Podcast
Questions and Answers
During which phase of HIV infection does the immune system start to exert control over the virus but cannot eliminate it completely?
During which phase of HIV infection does the immune system start to exert control over the virus but cannot eliminate it completely?
What is the defining characteristic of the viral set point in HIV infection?
What is the defining characteristic of the viral set point in HIV infection?
Which of the following is NOT a typical symptom experienced during the acute viral infection phase of HIV?
Which of the following is NOT a typical symptom experienced during the acute viral infection phase of HIV?
What triggers seroconversion in an HIV-infected individual?
What triggers seroconversion in an HIV-infected individual?
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During which phase of HIV infection are individuals most likely to experience nonspecific symptoms like frequent respiratory tract infections and weight loss?
During which phase of HIV infection are individuals most likely to experience nonspecific symptoms like frequent respiratory tract infections and weight loss?
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What is the average time frame for an HIV-infected individual to develop AIDS after becoming symptomatic?
What is the average time frame for an HIV-infected individual to develop AIDS after becoming symptomatic?
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Which of the following is an AIDS-defining illness?
Which of the following is an AIDS-defining illness?
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What role does the enzyme reverse transcriptase play in the HIV replication cycle?
What role does the enzyme reverse transcriptase play in the HIV replication cycle?
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Which of the following is the most accurate description of the relationship between the CD4+ count and the viral load in HIV infection?
Which of the following is the most accurate description of the relationship between the CD4+ count and the viral load in HIV infection?
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What is the primary reason individuals with AIDS are susceptible to opportunistic infections?
What is the primary reason individuals with AIDS are susceptible to opportunistic infections?
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What CD4+ count indicates the initiation of prophylaxis to decrease the risk of opportunistic infections?
What CD4+ count indicates the initiation of prophylaxis to decrease the risk of opportunistic infections?
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Which of the following is NOT a prerequisite before initiating antiretroviral therapy (ART)?
Which of the following is NOT a prerequisite before initiating antiretroviral therapy (ART)?
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What vaccination is specifically indicated for all HIV-positive patients to reduce the risk of pneumonia?
What vaccination is specifically indicated for all HIV-positive patients to reduce the risk of pneumonia?
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What is the generally accepted viral load target for stable HIV patients on antiretroviral therapy (ART)?
What is the generally accepted viral load target for stable HIV patients on antiretroviral therapy (ART)?
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How often should CD4+ counts be monitored in individuals receiving antiretroviral therapy (ART)?
How often should CD4+ counts be monitored in individuals receiving antiretroviral therapy (ART)?
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What is the approximate time from HIV infection to death for untreated individuals in resource-limited countries?
What is the approximate time from HIV infection to death for untreated individuals in resource-limited countries?
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Which comorbidities are mentioned to shorten the survival time of untreated HIV patients?
Which comorbidities are mentioned to shorten the survival time of untreated HIV patients?
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When was the first antibody test for HIV made available?
When was the first antibody test for HIV made available?
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What defines whether a person is classified as having AIDS, regardless of CD4+ count?
What defines whether a person is classified as having AIDS, regardless of CD4+ count?
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What was the original name given to the illness that later became known as AIDS?
What was the original name given to the illness that later became known as AIDS?
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What constitutes the first report of AIDS cases in the United States?
What constitutes the first report of AIDS cases in the United States?
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Which of the following statements about HIV disease progression is true?
Which of the following statements about HIV disease progression is true?
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How are individuals with HIV categorized in relation to the presence of signs or symptoms?
How are individuals with HIV categorized in relation to the presence of signs or symptoms?
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What is the primary reason a vaccine for HIV has not been developed?
What is the primary reason a vaccine for HIV has not been developed?
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Which group has the highest rate of new HIV infections in the United States as of the latest statistics?
Which group has the highest rate of new HIV infections in the United States as of the latest statistics?
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What is the role of CD4+ cells in the immune response?
What is the role of CD4+ cells in the immune response?
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Which of the following is NOT considered an opportunistic infection associated with HIV?
Which of the following is NOT considered an opportunistic infection associated with HIV?
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What is the significance of the World Health Organization's classification of HIV?
What is the significance of the World Health Organization's classification of HIV?
