HIV Infection and AIDS
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HIV is a retrovirus that integrates into CD4 T lymphocytes (a critical component of cell-mediated immunity), causing cell death and resulting in severe immunodeficiency, opportunistic infections, and malignancies:
- Because of treatment advances, HIV is now a chronic disease.
- The natural history of untreated HIV infection includes viral transmission, acute retroviral syndrome, recovery and seroconversion, asymptomatic chronic HIV infection, and symptomatic HIV infection or AIDS.
- Without antiretroviral treatment, the average patient develops AIDS ~10 years after transmission.
- All HIV-infected persons with CD4 <200 cells/mm3 or having AIDS-defining illnesses are categorized as having AIDS.
- At the end of 2008, 33.4 million people were estimated to be living with HIV/AIDS worldwide per UNAIDS and the World Health Organization. Yearly, 2.7 million new HIV infections and 2 million deaths are attributable to AIDS
- US: 47,129 new cases in 2010; estimated 17,774 deaths of persons with AIDS in 2009. 619,400 Americans have died from AIDS since beginning of epidemic (1,2)
- Estimated 1.2 million persons in the US are living with HIV/AIDS; 20% unaware of their status (2)
- HIV/AIDS cases are disproportionately high among racial/ethnic minority populations
- Transmission of a drug-resistant virus rising
- Younger females particularly vulnerable
- Sexual activity (70% of world transmission): Viral load strongest predictor of heterosexual transmission with ulcerative urogenital lesions (3)[B].
- Male-to-male sexual contact accounted for 61% of newly diagnosed HIV/AIDS cases in 2009.
- Injection drug use
- Children of HIV-infected women:
- Maternal HIV-1 RNA level is the best predictor of transmission risk.
- HIV testing and use of antiretroviral drugs in pregnant women and their newborns has reduced the incidence of perinatal HIV transmission by >70% (from 25–29% without treatment to 8% with treatment) (4)[B].
- Pregnant women should be treated until viral load is undetectable.
- Can be transmitted through breast-feeding
- Recipients of blood products between 1975 and March 1985
- Occupational exposure
People who lack CCR5, a cell-surface chemokine coreceptor used by HIV to infect cells, are highly resistant to HIV infection
Avoid unprotected sexual intercourse and injection drug abuse.
HIV, a retrovirus
Commonly Associated Conditions
- Syphilis may be more aggressive if HIV-infected
- Tuberculosis (TB) is coepidemic with HIV; test all persons with HIV for TB. Dually infected patients: 100× greater risk of developing active TB disease (compared with non-HIV) and higher rates of multidrug-resistant TB
- Patients coinfected with hepatitis C have a more rapid progression to cirrhosis.