Chapter 16 Acquired Immunodeficiency Syndrome

Human Immunodeficiency Virus (HIV): Retrovirus targeting the immune system, primarily CD4 T cells.

üGenetic Material: RNA virus with reverse transcriptase, converting viral RNA into DNA for integration into host cells.

• Acute HIV Infection: Initial weeks post-infection with high viral replication, flu-like symptoms.
• Clinical Latency: Asymptomatic phase with ongoing viral replication, variable duration.
• Symptomatic HIV Infection: Presence of HIV-related symptoms without meeting AIDS criteria.

• Pneumocystis jirovecii Pneumonia (PCP): Common opportunistic infection in advanced HIV.
• Cryptococcal Meningitis: Fungal infection affecting the central nervous system.
• Mycobacterium avium Complex (MAC): Bacterial infection causing disseminated disease.

• HIV-Associated Pulmonary Hypertension: Progressive lung disease affecting blood vessels.
• Tuberculosis: Increased susceptibility to TB due to immune suppression. TB is the leading cause of death for people with HIV infection worldwide
• HIV-Related Lung Infections: Pneumonia, bronchitis, and fungal infections.
• HAART(highly active antiretroviral therapy slows the progression of AIDS and improve the overall quality of life and survival time of persons with HIV infection) and prophylaxis treatment

• Esophageal Candidiasis: Fungal infection of the esophagus.
• Chronic Diarrhea: Infections such as cryptosporidiosis or inflammatory bowel disease.

• HIV Encephalopathy: Cognitive impairment due to direct viral effects.
• Toxoplasmosis: Brain infection causing focal neurological deficits.
• HIV-Associated Neurocognitive Disorders (HAND): Spectrum of cognitive impairments.
• HAART treatment

• Kaposi's Sarcoma: Cancer linked to Human Herpesvirus 8 (HHV-8). HAART
• Non-Hodgkin Lymphoma: Increased risk, particularly primary central nervous system lymphoma.

Severe Weight Loss: Involuntary weight loss exceeding 10% of baseline, often accompanied by chronic weakness.

• Lipodystrophy: Altered fat distribution(loss of subcutaneous fat, increased visceral fat in the abdomen) and metabolic abnormalities due to antiretroviral therapy.
• Insulin Resistance: Associated with metabolic complications, including diabetes.

Safer Sex Practices:

üCondom Use: Consistent and correct use of condoms to reduce the risk of sexual transmission.

• üPre-Exposure Prophylaxis (PrEP): Medication (e.g., tenofovir/emtricitabine) taken by individuals at high risk to prevent HIV acquisition.
• Needle Exchange Programs:

• üDistribution of Clean Needles: Reducing the risk of HIV transmission among injecting drug users.
• Antiretroviral Treatment as Prevention (TasP):

• üSuppressing Viral Load: Effective antiretroviral therapy (ART) suppresses viral load, reducing the risk of transmission.
• Mother-to-Child Transmission Prevention:

üAntenatal Screening: Identifying HIV-positive pregnant women.

üAntiretroviral Prophylaxis: Administering antiretroviral drugs during pregnancy and childbirth.

üAvoiding Breastfeeding: In regions with safe alternatives, avoiding breastfeeding to reduce transmission risk.

• HIV Testing:
• Enzyme Immunoassay (EIA): Initial screening test detecting HIV antibodies.
• Western Blot: Confirmatory test for EIA-positive results.
• Nucleic Acid Tests (NAT): Detecting viral RNA or DNA in early infection.
• CD4 T Cell Count:
• Monitoring Immune Function: Assessing the level of CD4 T cells to determine disease progression and guide treatment decisions.
• Viral Load Testing:
• Quantifying Viral Replication: Measuring the amount of HIV RNA in the blood to assess response to treatment.

Antenatal Care:

üRoutine Testing: Screening pregnant women for HIV during prenatal care.

• üCounseling: Providing information on HIV transmission risks and preventive measures.
• Antiretroviral Prophylaxis:

üMaternal Treatment: Initiating antiretroviral therapy (ART) in pregnant women to suppress viral load.

• üInfant Prophylaxis: Administering antiretroviral drugs to the newborn, starting shortly after birth.
• Mode of Delivery:

• üCesarean Section: Recommending cesarean delivery for women with high viral loads to reduce the risk of transmission during childbirth.
• Avoiding Breastfeeding:

üSafe Alternatives: Recommending formula feeding in regions where safe alternatives are available to prevent transmission through breast milk.

üAntiretroviral Prophylaxis if Breastfeeding: Administering antiretroviral drugs to infants if breastfeeding is chosen.

Early Testing:

üPCR Testing: Polymerase chain reaction (PCR) testing for HIV RNA or DNA in infants born to HIV-positive mothers.

• üTesting Timeline: Testing within the first weeks of life, repeating at 1-2 months and 4-6 months.
• Serologic Testing:

üAntibody Testing: Serologic testing becomes reliable after 18 months due to maternal antibodies in the infant's system.

üConfirmation: Positive results need confirmation through additional tests.

Adolescent Manifestations:

üPuberty Delays: Slower onset of puberty in HIV-infected adolescents.

• üPsychosocial Challenges: Stigma, disclosure issues, and mental health concerns.
• Progression to AIDS:

üAdvanced Disease: AIDS-defining illnesses and severe immunosuppression.

• üMalignancies: Increased risk of cancers, including lymphomas.
• Management:

üAntiretroviral Therapy (ART): Early initiation to suppress viral load and improve immune function.

üMultidisciplinary Care: Involvement of pediatricians, infectious disease specialists, and social support services.

üPrevention of Opportunistic Infections: Prophylactic measures based on CD4 counts.