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How does HIV primarily compromise the immune system?
How does HIV primarily compromise the immune system?
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What does seroconversion refer to in the context of HIV?
What does seroconversion refer to in the context of HIV?
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Which of the following is a common method of HIV transmission?
Which of the following is a common method of HIV transmission?
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What factor primarily contributes to the increase in susceptibility to infections in HIV-infected individuals?
What factor primarily contributes to the increase in susceptibility to infections in HIV-infected individuals?
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Which of the following statements about the epidemiology of HIV is true?
Which of the following statements about the epidemiology of HIV is true?
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Which symptom indicates a deterioration in status that requires immediate medical attention?
Which symptom indicates a deterioration in status that requires immediate medical attention?
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What is the recommended HIV screening frequency for individuals engaging in high-risk behaviors?
What is the recommended HIV screening frequency for individuals engaging in high-risk behaviors?
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Which testing method is capable of detecting HIV antibodies as early as 2 weeks after exposure?
Which testing method is capable of detecting HIV antibodies as early as 2 weeks after exposure?
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Which co-infection screening is necessary for individuals newly diagnosed with HIV?
Which co-infection screening is necessary for individuals newly diagnosed with HIV?
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What is the required follow-up time for a negative initial HIV screening test?
What is the required follow-up time for a negative initial HIV screening test?
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What type of assay may be conducted to evaluate resistance to antiretroviral therapy medications?
What type of assay may be conducted to evaluate resistance to antiretroviral therapy medications?
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Which method is NOT utilized for HIV confirmation?
Which method is NOT utilized for HIV confirmation?
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When is the CD4+ count typically obtained for individuals newly diagnosed with HIV?
When is the CD4+ count typically obtained for individuals newly diagnosed with HIV?
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Which of the following symptoms is NOT considered a common sign of an HIV infection?
Which of the following symptoms is NOT considered a common sign of an HIV infection?
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Why might the viral load be obtained every 3 to 4 months during the first 2 years of ART?
Why might the viral load be obtained every 3 to 4 months during the first 2 years of ART?
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Study Notes
HIV Disease Stages and Progression
- HIV disease progresses through stages, from acute infection to death.
- Without treatment, the time from infection to death is approximately 12 years.
- In resource-limited countries, this time is about 5 years.
- Comorbidities like malnutrition, TB, and malaria shorten survival time.
History of HIV/AIDS Recognition
- June 1981: CDC reported the first cases of PCP in gay men, leading to the term AIDS.
- 1985: Antibody test for HIV became available, revealing HIV infection without AIDS symptoms.
- 1986: CDC created a disease classification system based on HIV infection stages.
- Stages include acute, asymptomatic, symptomatic HIV infection, and AIDS.
Current HIV Classification
- Adults are categorized into three stages based on:
- CD4+ lymphocyte count.
- CD4+ percentage of total lymphocytes.
- Presence/absence of AIDS-defining conditions.
- If an individual has an AIDS-defining condition, they have AIDS, regardless of their CD4+ count.
- Infant/child classifications differ from adult classifications.
- Severity progression is one-way; reclassification to a less severe stage isn't possible.
Global HIV Statistics (2020)
- Approximately 37.7 million people globally were living with HIV.
- Approximately 1.5 million new HIV infections occurred.
- 680,000 deaths related to HIV occurred.
HIV Epidemiology in the U.S. (2016 & 2019)
- Approximately 2 million adults/children infected since the epidemic's start, and 600,000 fatalities.
- 1.1 million Americans currently live with HIV.
- 15% unaware of their infection.
- 2019 gay men had the highest rate of new infections (66%).
- African Americans are the most affected racial/ethnic group.
- New infections decreased by 8% from 2015-2019.
- District of Columbia, Georgia, and Florida have the highest HIV incidence currently.
HIV Transmission
- Primarily a sexually transmitted disease, but also transmitted through:
- Injection drug use (sharing equipment).
- Blood transfusions (rare).
- Occupational exposure (rare).
- Pregnancy and breastfeeding.
HIV Pathophysiology
- HIV compromises immune system functions (targeting CD4+ cells).
- Chronic destruction of CD4+ cells due to HIV replication.
- CD4+ cells (T helper cells) release cytokines to fight infections.
