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HIV Management (Human Immunodeficiency Virus)

What are HIV & AIDS? HIV, or human immunodeficiency virus, is a type of virus that infects human immune cells. Over time, immune cells are lost, which weakens the immune system and allows patients to be infected by other viruses and develop several types of tumors.

CAUSE
● RNA retrovirus HIV-1 was probably derived from transmission of a simian immunodeficiency virus (SIV) from chimpanzees in Central Africa; a related virus HIV-2 was derived from an SIV found in Sooty Mangebey
monkeys from West Africa.
● HIV-1 is the predominant pathogenic retrovirus in human populations; HIV-2 has limited distribution (primarily in West Africa) and tends to be less rapidly immunosuppressive than HIV-1.
● Transmitted by sexual contact, shared needles, blood transfusion, or from mother to child during pregnancy, delivery, or breastfeeding.
● Primary target of infection: CD4 lymphocyte .
● Direct central nervous system (CNS) involvement: manifested as encephalitis , myelopathy, or neuropathy
in advanced cases
● Renal failure , rheumatologic disorders, thrombocytopenia, or cardiac abnormalities


Management Strategies for the Asymptomatic Patient
● Initial testing: CD4 cell count and HIV viral load measured every 3 to 6 months to guide decisions regarding antiretroviral use and prophylaxis against PCP and MAC infection
● Other testing: identifi es previously acquired latent infections that may become reactivated because of loss of T cell
function but can be prevented by the use of specific agents
● Serology to Toxoplasma gondii (IgG):
● Clinical infection may be prevented by trimethoprimsulfamethoxazole (TMP-SMZ) used as prophylaxis for PCP.
● Venereal Disease Research Laboratories (VDRL) test:
● Lumbar puncture should be performed in patients with a confirmatory specifi c test (FTA).
● Treatment with intramuscular benzathine penicillin if the CSF fluid is normal, and intravenous penicillin for 10
days if the CSF VDRL test is reactive or CSF pleocytosis, protein elevation, or hypoglycorrhachia is present.
● PPD skin test showing induration of 5 mm or greater, or patients with exposure to someone with active tuberculosis
● Treatment with isoniazid 300 mg/day for 9 months or, in case of isoniazid-induced hepatitis, rifampin 600 mg PO qd (only for those not receiving protease inhibitors or nucleoside reverse transcriptase inhibitor agents) for 4 months

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