Infection with HIV

In patients infected with HIV (human immunodeficiency virus), the helper cell population is weakened to the point where the immune system is no longer able to function properly. The body thus becomes susceptible to otherwise nonlethal diseases such as pneumonia. 

AIDS (acquired immunodeficiency syndrome) is the final stage of disease caused by infection with HIV. In this stage, the vims infection has severely affected the immune system, causing a depletion of CD4+ T-helper cells. AIDS is characterized by the manifestation of typical diseases caused by opportunistic infections (Pneumocystis carinii pneumonia, CMV retinitis, candidiasis of the esophagus, cerebral toxoplasmosis), neurological manifestations, cachexia, or certain tumors (Kaposi sarcoma of the skin, B-cell lymphoma). 

Kuritzkes DR, Jacobson J, Powderly WG, Godofsky E, DeJesus E, Haas F, Reimann KA, Larson JL, Yarbough PO, Curt V, Shanahan WR Jr (2004) Anthetroviral activity of the anti-CD4 monoclonal antibody TNX-355 in patients infected with HIV type 1. J Infect Dis 189 286-291... 

Pomerantz RJ, Trono D, Feinberg MB, Baltimore D (1990) Cells nonproductively infected with HIV-1 exhibit an aberrant pattern of viral RNA expression a molecular model for latency. CeU... 

Giuhan D, Vaca K, Noonan CA (1990) Secretion of neurotoxins by mononuclear phagocytes infected with HIV-1. Science 250(4987) 1593-1596 Giuhan D, Wendt E, Vaca K, Noonan CA (1993) The envelope glycoprotein of human immunodeficiency virus type 1 stimulates release of neurotoxins from monocytes. Proc Natl Acad Sci USA 90(7) 2769-2773... 

There is a similar high prevalence of peripheral neuropathy (34%) in the pediatric population infected with HIV (Araujo et al. 2000). The frequency of IDP in the HIV-infected population is unknown but is thought to be rare (Wulff et al. 2000). In an outpatient population of HIV positive patients, mononeuritis multiplex and lumbosacral polyradiculopathy were found in less than 1% of patients with AIDS (Fuller et al. 1993). HIV-associated autonomic nervous system dysfunction is also not uncommon as up to 66% of patients have papillary involvement and 15% have sympathetic and parasympathetic involvement causing orthostatic hypotension and respiratory sinus arrhythmia (Gluck et al. 2000). 

GiuUan D, Vaca K, Noonan CA (1990) Secretion of neurotoxins by mononuclear phagocytes infected with HIV-1. Science 250 1593-1596... 

Unlike their mature counterparts, glial progenitors can be readily infected with HIV (Lawrence et al. 2004). 

Infection with a human immunodeficiency virus (HIV-1 and HIV-2 see Chapter 3) can cause the destruction of the TH cell, which is the eritieal eell of the immune system. This leads to the condition known as acquired immune deficieney syndrome (AIDS). At present, it is still not known why, in some cases, infection with HIV leaves the immune system intact whereas in others it is irreversibly destroyed, giving rise to AIDS. 

Adults and children 6 months of age and older who needed regular medical care or were in a hospital during the previous year because of a metabolic disease (such as diabetes), chronic kidney disease, or weakened immune system (including immune system problems caused by medicines or by infection with HIV/AIDS)... 

Hydration and electrolyte balance, often with ORT, are the cornerstone of treatment. The specific circumstances that antibiotics should be considered include high fevers, bloody stools, symptoms longer than 1 week, pregnancy, infection with HIV, and other immunocompromised hosts. 

Five million people were newly infected with HIV in 2005 alone. Most of these infections were acquired through heterosexual transmission. As of December 2005, women accounted for 46% of all people living with HIV worldwide in sub-Saharan Africa, women account for 57%. Persons aged 15 to 24 years accounted for nearly one-half of new HIV infections worldwide. 

Fatkenheuer G, Pozniak AL, Johnson MA, et al. Efficacy of short-term monotherapy with maraviroc, a new CCR5 antagonist, in patients infected with HIV-1. Nat Med 2005 11(11) 1170-1172. 

HIV-1 RNA levels have quickly become part of the routine management of patients infected with HIV-1, Recommendations for the appropriate use and interpretation of HIV-1 viral load assays in clinical practice have been developed, but a thorough discussion of these recommendations is beyond the scope of this review (Saag et al., 1996 Centers for Disease Control and Prevention, 1998). 

Table 13.11 WHO estimated numbers of individuals infected with HIV by the end of 2005. Almost 75 per cent of these live in the southern half of Africa...

Patients who are homeless, institutionalized, IV drug abusers, and/or infected with HIV... 

The vaccine should not be given to immunosuppressed patients (except those infected with HIV) or pregnant women. HIV-infected persons who have never had measles or have never been vaccinated should be given measles-containing vaccine unless there is evidence of severe immunosuppression. The vaccine should not be given within 1 month of any other live vaccine unless the vaccine is given on the same day (as with the MMR vaccine). Measles vaccine is indicated in all persons born after 1956 or in those who lack documentation of wild virus infection either by history or antibody titers. 

The extent of HIV infection in sub-Saharan Africa is alarmingly high. For example, as many as 90% of female prostitutes in Kenya are infected with HIV, while as many as 25% of the sexually active population of several cities in Rwanda may be infected. There may be 10 million HIV-infected individuals in Africa many of them will probably progress to AIDS and eventually die. Another virus related to HIV has also been discovered in Africa. The original HIV, which is associated with the great majority of AIDS cases, is called HIV-1. The new virus is called HIV-2 and is predominantly found in countries along the West... 

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