AIDS

AIDS

OVERVIEW:

The human immunodeficiency virus (HIV) infects immune system cells, causing cell death and a decline in immune function. As a result, a person infected with HIV eventually develops acquired immunodeficiency syndrome (AIDS), which includes opportunistic infections, cancer, and neurologic lesions. HIV appears to have direct effects on the central nervous system, the gastrointestinal tract, and other systems.

SIGNS AND SYMPTOMS:

• Chronic infection with variable course (50% of persons develop AIDS within 10 years)
• Acute infection: fever, rash, muscle aches, and malaise; this self-limited syndrome occurs about 6-8 weeks after infection
• Following infection, there is a variable period of time without symptoms.
• Lymph node enlargement persisting longer than 3 months
• Other diseases:
• Constitutional: fever lasting more than 1 month, weight loss, persistent diarrhea, skin rash, severe chronic fatigue
• Neurologic disease: dementia, nerve disorders
• AIDS-defining opportunistic infections: Pneumocystis carinii pneumonia (PCP); toxoplasmosis, candidiasis, tuberculosis, other infections
• Cancers: Kaposi's sarcoma, non-Hodgkin's lymphoma, other cancers

CAUSES:

Human immunodeficiency virus (HIV)

SCOPE:

There are more than 500,000 cases of AIDS cases in the United States, and more than 300,000 deaths.

MOST OFTEN AFFECTED:

Young adults 25-44 years of age. Males are affected more frequently than females.

RISK FACTORS:

• Sexual activity: Homosexual men are at greatest risk, but all sexually active people are at risk, depending on the risk factors of, and number of sexual partners.
• Intravenous (IV) drug use (sharing of contaminated needles)
• Recipients of blood products
• Hemophiliacs who have received pooled plasma products are at high risk.
• Children of HIV-infected women
• Health care workers' greatest risk is needle stick.

DIAGNOSIS

PHYSICAL EXAMINATION:

• The Physician will perform a physical examination to identify any of the conditions associated with HIV infection or AIDS.
• The Physician should screen for HIV infection when there is prolonged illness without ready explanation.

TESTS AND PROCEDURES:

• Blood tests. CD4 cells (the cells infected and destroyed by HIV) are counted; CD4 cell count gives an indication of the severity of HIV infection.
• Any number of radiology procedures or special tests may be done to assist in diagnosis, depending on the nature of opportunistic infections or other conditions.

TREATMENT

GENERAL MEASURES:

• HIV infection is managed by a primary care provider in an outpatient setting.
• Infectious disease or HIV specialist may be involved in acute episodes.
• Depending on CD4 cell counts, individuals with HIV infection may receive anti-viral therapy or preventive treatment for PCP, toxoplasmosis, or mycobacterium avium complex.

ACTIVITY:

Regular exercise is encouraged. Many community HIV groups have organized wellness activities.

DIET:

• Good nutrition is encouraged.
• Avoid raw eggs, unpasteurized milk, and other potentially contaminated foods.
• Vitamin supplements may be required.

MEDICATIONS

COMMONLY PRESCRIBED DRUGS:

• Didanosine (ddI, Videx), lamivudine (3TC, Epivir), stavudine (d4T, Zerit), zalcitabine (ddC, Hivid), zidovudine (AZT, Retrovir), Abacavir (ABC, Ziagen)
• Indinavir (Crixivan), ritonavir (Norvir), saquinavir (Invirase), amprenavir (Agenerase)
• Nevirapine (Viramune), efavirenz (Sustiva), delaviridine (Rescriptor)

CONTRAINDICATIONS:

Significant drug interactions; read drug product information.

PRECAUTIONS:

Anti-retroviral drugs have significant toxicities; read drug product information.

DRUG INTERACTIONS:

Drugs have potentially life-threatening interactions; read drug product information.

Other Drugs:

N/A

FOLLOW UP

PATIENT MONITORING:

• The Physician should be seen as frequently as needed based on the person's health, psychological status, and the need to monitor drug therapy.
• Blood tests every 3-6 months.

PREVENTION/AVOIDANCE:

• Avoid unscreened blood products.
• Avoid unprotected sexual intercourse.
• Use condoms.
• Avoid injection drug abuse.
• Avoid contact with body fluids of HIV-infected individuals.

COMPLICATIONS:

WHAT TO EXPECT:

• When HIV infection leads to AIDS, life expectancy is 2-3 years.
• AIDS-defining opportunistic infections usually do not develop until CD4 counts are less than 200.
• CD4 counts decline at a rate of 50 to 80 per year with more rapid decline as counts drop below 200.

MISCELLANEOUS

OTHER FACTORS:

N/A

PEDIATRIC:

Progresses more rapidly in infants

GERIATRIC:

Progresses more rapidly in individuals over the age of 50

OTHERS:

N/A

PREGNANCY:

The risk of bacterial pneumonia may be increased during pregnancy, and the risk of premature birth is also increased in HIV-infected women. Zidovudine (AZT) has been shown to decrease the risk of HIV transmission to infants.

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Medical Diagnosis » A » AIDS