HIV Infection and AIDS Overview
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Questions and Answers

What is a primary focus of the guidelines provided by the American Academy of Pediatrics for HIV-infected children?

  • Management of chronic illnesses in non-HIV patients
  • Development of educational programs for families
  • Vaccination protocols for non-infected children
  • Treatment and prevention of opportunistic infections (correct)

Which of the following is a common pathogen associated with opportunistic infections in HIV patients?

  • Mycobacterium tuberculosis (correct)
  • Streptococcus pneumoniae
  • Candida albicans (correct)
  • Escherichia coli

What is the immune reconstitution inflammatory syndrome (IRIS) commonly associated with?

  • Reactivity to previously present opportunistic pathogens post-treatment (correct)
  • Worsening of chronic liver disease
  • HIV-related neurocognitive disorders
  • Development of new ailments unrelated to HIV

What strategy is recommended to prevent opportunistic infections in HIV-exposed children?

<p>Early initiation of antiretroviral therapy (D)</p> Signup and view all the answers

Which element is crucial in the management of HIV-infected children according to current guidelines?

<p>Monitoring and treating opportunistic infections (C)</p> Signup and view all the answers

What is the primary mode of HHV-8 acquisition?

<p>Contact with saliva (A)</p> Signup and view all the answers

Which of the following is NOT a recommended control measure for HHV-8 transmission?

<p>Wearing protective clothing (A)</p> Signup and view all the answers

Why do some experts question the effectiveness of avoiding saliva exposure to control HHV-8 transmission?

<p>The feasibility of such a strategy has never been evaluated. (B)</p> Signup and view all the answers

What concludes the recommendations for measures to control HHV-8 transmission?

<p>Lack of standard guidelines (D)</p> Signup and view all the answers

What is a notable clinical manifestation of HIV infection?

<p>A wide array of clinical symptoms (D)</p> Signup and view all the answers

What is the focus of expert recommendations for those at high risk of Kaposi's Sarcoma (KS)?

<p>Avoidance of saliva exposure (D)</p> Signup and view all the answers

Which of the following best describes the state of recommendations for HHV-8 control measures?

<p>Recommendations are currently unavailable. (A)</p> Signup and view all the answers

What is a common pathogen observed in HIV patients?

<p>Cytomegalovirus (D)</p> Signup and view all the answers

What is a common early clinical manifestation of untreated pediatric HIV infection?

<p>Unexplained fevers (B)</p> Signup and view all the answers

Which of the following illnesses is associated with opportunistic infections in children with untreated HIV?

<p>Bacterial pneumonia (B), Tuberculosis (D)</p> Signup and view all the answers

What disease may manifest as central nervous system involvement in pediatric HIV infection?

<p>Encephalopathy (C)</p> Signup and view all the answers

What role does combination antiretroviral therapy (cART) play in children with HIV?

<p>It reduces the occurrence of AIDS-defining illnesses (B)</p> Signup and view all the answers

Which prevention strategy is crucial in managing HIV infection in pregnant women?

<p>Timely diagnosis and appropriate treatment (A)</p> Signup and view all the answers

What is a possible consequence of immune reconstitution inflammatory syndrome in HIV patients?

<p>Worsening of pre-existing infections (C)</p> Signup and view all the answers

Which of the following is NOT a common opportunistic infection in pediatric HIV patients?

<p>Chronic obstructive pulmonary disease (C)</p> Signup and view all the answers

What is an example of a persistent infection that may occur in untreated pediatric HIV?

<p>Recurrent diarrhea (B)</p> Signup and view all the answers

Which antiviral medication is suggested to inhibit HHV-8 replication?

<p>Valacyclovir (D)</p> Signup and view all the answers

What is the recommended approach for treating HHV-8 associated malignancies?

<p>Radiation and cancer chemotherapies (C)</p> Signup and view all the answers

Which antiretroviral agents may inhibit HHV-8 replication according to studies?

<p>Zidovudine and nelfinavir (C)</p> Signup and view all the answers

What precaution is recommended for the isolation of hospitalized patients with HHV-8 infection?

<p>Standard precautions (D)</p> Signup and view all the answers

Which treatment aspect may play a more significant role in diseases associated with active HHV-8 replication?

<p>Antiviral therapy (D)</p> Signup and view all the answers

What is the primary HIV type found in the United States?

