Human Immunodeficiency Virus (HIV) is a virus that weakens the immune system by destroying CD4 T-cells. Over time, untreated HIV leads to severe immunosuppression, increasing the risk of infections that normally do not cause disease in healthy individuals. These are called opportunistic infections (OIs). Proper treatment with antiretroviral therapy (ART) helps control HIV and prevent complications.
Transmission of HIV
- Unprotected sexual contact
- Sharing contaminated needles
- Blood transfusions (rare nowadays)
- Mother-to-child transmission during birth or breastfeeding
Symptoms of HIV Infection
1. Acute HIV infection
- Fever
- Sore throat
- Headache
- Rash
2. Chronic HIV infection
- Weight loss
- Persistent fever
- Recurrent infections
- Night sweats
3. Advanced HIV (AIDS)
Opportunistic infections and severe immunosuppression appear during this stage.
Diagnosis of HIV
- ELISA – screening test
- Western Blot – confirmatory
- CD4 count – measures immune strength
- Viral load test – measures amount of virus in blood
Treatment – Antiretroviral Therapy (ART)
ART suppresses virus multiplication, increases CD4 count, and prevents opportunistic infections.
First-Line ART Regimen
- Tenofovir + Lamivudine + Dolutegravir (TLD) – preferred regimen
Older Regimens
- Tenofovir + Lamivudine + Efavirenz
- Zidovudine-based combinations
Benefits of ART
- Reduces viral load
- Improves immune function
- Prevents opportunistic infections
- Improves quality of life
Opportunistic Infections (OIs)
OIs occur when the immune system becomes weak (low CD4 levels).
1. Pneumocystis Pneumonia (PCP)
- Symptoms: breathlessness, dry cough, fever
- Treatment: Trimethoprim–sulfamethoxazole (TMP-SMX)
- Prophylaxis: TMP-SMX when CD4 < 200
2. Tuberculosis (TB)
- Common in HIV patients
- Treatment: Standard anti-TB therapy
3. Candidiasis
- Symptoms: white patches in mouth, painful swallowing
- Treatment: Fluconazole or topical antifungals
4. Cytomegalovirus (CMV) Retinitis
- Symptoms: vision problems
- Treatment: Ganciclovir or valganciclovir
5. Toxoplasmosis
- Symptoms: seizures, confusion
- Treatment: Pyrimethamine + sulfadiazine + folinic acid
6. Cryptococcal Meningitis
- Symptoms: headache, fever, neck stiffness
- Treatment: Amphotericin B + flucytosine
Prevention of Opportunistic Infections
- Start and continue ART
- Regular monitoring of CD4 count
- Prophylaxis for PCP and TB
- Safe sexual practices
- Avoid sharing needles
- Vaccination (influenza, pneumococcal vaccines)
Patient Counseling
- Take ART medication every day without missing doses
- Inform doctor if side effects occur
- Adopt safe sexual practices
- Maintain proper hygiene to avoid infections
- Regular check-ups for CD4 and viral load
Detailed Notes:
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