HIV
- Epidemiology: susceptibility to infection; lifestyle factors; materno-fetal transmission - Pathogenesis: predilection for CD4 cells; mediation via T-cell depletion; CD4 count
- Clinical features: typical course of events following HIV infection - Co-existent infections: you should be aware of the common infections in HIV patients
- Basis of diagnosis: role of counselling; detection of specific antibody - Basis of management: simple overview only of the principles of treatment
- Minimising replication; prevention of viral resistance; repair of the immune response
| Incidence peaked in 1990s, but still significant health burden | |
|---|---|
| Etiology | retrovirus - obligate pathogen replicate in CD4+ T cells = T helper cells |
| Epidemiology | |
| Clinical presentation: | Incubation: 2-6 weeks Seroconversion: flu-like illness 1-2 weeks, macpap rash Latent phase: 1-2 years = rapid progressor; up to 10 years (slow progressors) B symptoms; oral ulcers, angular cheilitis, chronic candidiasis... |
| Pathogenesis | CD4 receptors on T cells |
| Diagnosis | p24 antigen (negative p24 at 4 weeks post exposure is highly likely to exclude HIV infection) serology "AIDS"/advanced HIV: CD4 count <200 cells/uL OR AIDS defining illness |
| Management: | generally two nucleoside reverse transcriptase inhibitors (NRTIs) + a third agent (preferably an integrase strand transfer inhibitor [INSTI], non-nucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) For example - bictegravir, emtricitabine, tenofovir Monitoring: HIV RNA viral load; CD4+ T cell count - Risk reduction counselling - measures to support ART adherence |