<p>HIV type 1 (HIV-1) (D)</p> Signup and view all the answers

Which condition is characterized by non-specific mononucleosis-like symptoms shortly after HIV infection?

<p>Acute retroviral syndrome (B)</p> Signup and view all the answers

What symptoms are associated with acute retroviral syndrome following HIV infection?

<p>Fever and skin rash (C)</p> Signup and view all the answers

Which stage is HIV-1 infection classified into when severe immune deficiency occurs?

<p>Acquired immunodeficiency syndrome (AIDS) (D)</p> Signup and view all the answers

What percentage of adolescents and adults experience acute retroviral syndrome after HIV infection?

<p>50% to 90% (C)</p> Signup and view all the answers

What is the primary concern surrounding the transmission of HHV-8 based on epidemiologic data?

<p>Contact with saliva (C)</p> Signup and view all the answers

Why has the recommendation to avoid saliva exposure for high-risk individuals been questioned?

<p>There is insufficient evaluation of its effectiveness (A)</p> Signup and view all the answers

Which of the following conclusions can be drawn regarding control measures for HHV-8 infection?

<p>No control measures can be recommended at this time (D)</p> Signup and view all the answers

What do clinical manifestations of human immunodeficiency virus (HIV) infection include?

<p>A wide array of clinical manifestations (D)</p> Signup and view all the answers

Which group is encouraged to follow avoidance of saliva exposure based on expert recommendations?

<p>Persons at high risk for Kaposi's Sarcoma (KS) (A)</p> Signup and view all the answers

What implication has been drawn from extensive data about HHV-8 acquisition?

<p>Behavioral practices exposing individuals to saliva are likely important (C)</p> Signup and view all the answers

What is a critical perspective held by experts regarding control measures for HHV-8?

<p>Efficacy of avoidance measures has never been evaluated (D)</p> Signup and view all the answers

What is one of the main recommendations for high-risk individuals concerning HHV-8 transmission?

<p>Counseling to avoid behavioral practices involving saliva (C)</p> Signup and view all the answers

What are early clinical manifestations of untreated pediatric HIV infection?

<p>Unexplained fevers and generalized lymphadenopathy (B)</p> Signup and view all the answers

Which condition is least likely to be associated with pediatric HIV infection?

<p>Osteoporosis (D)</p> Signup and view all the answers

How has the occurrence of AIDS-defining illnesses among children in industrialized countries been affected by early diagnosis and treatment?

<p>They are now rare. (C)</p> Signup and view all the answers

Which of the following is a potential consequence of untreated pediatric HIV infection?

<p>Central nervous system disease (C)</p> Signup and view all the answers

With the introduction of combination antiretroviral therapy (cART), what has been observed regarding clinical manifestations among HIV-infected children?

<p>Improvement in overall health and rare manifestations of disease (B)</p> Signup and view all the answers

Which symptom is NOT typically associated with early pediatric HIV infection?

<p>Frequent infections without fever (C)</p> Signup and view all the answers

What is a common opportunistic infection that may occur in untreated pediatric HIV patients?

<p>Parasitic infections (D)</p> Signup and view all the answers

Which of the following is an effect of untreated HIV infection on infants and children?

<p>Development of opportunistic infections (A)</p> Signup and view all the answers

What were the most common opportunistic infections observed among children in the pre-cART era?

<p>Invasive encapsulated bacteria, Pneumocystis jirovecii, and herpes simplex virus (D)</p> Signup and view all the answers

What is a characteristic of immune reconstitution inflammatory syndrome (IRIS)?

<p>It results in clinical deterioration after the restoration of cell-mediated immunity. (A)</p> Signup and view all the answers

Which opportunistic pathogens are less commonly observed in pediatric HIV patients?

<p>Cryptosporidium species and Cryptococcus species (D)</p> Signup and view all the answers

What factors influenced the frequency of opportunistic infections in children before starting combination antiretroviral therapy?

<p>Age, pathogen type, previous infection history, and immunologic status (C)</p> Signup and view all the answers

What may predispose a patient to immune reconstitution inflammatory syndrome (IRIS)?

<p>Underlying infections with mycobacteria and herpesviruses (C)</p> Signup and view all the answers

Which of the following is NOT considered an opportunistic infection in pediatric HIV patients?

