Human immunodeficiency virus infection (HIV)/Acquired immunodeficiency syndrome (AIDS)

Overview of HIV infection/AIDS –

  • HIV is a viral infection that spreads through body fluids (blood, semen, vaginal secretions). It is a sexually transmitted infection.
  • HIV damages the immune system of the body, which lowers the body’s ability to fight the organisms that cause disease.
  • AIDS – AIDS is a late stage of HIV infection where the body is unable to fight off many infectious diseases. AIDS occurs when CD4 T cells fall below 200 cells/microL.CD4 T cells are white blood cells that fight infections.
  • HIV spreads by having sex with infected partners, blood transfusion with infected blood, sharing needles, or infected mothers can pass the virus to the baby during pregnancy; childbirth; or breast-feeding.

Symptoms of HIV infection/AIDS –

  • Flu-like symptoms within a month or two after infection – fever, muscle aches, joint pain, headache, sore throat, rash. These symptoms are during primary infection. The amount of virus in the blood is very high at this time and spreads more easily.
  • After the primary infection, in some people, there are no signs and symptoms for a while except enlarged lymph nodes. HIV remains in the white blood cells of the body. This phase may last around 10 years without any antiretroviral therapy.
  • As the virus continues to multiply and destroy the immune system, you may notice – fever, weakness, diarrhea, weight loss, shingles (a painful rash that is caused by varicella- zoster virus), oral yeast infection.
  • Untreated HIV infection generally turns into AIDS in 10 years. In AIDS the immune system is severely damaged and the body is more prone to opportunistic infections and cancers. The signs and symptoms may include weight loss, persistent weakness, night sweats, chronic diarrhea, skin rashes.

Complications of HIV/AIDS –

  • Oropharyngeal (fungal infection of mouth and pharynx) or vulvovaginal candidiasis (Fungal infection vagina and vulva)
  • Oral hairy leukoplakia (white lesions or patches on the tongue caused by Epstein-Barr virus)
  • Seborrheic dermatitis (scaly patches and red skin on the scalp)
  • Bacterial folliculitis (infection of hair follicles), particularly due to Staphylococcus aureus
  • Herpes simplex virus (HSV) infections causing painful blisters on genitals and/or mouth
  • Varicella zoster virus (VZV) infections causing shingles (painful rash)
  • Human papillomavirus virus (HPV) infections causing warts on genitals or surrounding skin.
  • Sexually transmitted infections (STIs), such as syphilis, and hepatitis B and C virus infections are also common because of shared routes of transmission
  • Streptococcus pneumoniae infection causing pneumonia, meningitis, sinusitis.
  • AIDS-defining conditions-

-Infections with fungi such as candida, coccidioides, cryptococcus, histoplasma, pneumocystis; parasites such as cryptosporidium, isospora, toxoplasmosis; viruses such as cytomegalovirus, herpes simplex; Bacteria such as mycobacterium avium, mycobacterium tuberculosis, salmonella

-Cancers such as cervical cancer, Kaposi’s sarcoma (lesions in the soft tissues such as the lining of the mouth, nose, and throat, in lymph nodes, or in other organs), lymphoma (cancer of infection-fighting cells, called lymphocytes)

-Pneumonia, encephalopathy (brain disease that alters function or structure of the brain), wasting syndrome
 

Diagnosis of HIV –

  • The two tests used for diagnosing HIV infection are –

ELISA (enzyme-linked immunosorbent assay) test and western blot test

  • If the ELISA test is positive, the western blot test is done to confirm the diagnosis of HIV infection. 

Additional tests done to determine stages of HIV infection-

  • CD4 T cell count – CD4 T cells are white blood cells that fight infections. HIV progresses to AIDS when CD4 T cell count falls below 200 cells/microL
  • Viral load test – This test measures the amount of virus in the blood.
  • Your doctor may also do a drug resistance test to guide in treatment decisions.
  • Tests to detect complications, as the disease progresses. 

Management of HIV infection/AIDS

Lifestyle management – 

  • Follow a healthy diet that includes whole grains, fresh fruits, and vegetables, lean proteins.
  • Do not eat raw eggs, raw seafood such as oysters, sushi or sashimi. Avoid unpasteurized dairy products and undercooked meat. Cook meat well.
  • Avoid being around pets that can put you at risk for infections. Reptiles can carry salmonella (bacteria), and birds can carry cryptococcus or histoplasmosis (fungi). Cat feces can cause toxoplasmosis (a parasitic infection).
  • Take steps to avoid spreading the infection to others. Don’t have unprotected sex. Do not share needles with others.
  • Inform your current and past sexual partners that you have HIV infection. They need to be tested. 

Pharmacologic management-

  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) – efavirenz, etravirine and nevirapine.
  • Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) – Abacavir, and the combination drugs emtricitabine/tenofovir , tenofovir alafenamide/emtricitabine, and lamivudine-zidovudine.
  • Protease inhibitors (PIs) – atazanavir, darunavir, fosamprenavir, and indinavir
  • Integrase inhibitors – raltegravir and dolutegravir.
  • Entry or fusion inhibitors – enfuvirtide and maraviroc 

Pregnancy – HIV infected mother can pass the infection to the baby. But treatment during pregnancy can cut your baby’s risk significantly.

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