HIV Infection: An Introduction

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HIV Infection An Introduction

• Amy V. Kindrick, M.D., M.P.H.
• National HIV/AIDS Clinicians Consultation Center
• akindrick_at_nccc.ucsf.edu
• Http//www.ucsf.edu/hivcntr
• 800 933-3413

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Opportunistic Infections In The HAART Era
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Adults and Children Living With HIV/AIDS, Year
End 2000
Total 36.1 million
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Adults and children estimated to be living with
HIV/AIDS as of end 2003
Eastern Europe Central Asia 1.2 1.8 million
Western Europe 520 000 680 000
North America 790 000 1.2 million
East Asia Pacific 700 000 1.3 million
North Africa Middle East 470 000 730 000
Caribbean 350 000 590 000
South South-East Asia 4.6 8.2 million
Sub-Saharan Africa 25.0 28.2 million
Latin America 1.3 1.9 million
Australia New Zealand 12 000 18 000
Total 34 46 million
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Estimated number of adults and childrennewly
infected with HIV during 2003
Eastern Europe Central Asia 180 000 280 000
Western Europe 30 000 40 000
North America 36 000 54 000
East Asia Pacific 150 000 270 000
North Africa Middle East 43 000 67 000
Caribbean 45 000 80 000
South South-East Asia 610 000 1.1 million
Sub-Saharan Africa 3.0 3.4 million
Latin America 120 000 180 000
Australia New Zealand 700 1 000
Total 4.2 5.8 million
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Epidemiology USA

• Numbers of AIDS deaths are falling
• Number of AIDS diagnosis are falling
• Rates of HIV infection have NOT changed
• Trends
• Disease of the Marginalized
• Younger People (25 under age 25)
• IDU
• Ethnic and racial minorities
• Women
• Young MSM of color

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Dianna and her Sons, 1995
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What Is HIV?
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Human Immunodeficiency Virus
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What is AIDS?
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Acquired Immunodeficiency Syndrome

• HIV infection immune system damage
• CD4 count lt 200
• Pneumocystis carinii pneumonia
• Toxoplasmosis
• Kaposis sarcoma
• Mycobacterium avium complex
• Invasive cervical cancer
• etc...

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How Is HIV Transmitted?
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HIV Transmission

• Requires
• Infected body fluid
• Entry of infected fluid into the body

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Modes of Transmission

• Sexual
• Anal, vaginal, oral
• Receptive partner at greatest risk
• Percutaneous
• IDU
• Occupational needle stick
• Transfusion

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Modes of Transmission, cont.

• Cutaneous
• Infected fluid to broken skin
• Mucous Membrane
• Infected fluid to eyes, nose, mouth
• Maternal Child
• In utero
• Peripartum
• Breastfeeding

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Transmission Probabilities

• Infection Route
• SexFemale to Male Male to FemaleMale to Male
• Needle Stick
• Needle Sharing
• Infected Blood Transfusion
• Mother to ChildNo AZTWith AZT

• Risk of Infection
• 1/700 to 1/30001/200 to 1/2000 1/10 to 1/1600
  
• 1/300
• 1/150
• 95/100
• 1/4lt1/10

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Post Exposure Prophylaxis

• Treatment with antiretroviral drugs after an
  exposure to HIV.
• Must be started within 72 hours (sooner the
  better) and continued for a month.
• PEP showed a 80 reduction in HIV infections for
  occupational exposures.
• Concerns for drug and sexual exposures
• Preventing exposures is key

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How Is HIV Diagnosed?
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The Antibody Test

• Highly reliable
• Negative predictive value
• 85 at 3-6 weeks
• 99 at 3 months
• May be negative during the window period

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Stages of Infection

• Exposure
• Primary Infection/Antibody Development
• Asymptomatic Period
• 7-12 yrs average
• AIDS

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Natural History Of HIV Infection
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Acute HIV Infection

• Symptoms occur 2-6 wks after exposure
• 75 - 90 have symptoms
• Fever
• Rash
• Sore throat
• Enlarged lymph nodes

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Oral Thrush
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Tinea Pedis
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Oral Herpes Simplex Virus Infection
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Perianal Herpes Simplex Virus
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Zoster in Thoracic Distribution
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Bacterial Pneumonia
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PCP
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Kaposi Sarcoma
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Toxoplasmosis
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CMV Retinitis
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Other Common HIV-related Problems

• Fatigue
• Weight loss
• Depression
• Neuropathy
• Nausea
• Diarrhea

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Measuring Plasma HIV RNA and CD4 T Cells

• At the time of diagnosis
• Every 3-4 months in the untreated patient
• Immediately prior to initiating therapy
• 2-8 weeks after initiating therapy
• Every 3-4 months in patients on therapy
• As indicated in the opinion of the provider

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HIV Treatments

• Antiretrovirals
• OI prophylaxis
• OI treatment
• Immune-based therapies
• Vaccines
• Complementary therapies

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Antiretroviral Medications 2004

• Nucleoside- and Nucleotide-analog Reverse
  Transcriptase Inhibitors (NRTIs)
• Non-nucleoside analog Reverse Transcriptase
  Inhibitors (NNRTIs)
• Protease Inhibitors (PIs)
• Fusion Inhibitors

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Antiretroviral Therapy Persistent Uncertainties

• When to start
• What to start with
• When to change
• What to change to
• When to stop (if ever)

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What Else Can We Do?

• Drug and alcohol treatment
• Nutrition
• Community support
• Mental health
• Social
• Spiritual
• Transmission prevention counseling

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National HIV/AIDS Clinicians Consultation Center

• A Joint Program of UCSF
• and San Francisco General Hospital
• Supported by HRSA and CDC
• http//www.ucsf.edu/hivcntr
• PEPLine [phone]
• Warmline [phone]

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