- HIV targets, disables, and destroys CD4+ cells.
- Untreated HIV infection leads to opportunistic infections (OIs).
Opportunistic Infections (OIs)
- Infections like TB, toxoplasmosis, candidiasis, PCP, CMV, HSV, histoplasmosis, Kaposi’s sarcoma, MAC, etc., are more severe in people with weakened immune systems.
- These pathogens exploit the weakened immune system.
HIV Viral Replication
- Acute viral infection:
- Inflammatory reaction upon infection.
- Virus enters CD4+ cell, converting RNA to DNA.
- Viral DNA integrates into host DNA.
- New viral proteins are assembled and released, destroying the CD4+ cell.
- Rapid decrease in CD4+ lymphocytes and increase in viral load.
- Flu-like symptoms may occur, followed by antibody development (seroconversion).
Asymptomatic Chronic Infection
- Immune system controls viral replication, but not elimination.
- CD4+ count rises to near normal, viral load decreases.
- Viral replication and CD4+ cell loss both continue slowly.
Symptomatic Chronic Infection
- Reduced immune control of viral replication as CD4+ count declines.
- Symptoms develop due to impaired immunity.
- Respiratory infections, skin problems, lymphadenopathy, weight loss.
- CD4+ declines rapidly, viral load increases.
- Average time to AIDS once symptomatic: 2 years.
Acquired Immune Deficiency Syndrome (AIDS)
- Declining CD4+ count results in a severely weakened immune system.
- Infections become harder to control, may reactivate.
- AIDS occurs when a person has a CD4+ count less than 200 cells/mcL and/or AIDS-defining illnesses.
Clinical Manifestations (HIV/AIDS)
- Common signs/symptoms: fever, cough, weakness, nausea/vomiting, diarrhea, difficulty swallowing, forgetfulness, skin lesions, shortness of breath, headache, vision changes, pain, night sweats, swollen lymph nodes.
- Urgent attention required for: new cough, increased fatigue, temperature over 102°F, night sweats, new headaches/vision changes/mental status problems, new skin lesions, new diarrhea, weight loss of over 10%.
Interprofessional Management
- **Medical Management:** Diagnostic testing, prophylaxis, and antiretroviral therapy (ART).
- **Diagnostic Testing:**
- Annual HIV screening for adolescents and adults (15–65). Higher-risk individuals may need more frequent testing (every 3 months).
- Pregnant person screening.
- Screening for HIV antibodies (rapid tests, ELISA/EIA, Western Blot, PCR).
- Genotype, viral load, and CD4+ testing.
- Co-infection screening (TB, other STIs).
- **Prophylaxis:** Treating OIs (e.g., toxoplasmosis, PCP) if CD4+ count is low. The prophylaxis can be discontinued as the immune count improves.
- **Antiretroviral Therapy (ART):** Suppressing viral load through lifelong medication adherence; initiating ART is recommended for all HIV-positive people.
- **Treatment Preparation:** Explaining advantages/disadvantages of therapy, explaining the necessity of lifelong adherence to treatment, why a certain combination of medications was selected, how and when to take medications, side effects, reducing potential side effects, and the effect of medications on the immune system.
Immunizations
- Vaccination maintenance is essential for PLWH.
- Vaccines recommended for PLWH: Tdap, Streptococcus pneumoniae, seasonal influenza, hepatitis A/B, meningococcal, HPV, zoster,
- Specific recommendations for pneumococcal vaccines: PCV13 and then PPSV23, with PPSV23 given every 5 years.
- Influenza vaccine annually.
- Tetanus, diphtheria, and pertussis every 10 years.
- Herpes zoster RV using non-live recombinant vaccine at age 50 (CD4+ over 200).
Prevention
- Routine HIV testing (opt-out) for adults (15–65).
- Annual testing for high-risk individuals.
- ART for PLWH reduces transmission.
- Maintaining viral suppression is key in the cascade of care to reduce transmission.
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Description
Explore the various stages and progression of HIV disease from acute infection to AIDS. This quiz covers the historical recognition of HIV/AIDS, the development of classification systems, and current criteria based on CD4 counts and conditions. Test your knowledge on this significant topic in public health.
