Human Immunodeficiency Virus Book

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HIV Course

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  1. Natural History of HIV Disease
    1. Active immune response after infection: 2.1 months
    2. Primary infection usually asymptomatic
      1. Acute Retroviral Syndrome in 30-50%
    3. Initial infection with single genotype
      1. Evolves into 15-20 distinct viral variants
    4. Over time:
      1. CD4 cell numbers decrease
      2. Viral concentrations increases
  2. CD4 Count Related Disease progression
    1. Kaposi's Sarcoma, Dementia: 275 CD4 cells
    2. Non-Hodgkin's Lymphoma: 200 CD4 Cells
    3. Pneumocystis carinii Pneumonia: 150 CD4 Cells
    4. Mycobacterium Avium Complex: 100 CD4 Cells
    5. Toxoplasmosis: 50 CD4 Cells
  3. Staging: Early disease (CD4 Count > 500 cells)
    1. Presentation
      1. No symptoms
      2. May show mild Lymphadenopathy
    2. Management
      1. No treatment required
    3. Course over following 18-24 months
      1. Risk of occult infection or death: <5%
      2. Slow decline in CD4 Counts (40 to 80 cells/year)
  4. Staging: Intermediate Disease (CD4 Count 200 - 500 cells)
    1. HIV related disorders
      1. Thrush
      2. Vaginal Candidiasis
      3. Recurrent Herpes Simplex Virus Infection
      4. Recurrent Varicella Zoster Virus Infection
      5. Pruritic Folliculitis
      6. Recurrent bacterial infections
      7. Mycobacterium tuberculosis
    2. Complications
      1. Pneumocystis carinii Pneumonia
        1. Atypical in this stage
      2. Kaposi's Sarcoma
      3. Non-Hodgkin's Lymphoma
    3. Management
      1. Antiretroviral therapy usually indicated
    4. Course (Untreated) over following 18-24 months
      1. Risk of occult infection or death: 20-30%
      2. Treatment reduces risk by 2-3 fold
  5. Staging: AIDS Late Symptomatic Disease (CD4 50-200 Cells)
    1. Complications
      1. Development of Occult Infections
    2. Management
      1. Routine anti-Pneumocystis carinii prophylaxis
      2. Antiretroviral treatment
    3. Course (Untreated) over following 18-24 months
      1. Risk of occult infection or death: 70-80%
  6. Staging: Advanced Disease (CD4 Count < 50-100 cells)
    1. Complications
      1. Disseminated Mycobacterium Avium Complex
      2. Cryptococcal Meningitis
      3. Cytomegalovirus retinitis
      4. Cryptosporidiosis
      5. Disseminated Histoplasmosis
      6. Progressive Multifocal Leukoencephalopathy
      7. Primary CNS Lymphoma
      8. AIDS Dementia
    2. Routine Management
      1. Anti-Pneumocystis carinii prophylaxis
      2. Antiretroviral Management
      3. Anti-Mycobacterium Avium Complex prophylaxis
        1. Start at CD4 Count < 100 cells
      4. Screen for CMV Retinitis
        1. Ophthalmology exam every 6 months
    3. Course
      1. High likelihood of Occult Infection or death

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