The human immunodeficiency virus (HIV) is an enveloped retrovirus that contains 2 copies of a single-stranded RNA genome. It causes the acquired immunodeficiency syndrome (AIDS) that is the last stage of HIV disease. Four to 10 weeks after the HIV enters the body, the patient may complain of symptoms of primary infection. After that, a long chronic HIV infection occurs, which can last for decades AIDS is mainly characterized by opportunistic infections and tumors, which are usually fatal without treatment.
The cause of this infectious disease is the human immunodeficiency virus (HIV) which can be classified into HIV-1 and HIV-2. HIV-1 is more globally expanded and virulent. It originated in Central Africa. HIV-2 is much less virulent and comes from West Africa. Both viruses are related antigenically to immunodeficiency viruses found primarily in primates.
The estimated number of people living with HIV/AIDS is 36.7 million worldwide as 2016. In the United States, a critical risk factor for the HIV propagation among young people is the use of drugs before having sex including marijuana, alkyl nitrites ("poppers"), cocaine, and Ecstasy. Other risk factors associated with a risk of acquiring HIV infection include men who have sex with men, unsafe sexual practices, the use of intravenous drugs, and unsafe blood transfusions or blood products.
HIV attaches to CD4 molecule and CCR5 (a chemokine co-receptor), the virus surface fuses with the cellular membrane which allows it entry into a T-helper lymphocyte. After integration in the host genome, the HIV provirus forms and then follows transcription and the production of viral mRNAs. HIV structural proteins are made and assembled in the host cell. Viral budding from host cells can release millions of HIV particles that can go to infect other cells.
Benign lymphadenopathy biopsies of HIV patients have shown one of the following morphological patterns:
These histological features relate clinical stage of the disease with CD4 counts.
Primary infection occurs 4 to 10 weeks after unprotected sexual practice with an HIV-infected person. The primary HIV infection is characterized by the following symptoms:
Chronic HIV infection is characterized by the following signs and symptoms and can last for decades:
Antiretrovirals are drugs used to treat HIV infections/AIDS, and they are used in various combinations commonly referred to as highly active retroviral therapy (HAART). The antiretrovirals agent include nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), NRTI fixed-dose combinations, integrase inhibitors, non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors and CCR5 inhibitors. All patients with HIV regardless of what level of CD4 should be started on HAART, which is a treatment for life. This therapy has been shown to reduce morbidity and mortality plus lower the risk of transmitting the infection to others, as long as the individual has low or undetectable viral load.
Single Tablet Regimens
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
NRTI Fixed-Dose Combinations
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Patients with HIV and a CD4 counts greater than 200, but less than 500 do not have AIDS but can develop chronic infections as well as noninfectious conditions. Diseases such as chronic candidiasis of the mouth or recurrent vaginal candida may occur. Patients may develop severe bouts of herpes simplex or herpes zoster (shingles). Patients are also at a higher risk for cancers that are much more difficult to treat than in healthy people. Patients with normal CD4 counts (greater than 500) tend to have a good quality of life with a lifespan within 4 years of someone without HIV Patients with a CD4 count less than 200 have AIDS and are susceptible to opportunistic infections. They usually have a lifespan of 2 years if they are started on HAART. If these patients are treated with antiretroviral agents and achieve a CD4 count greater than 500, they will have a normal life expectancy.
The prognosis of a patient with HIV and a CD4 count greater than 500 (normal) results in a life expectancy as someone without HIV. A person with untreated AIDS has a life expectancy of about 1 to 2 years after the first opportunistic infection. Antiretroviral treatment can increase CD4 counts and change the patient's status from AIDS to someone with HIV.
Complication of HIV disease is its progression to acquired immunodeficiency syndrome (AIDS). The physician should suspect it once opportunistic infections and/or low CD4 count are present in an individual who is HIV positive.
Principal facts for HIV prevention are patient education which includes the following:
The management of an HIV-positive patient is complex, and it should be carried out by an interprofessional, health care team that includes nurses, a social worker, a family doctor, an internal medicine specialist, and an infectious disease specialist. If an opportunistic infection or a mass develops, the patient should be evaluated by an oncologist and/or surgeon. Psychological support must be provided once the diagnosis of HIV is made.
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