<p>E. coli urinary tract infection (D)</p> Signup and view all the answers

What is the primary cause of increased frequency of opportunistic infections in children with HIV before antiretroviral therapy?

<p>Compromised immune system and exposure to pathogens (D)</p> Signup and view all the answers

Which species has been previously referred to as Pneumocystis carinii pneumonia, also known as PCP?

<p>Pneumocystis jirovecii (B)</p> Signup and view all the answers

What type of lymphoma is more common in HIV-infected children compared to immunocompetent children?

<p>Non-Hodgkin B-cell lymphoma of the Burkitt type (A)</p> Signup and view all the answers

What significant change has occurred in the incidence of malignant neoplasms in HIV-infected children during the cART era?

<p>Decreased incidence (B)</p> Signup and view all the answers

Which neurological condition has seen a substantial decrease in incidence among HIV-infected children in the cART era?

<p>HIV encephalopathy (C)</p> Signup and view all the answers

What predicts a poor outcome for untreated infants who acquired HIV infection through mother-to-child transmission?

<p>Severe suppression of CD4+ T-lymphocyte counts (A)</p> Signup and view all the answers

What is the classification of HIV-1 and HIV-2 in terms of their viral family?

<p>Family Retroviridae, genus Lentivirus (C)</p> Signup and view all the answers

What is the outcome if untreated HIV-infected infants exhibit AIDS-defining conditions within the first 6 months of life?

<p>Predictors of a poor outcome (D)</p> Signup and view all the answers

Which group of HIV viruses is most prevalent worldwide?

<p>Group M (B)</p> Signup and view all the answers

What is the role of reverse transcriptase in the HIV life cycle?

<p>Converts viral RNA into double-stranded DNA (C)</p> Signup and view all the answers

Flashcards

HHV-8 transmission

Primarily through contact with saliva, according to some experts.

High-risk KS

Individuals at increased risk of Kaposi's sarcoma (KS).

Control measures HHV-8

No recommendations exist currently for controlling HHV-8 transmission.

HIV infection

A condition leading to various clinical symptoms.

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Clinical manifestations

Various symptoms caused by HIV infection.

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Kaposi's sarcoma(KS)

A type of cancer potentially associated with HIV.

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Saliva contact

Exposure to bodily fluids possibly involved in HHV-8 transmission.

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Expert opinions on HHV-8

Differ on the feasibility and efficacy of behavioral changes to control transmission.

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HIV in children (US/developed)

Rarely shows clinical symptoms with appropriate treatment for pregnant women, infants, and children.

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Untreated HIV Symptoms (kids)

Includes fevers, swollen lymph nodes, enlarged liver/spleen, poor growth, oral/diaper fungus, diarrhea, and more.

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Hepatomegaly

Enlarged liver.

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Splenomegaly

Enlarged spleen.

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Failure to Thrive

Poor growth and development in children.

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Opportunistic Infections (OIs)

Infections that occur more often in people with weakened immune systems.

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AIDS-defining illnesses

Illnesses that are common complications of advanced HIV infection in adults and are now uncommon in children who are treated.

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Combination Antiretroviral Therapy (cART)

A treatment approach where multiple antiretroviral drugs are used together to fight HIV.

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AAP HIV Policy

The American Academy of Pediatrics (AAP) has policy statements on HIV/AIDS in children.

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Opportunistic Infections

Infections that target weakened immune systems.

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HIV-Exposed Children

Children who have been potentially exposed to HIV.

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HIV-Infected Children

Children diagnosed with HIV.

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Prevention & Treatment Guidelines

The guidelines instruct on how to handle opportunistic infections in HIV-exposed/infected children.

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HHV-8 Treatment

Valacyclovir, famciclovir, cidofovir, and foscarnet are used to reduce HHV-8 replication. Antiretroviral therapy, especially zidovudine and nelfinavir, might also inhibit HHV-8 replication.

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HHV-8 Associated Malignancies

HHV-8 can lead to Kaposi's sarcoma (KS), primary effusion lymphoma (PEL), and multicentric Castleman's disease (MCD).

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HHV-8 Treatment for Associated Diseases?

Antiviral therapy might play a larger role in treating diseases related to active HHV-8 replication, particularly MCD and KICS.

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Treating HHV-8 Malignancies

Radiation and cancer chemotherapy are used to manage malignancies associated with HHV-8.

