection may be prevented by trimethoprimsulfamethoxazole (TMP-SMZ) used as prophylaxis for PCP.
● Venereal Disease Research Laboratories (VDRL) test:

● Lumbar puncture should be performed in patients with a confirmatory specifi c test (FTA).
● Treatment with intramuscular benzathine penicillin if the CSF fluid is normal, and intravenous penicillin for 10
days if the CSF VDRL test is reactive or CSF pleocytosis, protein elevation, or hypoglycorrhachia is present.
● PPD skin test showing induration of 5 mm or greater, or patients with exposure to someone with active tuberculosis
● Treatment with isoniazid 300 mg/day for 9 months or, in case of isoniazid-induced hepatitis, rifampin 600 mg PO qd (only for those not receiving protease inhibitors or nucleoside reverse transcriptase inhibitor agents) for 4 months.


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