HIV Infection 2018-01-30T16:38:19+00:00

Clinical manifestations

  • Seroconversion
    • Fever
    • Lymphadenopathy
    • Malaise
    • Rash
    • Myalgia / arthralgia
    • Sore throat
    • Headache
  • Early symptomatic HIV (B conditions – occur with other disorders but more frequent / severe with HIV)
    • Vaginal candidiasis
    • Oral hairy leukoplakia
    • Herpes zoster (recurrent or disseminated)
    • Cervical carcinoma in situ
    • Immune thrombocytopaenia purpura
    • Psoriasis
  • AIDS-defining illnesses (or CD4 count < 200)
    • AIDS wasting syndrome
    • Recurrent
      • Pneumonia
      • Bacterial infections of any kind
      • Salmonella bacteraemia
    • Respiratory tract
      • Pneumocystis jirovecii infection
      • Mycobacterium tuberculosis infection (of any site)
      • Mycobacterium avium complex (disseminated or extra-pulmonary)
      • Recurrent pneumonia
    • Gastrointestinal tract
      • Oesophageal candidiasis (odynophagia)
      • Cytomegalovirus infection (chronic diarrhoea)
      • Chronic intestinal cryptosporidiosis (> 1 month)
      • Chronic intestinal isosporiasis
    • Central nervous system
      • Cryptococcal meningitis
      • Cerebral toxoplasmosis
      • Progressive multifocal leukoencephalopathy
      • HIV-related encephalopathy
    • Malignancy
      • Lymphoma
      • Karposi’s sarcoma
      • Invasive cervical cancer

Investigation

  • HIV antibody testing – 4th generation ELISA (98% sensitivity and specificity)
  • Confirmation with Western blot (this combination gives very high positive predictive value)
  • Can be supported by testing for HIV viral load or repeating test at different intervals

Management

  • Antiretroviral therapy
    • Indications
      • CD4 count ≤ 500
      • In the setting of opportunistic infection
      • Early ARV decreases AIDS progression, lowers viral set-point and reservoir and transmission
    • Types (bay all cause worsening glycaemic control and dyslipidaemia)
      • Nucleoside reverse transcriptase inhibitors (NRTIs)
        • Abacavir (ABC) – hypersensitivity syndrome (can be fatal)
        • Emtricitabine (FTC)
        • Lamivudine (3TC)
        • Stavudine (D4T)
        • Zidovudine (ZDV) – anaemia, lactic acidosis, peripheral neuropathy, lipodystrophy
        • Tenofovir (TDF) – Fanconi syndrome (NAGMA, low K, PO4, glycosuria)
      • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
        • Efavirenz (EFV) – giddiness, neuropsyhiatric side-effects (usually given ON)
        • Etravirine (ETR)
        • Rilpivirine (RPV)
      • Protease inhibitors (PIs) – ritonavir can reduce side-effects of PI (give together = boosted PI)
        • Atazanavir (ATV) – renal stones, unconjugated bilirubinaemia
        • Darunavir (DRV) – transaminitis
        • Lopinavir (LPV) – diarrhoea
      • Integrase inhibitors (II)
        • Raltegravir (RAL)
      • CCR5 inhibitors
        • Maraviroc
      • Combinations
        • 1 NNRTI + 2 NRTIs
        • 1 PI + 2 NRTIs
        • 1 II + 2 NRTIs
  • Prophylaxis
    • CD4 ≤ 200 – PCP prophylaxis (Bactrim)
    • CD4 ≤ 100 – toxoplasmosis (Bactrim)
    • CD4 ≤ 50 – Mycobacterium avium complex (azithromycin)
  • Post-exposure prophylaxis
    • Given to patients exposed to blood or bodily fluids of patients who are known to be HIV positive
    • Must be given within 36 hours
    • Tenofovir + lamivudine + raltegravir
    • 28-day course
  • Pre-exposure prophylaxis (PrEP)
    • Given to HIV-negative individuals to decrease their risk of acquiring HIV
    • Tenofovir + emtricitabine (Truvada®) one tablet OM
    • Take daily
    • Review need for continued PrEP every 90 days
  • Opportunistic infections
    • Pneumocystis jirovecii pneumonia
      • Bactrim (15-20mg/kg/day of trimethoprim)
      • Prednisolone 40mg OM if PaO2 < 70 mmHg on room air
      • Chest drain for pneumothorax
      • Often worsens transiently on day 5 of treatment
    • Toxoplasmosis
      • Sulfadiazine
      • Pyrimethamine
      • Leucovorin to prevent myelosuppression with pyrimethamine
  • Vaccinations
    • Influenza
    • Pneumococcal vaccine
    • Hepatitis B
    • Hepatitis A
    • Varicella zoster virus (if not previously infected and CD4 count ≥ 200)

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This Sliding Bar can be switched on or off in theme options, and can take any widget you throw at it or even fill it with your custom HTML Code. Its perfect for grabbing the attention of your viewers. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile.