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Acquired Immune
Deficiency Syndrome or HIV
infection
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AIDS is caused by infection with the human immunodeficiency virus HIV-1. The HIV virus infects cells in the body that fight infection. The primary cell infected is the CD4 lymphocyte, but it infects other infection-fighting cells as well. This causes immune system impairment and difficulty fighting infection. Because the immune system has a role in cancer prevention, there is also an increase in certain cancers. To be HIV positive means that one is infected with the HIV virus. To be given the diagnosis of AIDS, one must be infected with HIV, which means that the HIV infection has
compromised the immune system to the extent that an
AIDS-defining illness (one of multiple illnesses) has
occurred. Before current "triple therapy" was developed,
nearly all those who were HIV positive went on to develop
AIDS. Now it is not the case. But, not all persons respond
to "triple therapy" and a proportion still goes on to
develop AIDS.
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Fever
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Sweats
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Sore throat
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Enlarged lymph glands
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Headaches
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Weight loss
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Joint aches
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Muscle aches
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Rash
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Oral ulcers
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Symptoms of any opportunistic illness
(i.e., bacteria, fungi, protozoa, and viruses)
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Some may not develop any symptoms for
years after exposure.
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Candidiasis (white patches in
mouth)
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Pneumocystis carinii (lung infection
characterized by dry cough and shortness of
breath)
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Atypical mycobacterium
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Toxoplasmosis (infection in brain with confusion) Progressive multifocal leukoencephalopathy (causes dementia)
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Diarrheas --
cryptosporidosis
and isoporiasis
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Recurrent pneumonias
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HIV wasting syndrome
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Cytomegalovirus infection
/blindness
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Disseminated coccidiomycosis (fungal infection found in Southwest United States, typically affects lungs, but in HIV may go into spinal fluid and cause meningitis)
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AIDS wasting (weight loss)
syndrome
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Neuropathies
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Pain
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HIV can be found in many types of
bodily secretions (i.e., semen, urine, tears, saliva, blood,
breast milk, spinal fluid, vaginal secretions). However, the
risk of transmission is highest through semen and sexual
activities.
- Anal sex -- highest transmission
rate
- Heterosexual sex, homosexuals, bisexual
males who engage in unprotected sex
- Intravenous drug abusers who share
needles
- Oral Sex -- lower, but risk still
present
- Blood and blood product transfusions
between 1977-1985 (now rare, because blood products are
carefully screened)
- Contaminated needle stick as in
healthcare professionals (1:300 risk)
- Children born to mothers with HIV infection
- Not spread through casual contact such
as touching, hugging, or sharing toilet seats
- Not transmitted by insect bites such as
mosquitoes
- No documented cases of HIV infection from
saliva or tears; however, if there is an open sore on the
skin or mouth, the risk increases.
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Examination:
- May be normal
- Signs & symptoms of
AIDS-defining illnesses (see below)
- Laboratory Findings:
- HIV antibody test -- the HIV virus
multiplies in the body for weeks or months before the body
responds by making antibodies to it, at which time the HIV
test is considered positive. Decreased CD4 lymphocyte (also
known as T-helper cells) count (the lower the count the more
likely to develop infections and illness)
- Symptoms begin to occur with CD4
count falling below 350/ml
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Anemia
- Polyclonal
hypergammaglobulenimia
- High cholesterol
- Skin antigen testing fails to
react to typical
antigens
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The goal of treatment is to keep CD4
count above 200/ml, prevent/control opportunistic
infections, and improve the quality of life.
- Anti-retroviral drugs (Highly Active Anti
Retroviral Therapy or HAART) -- these interfere
with the HIV virus' ability to replicate. Some common ones are listed
below:
- Nucleoside analogs
- Zidovudine (AZT)
- Zalcitabine (ddC)
- Lamivudine
- Stavudine
- Indinavir
- Ritonavir
- Nelfinavir
- Saquinavir
- Triple therapy -- it has been found that combining two nucleoside analogue drugs with one protease inhibitor can substantially reduce the viral burden, infection rate, and death rate in HIV infection.
- Post-exposure prophylaxis (e.g., after
a needle stick)
- AZT probably
beneficial
- AZT plus other antiretroviral
drugs probably will be shown to be more
effective.
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Before the more effective "triple
therapy" was developed, various regimens were recommended to
prevent specific infections. For example,
Trimethoprim-Sulfamethoxazole for Pneumocystitis carinii
included various regimens that are now reserved for those
who fail to respond or are intolerant of "triple
therapy."
- Abstinence
- Safe sex (use of condoms and
oral barriers)
- HIV testing prior to a
relationship
- Stop intravenous drug abuse,
sharing of dirty needles, and other high-risk behaviors.
- Healthy lifestyle and join
support groups if at
risk
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