Ch. 32 HIV
EIA: enzyme immunoassay; HIV antibody test
ELISA: enzyme-linked immunosorbent assay
Both allow early diagnosis of HIV before the onset of symptoms
Western Blot: confirms seropositivity
Normal CD4 counts: 500-1500 cells/mm³
Stage 0: from point of infection to the development of HIV-specific antibodies
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Initially, antibody tests are (-); viral loads are very high; highly contagious; s/s: fever, fatigue, rash
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Window period: no antibodies to HIV
Stage 1: CD4 count 500+
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Viral set point: equilibrium b/w virus & immune response
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Steady state: replication & clearance balanced
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The higher the viral set point, the poorer the prognosis
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Can last 8-10 years; considered asymptomatic (few, if any symptoms)
Stage 2: CD4 count 200-499
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Symptomatic
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CDC category B conditions: candidiasis, cervical dysplasia, lymphadenopathy, diarrhea, fever
Stage 3: CD4 count <200 or opportunistic infection
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AIDS
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CDC category C conditions:
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Pneumocystis jiroveci pneumonia
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Mycobacterium avium complex
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Cytomegalovirus (CMV)
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Wasting syndrome
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Cryptococcus meningitis
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Kaposi's sarcoma
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Herpes → tx w/ Acyclovir
Unknown stage: no info on CD4 count
Transmission: body fluids; blood, seminal fluid, vaginal secretions, amniotic fluid, & breast milk
Mother to baby: in utero, during labor, or thru breastfeeding
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Mothers get Zidovudine (AZT) → has eliminated transmission during birth
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Women who have a viral load >1000 near delivery:
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IV zidovudine should be administered at time of delivery
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cesarean recommended
PPE: gloves, gown, mask when coming in contact w/ blood & body fluids
PEP
Post-exposure prophylaxis
Take ART asap; no more than 72 h (3 days) after HIV exposure
3 NRTI drugs are prescribed
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Zidovudine (ZDV)
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Lamivudine (3TC)
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Emtricitabine (FTC) (Truvada)
Whether taking PEP or not, get reevaluated within 72 h of exposure
Take precautions to prevent secondary exposure to others (for 6-12 wks)
Get HIV tested at baseline, 6 wks, 12 wks, & 6 mo.
PrEP
Pre-exposure prophylaxis
One pill containing 2 meds:
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tenofovir disoproxil fumarate 300 mg & emtricitabine 200 mg
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daily for ages 12+
Check HIV status every 3 mo.
ART
Antiretroviral Therapy
For those taking ART & maintaining viral suppression → no risk of transmitting HIV through sex
NRTIs
NNRTIs: numbness, tingling toes
Protease Inhibitors: fat redistribution
IRIS
Immune reconstitution inflammatory syndrome
Either kills a infection or causes a new infection
Occurs during the initial (3 mo.) months after beginning ART
Associated w/ mycobacteria, herpes viruses, & deep fungal infections
s/s:
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Fever, respiratory/abdominal symptoms, worsening manifestations of an opportunistic infection.
Tx: cortisone (anti-inflammatories)
Pneumocystis Pn