HIV-AIDS

 

 

 

Microbiology

One of the four known pathogenic human retroviruses and a member of the Lentiviruses
Two recognized subtypes of HIV:
HIV-1 causes AIDS worldwide
HIV-2 produces an AIDS-like illness but appears to be less pathologic
Each virion has 2 identical copies of a single-stranded viral RNA genome
Goes through reverse transcription (RNA into double-stranded DNA)
Contains three essential genes for viral replication: gag (Group-specific AntiGen), pol (polymerase) and env (envelop)

Epidemiology

HIV is now the leading cause of death of men aged 25-40, the sixth leading cause of death of adolescent males 15-24 years of age, and the fourth leading cause of death in women 25-44 years of age.
By the year 2000, the World Health Organization estimates that there will be 40 million HIV-infected individuals worldwide.
Male homosexuality continues to be the most common mode of transmission, but I.V. drug use and heterosexual transmission continues to rise
HIV in women continues to rise
Minorities account for a disproportionate amount of AIDS

Clinical syndromes

Category A:
Asymptomatic HIV infection
Persistent generalized lymphadenopathy (PGL)
Acute (primary) HIV illness
Category B
Symptomatic, not A or C conditions
Examples include but not limited to:
Bacillary angiomatosis
Candidiasis, vulvovaginal: persistent >1 month, poorly responsive to therapy
Candidiasis, oropharyngeal
Cervical dysplasia, severe, or carcinoma in situ
Constitutional symptoms (eg, fever >38.5°C or diarrhea >1 month)
NB: attributed to HIV infection or have a clinical course or management complicated by HIV
Category C
Candidiasis: esophageal, trachea, bronchi
Coccidioidomycosis, extrapulmonary
Cryptococcosis, extrapulmonary
Cervical cancer, invasive
Cryptosporidiosis, chronic intestinal (>1 month)
CMV retinitis, or other than liver, spleen, nodes
HIV encephalopathy
Herpes simplex with mucocutaneous ulcer >1 month, bronchitis, pneumonia
Histoplasmosis: disseminated, extrapulmonary
Isosporiasis, chronic (>1 month)
Kaposi's sarcoma
Lymphoma: Burkitt's, immunoblastic, primary in brain
M. avium or M. kansasii, extrapulmonary
M. tuberculosis: pulmonary or extrapulmonary
Mycobacterium, other species disseminated or extrapulmonary
Pneumocystis carinii pneumonia
Pneumonia: recurrent (>2 episodes in 1 year)
Progressive multifocal leukoencephalopathy
Salmonella bacteremia, recurrent
Toxoplasmosis, cerebral
Wasting syndrome due to HIV

Diagnosis

Serology (ELISA and Western Blot)
PCR
CD4 counts

Comments on treatment

For more info see: AIDS

 Primary: 
PI (protease inhibitors) + 2 NRTIs (nucleoside reverse-transcriptase inhibitors)

Indinavir + ZDV + 3TC
Nelfinavir + d4T + ddI
(Sequinavir ± ritonavir) + [(ZDV + DDC) or (d4T + 3TC)
Alternative : 
2 NRTIs (ZDV, ddI, DDC, d4T, 3TC) + NNRTI (delavirdine , nevirapine, efavirenz)
[(ZDV + 3TC) or (d4T + ddI) or (ZDV + DDC) or (d4T + 3TC)] +(efavirenz or delavirdine or nevirapine)