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Hospital Isolation for HHV-8

Standard precautions are recommended for isolating patients infected with HHV-8.

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How is HHV-8 primarily spread?

Some experts believe that HHV-8 is primarily transmitted through contact with saliva.

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Who's at risk for KS?

People with high risk for Kaposi's sarcoma (KS) are advised to avoid contact with saliva, according to some experts, to lower their risk of HHV-8 infection.

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Why are there no standard guidelines for preventing HHV-8?

There is no consensus on the effectiveness of preventing HHV-8 transmission through behavioral changes, and more research is needed.

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What does HIV infection do to the body?

HIV infection can cause a wide range of symptoms and health problems.

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What are clinical manifestations of HIV infection?

Clinical manifestations of HIV infection are the various symptoms that occur as a result of the infection.

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Why are opportunistic infections common in people with HIV?

Opportunistic infections are common in people with HIV because their immune systems are weakened, making them more vulnerable to infections.

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What is the purpose of combination antiretroviral therapy (cART)?

cART involves using multiple antiretroviral drugs together to fight HIV infection and reduce its impact on the body.

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What are AIDS-defining illnesses?

AIDS-defining illnesses are serious health conditions that are common complications of advanced HIV infection.

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HIV-1 vs. HIV-2

HIV type 1 (HIV-1) is more prevalent in the US than HIV type 2 (HIV-2). This chapter primarily focuses on HIV-1 infection, unless otherwise specified.

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AIDS

Acquired immunodeficiency syndrome (AIDS) is the advanced stage of HIV infection, defined by CDC criteria.

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Acute Retroviral Syndrome

This syndrome develops in 50-90% of adults and adolescents within weeks of HIV infection. It features symptoms like fever, fatigue, swollen lymph nodes, and skin rash.

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What defines AIDS?

The Centers for Disease Control and Prevention (CDC) establishes specific criteria to diagnose AIDS in children, adolescents, and adults.

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What are the symptoms of Acute Retroviral Syndrome?

Acute retroviral syndrome manifests with symptoms similar to mononucleosis, including fever, fatigue, swollen lymph nodes, and skin rash.

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Untreated Pediatric HIV

In children who have not received HIV treatment, early symptoms may include unexplained fevers, swollen lymph nodes, enlarged liver and spleen, poor growth, recurring oral and diaper yeast infections, frequent diarrhea, and other complications like brain problems, lung issues, and opportunistic infections.

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AIDS-Defining Illnesses in Children

Serious health problems that often appear in adults with advanced HIV but are now rare in children with timely diagnosis and treatment.

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cART for HIV in Children

Combination antiretroviral therapy (cART) is a powerful approach that uses multiple anti-HIV drugs together to effectively manage the infection in children.

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Lymphoid Interstitial Pneumonia

A serious lung condition that can occur in children with untreated HIV, causing inflammation and thickening of the lung tissue.

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Central Nervous System (CNS) Disease in HIV

HIV can affect the brain and nervous system in children, leading to problems like encephalopathy, abnormal reflexes, and developmental delays.

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Hepatomegaly and Splenomegaly

An enlarged liver (hepatomegaly) and an enlarged spleen (splenomegaly) are common signs of untreated HIV in children.

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Failure to Thrive in HIV

Children with HIV may experience poor growth and development (failure to thrive) due to the virus's impact on their body.

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Pre-cART Era OIs in Children

Before effective HIV treatment, common OIs in children included infections with bacteria, Pneumocystis jirovecii, varicella-zoster virus, CMV, HSV, Mycobacterium avium complex, and Candida.

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Immune Reconstitution Inflammatory Syndrome (IRIS)

A paradoxical worsening of symptoms after starting HIV treatment due to the immune system's recovery.

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Underlying Infections Associated with IRIS

Mycobacteria (including TB), herpesviruses, and fungi (like Cryptococcal species) can trigger IRIS.

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cART and Opportunistic Infections

Combination antiretroviral therapy (cART) has significantly reduced the frequency of opportunistic infections in people with HIV.

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cART and IRIS

Even with successful HIV treatment, IRIS can still occur in some individuals.

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Common OIs Before cART

Invasive bacteria, Pneumocystis jirovecii, varicella-zoster virus, CMV, HSV, Mycobacterium avium complex, and Candida were common before effective HIV treatment.

