Human Immunodeficiency Virus (HIV) Infection

1. There are 2 types of HIV: HIV-1 and HIV-2.

2. Most reported cases of HIV infection around the world are caused by HIV-1.

3. HIV-1 and HIV-2 are clinically indistinguishable and have identical modes of
transmission.

4. HIV-2: less easily transmitted and slower progression to AIDS.

Epidemiology
1. Persons with undiagnosed HIV infection are responsible for a substantial proportion of
HIV transmission.

2. Globally, half of HIV-infected persons are women.

Transmission of HIV infection

- You have to understand what behaviors and conditions affect the risk of transmission.
1. The risk of acquiring HIV varies greatly depending on the exposure.

2. Modes of transmission:
- Sexual
- Perinatal (in utero, at the time of birth and through breast milk)
- Parenteral inoculation (e.g. IV drug injection, occupational exposure)
- Blood products
- Donated organs or semen

3. The risk of sexually acquiring HIV varies greatly:

- Receptive anal intercourse (0.5%)
- Receptive penile-vaginal intercourse (0.1%)
- Insertive intercourse (0.05-0.07%)
- Oral intercourse (0.005-0.01%)

4. The mode of transmission of HIV infection varies from region to region.

5. In Malaysia, all blood donations have been routinely tested for HIV-1 antibody since ?

6. Circumcision and proper use of latex condoms decrease the risk of acquiring HIV
infection.

Symptoms and findings associated with acute HIV-1 infection (>50% of patients)
1. Fever
2. Fatigue
3. Rash
4. Headache
5. Lymphadenopathy
6. Pharyngitis
7. Myalgia or arthralgia
8. Nausea, vomiting, or diarrhea
9. Night sweats

Common clinical clues to chronic HIV infection

1. History of high-risk behavior
2. History of a sexually transmitted disease
3. Request for HIV testing
4. Active tuberculosis
5. Herpes zoster in a person <50 years old
6. New severe psoriasis Commented [YC1]:
7. Unexplained severe skin disorder Commented [YC2]:
8. Hepatitis B or C infection
9. Cervical cancer or HPV infection
10. Thrush not related to recent antibiotic use
11. Unexplained cachexia or weight loss
12. Diffuse lymphadenopathy
13. Unexplained thrombocytopenia, leukopenia, or anaemia
14. Unusual neurologic illness
15. History of unusual infection in an otherwise healthy individual
16. Prolonged unexplained illness

Laboratory diagnosis
1. Screening tests (high [>99%] sensitivity and specificity) for HIV-1 infection:
I) Conventional tests:
- Enzyme-linked immunosorbent assays (ELISAs)
- Enzyme immunoassays (EIAs)

II) FDA-approved rapid test

2. Confirmation test Commented [YC3]: Because of the low positive

- Western blot (WB) antibody testing predictive values in low-prevalence populations.
- Results can be positive, negative or indeterminate.
- If the results are indeterminate, next step is risk assessment of HIV infection and retest Commented [YC4]: HIV RNA assays may be of
in 1 to 3 months. additional help in these cases.

Natural history of HIV infection and AIDS, including AIDS-defining conditions

Acute HIV infection Chronic HIV infection
1. 1.

Treatment of HIV infection its indications and the basic principles of antiretroviral
treatment
1.

Primary care and HIV infection

Immunizations
1.

Prophylaxis for opportunistic infection in HIV-infected patients its indications

- You do not give prophylaxis for all infections.
1.

Substance abuse
1.

Postexposure prophylaxis
1.