TERMINOLOGY
CLINICAL CLARIFICATION 1
• Diagnosis requires a positive result from an initial HIV antibody or combination antigen/antibody test plus an accompanying or subsequent positive result from a supplemental HIV test different from the initial test 1
• Current guidelines suggest using a Fourth generation assay that detects HIV p24 antigen AND HIV antibodies 19 o Positive results are confirmed by an HIV-1/HIV-2 differentiation immunoassay
- If the differentiation immunoassay is indeterminate or negative, plasma HIV RNA level ("HIVviralload") should be checked. o Note that these current guidelines differ from the classic approach of first testing with a third generation antibody test, an enzyme immunoassay (EIA), and then confirming
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(2 or more episodes in 12 months)
- Esophageal candidiasis
- Invasive cervical carcinoma confirmed by biopsy
- Disseminated or extra pulmonary coccidioidomycosis
- Extrapulmonary cryptococcosis
- Chronic intestinal cryptosporidiosis (>1 month in duration)
- Cytomegalovirus disease (other than liver, spleen, or nodes)
- HIV-related encephalopathy
- Herpes simplex virus characterized by chronic ulcers (>1 month in duration), or bronchitis, pneumonitis, or esophagitis
- Disseminated or extra pulmonary histoplasmosis
- Chronic intestinal isosporiasis, (>1 month in duration)
- Kaposi sarcoma
- Lymphoma (Burkitt, immunoblastic, or primary central nervous system)
- Disseminated or extra pulmonary Mycobacterium avium complex (MAC) or Mycobacterium kansasii
- Pulmonary or extrapulmonary Mycobacterium tuberculosis
- Disseminated or extra pulmonary Mycobacterium, other species or unidentified species
- Pneumocystisjiroveci (formerly carinii) pneumonia (PCP)
- Progressive multifocalleukoencephalopathy (PML)
- Recurrent (nontyphoid) Salmonella septicemia
- Toxoplasmosis of brain
- HIV wasting syndrome (involuntary weight loss >10% of baseline body weight) associated with either chronic diarrhea (two or more loose stools per day For 1 month) or chronic weakness and documented Fever For 1 month
DIAGNOSIS
CLINICAL PRESENTATION
• History o Greater than 50% with acute HIV infection develop symptoms, although timing and duration are variable 4
- Acute illness develops within 1-4 weeks
Antivirals are the treatment for HIV and presently there is no known cure. Treatment most often involves combinations of different drugs to avoid creating strains of the virus that are immune to single drug treatments (Mayo Clinic, 2013). The number of CD4 or T cells monitors treatment response. The viral load should be undetectable while undergoing antiviral therapy. The count is checked when treatment starts and usually monitored every 3-6 months. Even if someone has an undetectable viral load, the spreading of HIV is still a possibility.
When infected by HIV in the early stages the immune system tries fight against the virus which is the cause of the symptoms sufferers start to experience. Once these symptoms begin to leave your body generally suffers do not experience any other symptoms afterwards. However due to the damage done to the immune system after years of suffering from the disease it is likely to experience weight loss, hot sweats, skin issues and serious illnesses. It is vital that when testing for HIV the 5 C’s are followed which have been placed by the world health organisation which are as
Known or suspected human acquired immunodeficiency virus (HIV) - positive patients, or severe diseases such as acquired immunodeficiency syndrome (AIDS) or tuberculosis.
The Acquired Immune Deficiency Syndrome denotes a spectrum of conditions that are caused by the HIV virus. Infection with this disease does not result in the instant occurrence of the related signs and symptoms. However, an individual is likely to experience flu-like symptoms after he or she is infected with it. Eventually, the person experiences a prolonged period of apparent health with no visible signs. On progression, the infection adversely interferes with the immune system of the individual. The weakening of the body’s defense system increases the risk of recurrence of common infections and opportunistic illnesses that
K.D. is a 36-year-old gay professional man who has been human immunodeficiency virus (HIV) positive for 6 years. Until recently, he demonstrated no signs and symptoms (S/S) of acquired immunodeficiency syndrome (AIDS). The appearance of purplish spots on his neck and arms persuaded him to make an appointment with his physician. When he arrives at the physician’s office, the nurse performs a brief assessment. His vital signs (VS) are 138/86, 100, 30, 100.8° F. K.D. states that he has been feeling fatigued for several months and is experiencing occasional night sweats, but he also has been working long hours, has skipped meals, and has been particularly stressed over a project at work. K.D.’s physical examination is within normal limits (WNL) except for his rapid heart rate and respirations, low-grade fever, and skin lesions. The doctor orders a chest x-ray (CXR), CBC, lymphocyte studies, ultra viral load, Cytomegalovirus (CMV) assay, and a PPD (purified protein derivative) test. K.D. made an appointment
Testing to see if you have been infected with HIV is easy. There is a rapid HIV test available where they use a blood sample to look for antibodies to HIV. This test takes about twenty minutes if positive follow up testing in necessary (Cdc.gov, 2014).
A disease as serious as HIV/AIDS should be looked at as a worldly disease instead of a gender based issue (Stephen/Spence). Blood donor has found new and improved process called NAT(Nucleic Acid Testing) to check the blood of any viruses or infections in the blood stream. This process can tell whether or not a person's blood is infected with HIV within a ten days notice, a lifetime is more than enough time to check if someone is living with this disease (Darling).