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Impact of cART on OIs

Effective HIV treatment (cART) has significantly reduced the occurrence of opportunistic infections in people with HIV, particularly in children.

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HIV in children

HIV infection in children is less common than in adults, but it can still have severe consequences.

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Burkitt lymphoma

A type of B-cell lymphoma that is more common in children with HIV than in children with healthy immune systems.

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HIV encephalopathy

A brain disorder caused by HIV infection, leading to cognitive decline and other neurological issues.

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cART (Combination Antiretroviral Therapy)

A treatment approach that uses multiple drugs to fight HIV and improve the health outcomes of HIV-infected children.

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HIV transmission from mother to child (MTCT)

A major way for HIV to spread from a pregnant woman to her baby, during pregnancy, labor, or delivery.

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Prognosis of untreated HIV infection

Without cART, HIV-infected infants with high viral loads and low CD4+ T-lymphocyte counts have a poor prognosis.

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AIDS-defining conditions

Conditions that indicate advanced HIV infection, such as PCP, neurologic disease, and severe wasting

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Study Notes

Human Immunodeficiency Virus Infection

  • HIV infection leads to a range of clinical manifestations, with HIV-1 more common in the U.S. than HIV-2.
  • Acquired Immunodeficiency Syndrome (AIDS) is an advanced stage of HIV infection, categorized by specific criteria in children, adolescents, and adults.
  • Acute retroviral syndrome (in 50-90% of infected adults and adolescents) appears during the initial weeks, characterized by nonspecific symptoms like fever, malaise, lymphadenopathy, and rash.
  • Early symptoms in untreated children include unexplained fevers, lymphadenopathy, enlarged liver and spleen, failure to thrive, recurring oral thrush, diarrhea, parotitis (inflammation of the salivary glands), and hepatitis, CNS issues (e.g., encephalopathy, hyperreflexia, hypertonia, floppiness, developmental delays), lymphoid interstitial pneumonia, and recurring infections.
  • Timely diagnosis and treatment reduce the occurrence of AIDS-defining illnesses in children and adolescents in developed countries.
  • In the era of combination antiretroviral therapy (cART), there's been a substantial decrease in opportunistic infections (OIs).
  • Immune reconstitution inflammatory syndrome (IRIS) is a paradoxical deterioration observed shortly after starting cART, due to inflammation as the immune system recovers.

HIV Infection in Adolescents

  • HIV infection in adolescents is primarily transmitted through sexual activity, followed by injection drug use.
  • In 2014, males in the 13-24 age group primarily acquired HIV through male-to-male sexual contact.
  • In 2010, there were approximately 40,144 adolescents (13-24 years old) living with HIV in the U.S. and associated territories.
  • A large proportion of adolescents with HIV infection are undiagnosed.
  • Most adolescents with HIV infection are asymptomatic, and unaware of infection at diagnosis.

HIV Incubation Period

  • Untreated infants and children typically show symptoms 12-18 months after infection, while some present earlier or remain asymptomatic for several years.
  • Early presentation of symptoms can occur, but a bimodal distribution generally follows, with rapid progressors dying before age four, and slower progressors remaining asymptomatic for years.

Diagnostic Tests for HIV

  • Serologic assays (including antigen/antibody combination immunoassays and antibody differentiation assays) are used.
  • Nucleic acid amplification assays (e.g., HIV-1 DNA/RNA assays) can detect HIV infection and measure viral load.

Treatment and Prevention of HIV

  • Combination antiretroviral therapy (cART) is standard treatment, aimed at suppressing viral load and restoring immune function.
  • Antiretroviral prophylaxis (ARV) is crucial during pregnancy to prevent mother-to-child transmission (MTCT).
  • Cesarean delivery before labor and before rupture of membranes, and avoidance of breastfeeding are important strategies to prevent transmission.
  • Vaccination strategies are consistent with recommendations for the general population, however considerations for specific situations must be made.
  • Opportunistic infections, like Pneumocystis jirovecii pneumonia (PCP), should be addressed with prophylaxis in accordance with the CD4+ T-lymphocyte count, viral load, and other medical factors.

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Description

This quiz explores the characteristics and clinical manifestations of HIV infection, focusing on the differences between HIV-1 and HIV-2. Learn about the symptoms, diagnosis, and treatment strategies for preventing the progression to AIDS in various age groups. Test your knowledge on HIV's impact and management.

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