Family history: Mmother, alive at the age of 31, with a history of aplastic anemia, s/p liver and stem cell transplant after being diagnosed with fulminant
AIDS: As the number of your CD4 cells begins to fall below 200 cells per cubic millimetre of blood, you will be diagnosed as having AIDS. (Normal CD4 counts are between 500 and 1,600 cells/mm3.) This is the stage of infection that happens when your immune system is badly damaged and you become vulnerable to other infections. Without treatment,
From the Department of Medicine (MB, MZH, ZDG), Divisions of General Internal Medicine (MB, MZH), and Cardiology (ZDG), University of Washington School of Medicine, Harborview Medical Center, Seattle; the Department of Internal Medicine (SS, DRK), the Division of Infectious Disease (DRK), University of Michigan Medical School, and the Department of Veterans Affairs Health Services Research and Development Center of Excellence (SS), Ann Arbor.
HIV RNA (viral load) and CD4 T lymphocyte (CD4) cell count are the two surrogate markers of antiretroviral treatment (ART) responses and HIV disease progression that are used to manage and monitor HIV infection. The key goal of ART is to achieve and maintain durable viral suppression. If a patient has virologic failure, it means that they are unable to achieve or maintain suppression of viral replication to an HIV RNA level <200 copies/mL. Therefore, they should be assessed for virologic failure which include an assessment of adherence, drug-drug or drug-food interactions, drug tolerability, HIV RNA and CD4 T lymphocyte (CD4) cell count trends over time, treatment history, and prior and current drug-resistance testing results. Moreso, drug-resistance testing should be performed while the patient is taking the failing antiretroviral (ARV) regimen or within 4 weeks of treatment discontinuation.
Primary HIV infection is the first stage and only lasts for a few weeks. Flu-like illnesses may be present during this stage. The second stage is known as clinically asymptomatic stage and typically lasts for an average of ten years. Although major symptoms might not exist during this stage, the HIV-positive person may experience swollen glands. Symptomatic HIV infection is the third stage. As the immune system continues to fail, symptoms surface and become miniscule at first then later leading to more prevalent symptoms. This third stage is generally caused by illnesses, involving cancers and infections, which the immune system would normally fight off but is not able to because the immune system is too weak. Finally, AIDS, Acquired Immune Deficiency Syndrome, develops and is the final stage of HIV. A person is diagnosed with AIDS when they show the symptom called an opportunistic infection. This is when infections take advantage of the weakened immune system. HIV leads into life threatening AIDS and causes the infected individual to feel escalating amounts of pain such as neurotic pain, tremendous headaches, gastrointestinal pain, chest pain, and even emotional pain such as depression. This pain can be intense enough to cease the individual from living a productively normal life. HIV and AIDS can strike anyone at any point in their life and should be taken seriously.
HIV is a disease with multiple stages of severity. Persons who acquire this disease may unknowingly be a carrier for years without realizing it. At early onset of acute HIV infection (Stage 1), a few weeks after exposure, viral replication is rapid and there may be mild, generalized flulike symptoms such as low fever, fatigue, arthralgia, and sore throat (VanMeter, 2014). Following this brief illness, if any, of stage I the person would then go into Stage 2 or clinical latency. This period can also be referred to as asymptomatic HIV infection due to the low levels of HIV reproductions. For some, this period can last many years to a full decade or beyond, but without treatment many will go through this phase quickly. Those that test
Since AIDS (acquired immune deficiency syndrome) is a disease of the immune system caused by HIV, which is a retrovirus that causes acute immunosuppression. HIV can produce an increase in fatal diseases which includes wasting syndromes and central nervous system disintegration. People with acquired immune deficiency syndrome (AIDS) develop opportunistic infections once the immune system becomes severely compromised. A patient’s CD4 T-cell is directly related to the risk of developing an opportunistic infection. Additionally, HIV most frequently infects CD4 cells. The CD4 cell count is a key gauge of the health of the immune system. CD4 levels lower than 200 will be at risk for an opportunistic infection. .Patients with AIDS routinely receives a test called the CD4 test. This blood test is taken to count several types of cells. Moreover, this test do not count CD4 cells, it is a calculation based on total white blood cells and the proportion of cells that are CD4. The blood sample is tested to count several types of cells. Interpretation of this test does not count the CD4 cells directly. Instead, the laboratory makes an estimate based on total white blood cells and the percentage of cells that are CD4. Therefore, the CD4 count is not exact. When the CD4 cells has gone down, it is indicative of a weakened immune system. The lower the CD4 cells, the more probable the patient will become sick. A patient loses the ability to fight infection when the CD4 cells have gone down. Once the patient has lost the ability to fight off germs, an opportunistic infection such as pneumonia, skin infections, oral disorders, diarrhea, AIDS related dementia, Kaposi sarcoma, and CNS disorders may occur. Routinely patients are advised to check CD4 cells every three to six months when initiating antiretroviral treatment and once levels has increased, test every six to twelve
Advanced HIV related symptoms - Moderate anaemia, thrush/derma77s, persistent generalised lymphadenopathy (PGL), diarrhoea, weight loss, recurring fever, Kaposis sarcoma