Human Immunodeficiency Virus Infection PDF

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MeritoriousBoron7619

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USA Health Children's & Women's Hospital

David W. Kimberlin

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HIV infection human immunodeficiency virus clinical manifestations medical handbook

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This document provides information about human immunodeficiency virus (HIV) infection, including clinical manifestations, treatment options, preventive measures, and epidemiological aspects, from an expert standpoint. It serves as a resource for medical professionals in understanding and treating HIV.

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HUMAN IMMUNODEFICIENCY VIRUS INFECTION 459 cidofovir, and foscarnet. Valacy...

HUMAN IMMUNODEFICIENCY VIRUS INFECTION 459 cidofovir, and foscarnet. Valacyclovir and famciclovir more modestly reduce HHV-8 rep- lication. Retrospective cohort studies and in vitro assays suggest that antiretroviral ther- apy (particularly zidovudine and nelfinavir) may inhibit HHV-8 replication. Antiviral therapy may play a more significant role in the treatment of diseases associated with ac- tive HHV-8 replication, specifically MCD and KICS. HHV-8 associated malignancies can be treated with radiation and cancer chemotherapies. ISOLATION OF THE HOSPITALIZED PATIENT: Standard precautions are recommended. CONTROL MEASURES: Although there are no standard guidelines on preventing HHV-8 transmission, the extensive and consistent epidemiologic and virologic data implicating contact with saliva as the primary mode of HHV-8 acquisition have led some experts to recommend that persons at high-risk for the development of KS be counseled to avoid behavioral practices with exposure to saliva. Other experts, however, have questioned the feasibility or efficacy of such a strategy, which has never been evaluated. As such, no rec- All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. ommendations for measures to control transmission of HHV-8 infection can be recom- mended at this time. Human Immunodeficiency Virus Infection1 CLINICAL MANIFESTATIONS: Human immunodeficiency virus (HIV) infection results in a wide array of clinical manifestations. HIV type 1 (HIV-1) is much more common in the United States than HIV type 2 (HIV-2). Unless otherwise specified, this chapter addresses HIV-1 infection. Acquired immunodeficiency syndrome (AIDS) is the name given to an advanced stage of HIV infection based on specific criteria for children, adolescents, and adults established by the Centers for Disease Control and Prevention (CDC). Acute retroviral syndrome develops in 50% to 90% of adolescents and adults within the first few weeks after they become infected with HIV. Acute retroviral syndrome is characterized by nonspecific mononucleosis-like symptoms, including fever, malaise, lym- phadenopathy, and skin rash. With timely diagnosis of HIV infection in pregnant women, infants, and children and appropriate treatment, clinical manifestations of HIV infection, including the occurrence of AIDS-defining illnesses, now are rare among children in the United States and other industrialized countries. Early clinical manifestations of untreated pediatric HIV infection include unexplained fevers, generalized lymphadenopathy, hepatomegaly, splenomegaly, failure to thrive, persistent or recurrent oral and diaper candidiasis, recurrent diarrhea, parotitis, hepatitis, central nervous system (CNS) disease (eg, encephalopathy, hyperre- flexia, hypertonia, floppiness, developmental delay), lymphoid interstitial pneumonia, re- current invasive bacterial infections, and other opportunistic infections (OIs) (eg, viral, parasitic and fungal). 2 In the era of combination antiretroviral therapy (cART), there has been a substantial Copyright 2018. American Academy of Pediatrics. 1 For a complete listing of current policy statements from the American Academy of Pediatrics regarding human immunodeficiency virus and acquired immunodeficiency syndrome, see http://pediatrics. aappublications.org/collection/committee-pediatric-aids. 2 Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Department of Health and Human Services. Available at: http://aidsinfo.nih.gov/contentfiles/lvguidelines/ oi_guidelines_pediatrics.pdf EBSCO Publishing : eBook Academic Collection (EBSCOhost) - printed on 8/17/2021 6:25 AM via UNIV OF SOUTH ALABAMA AN: 1809323 ; Kimberlin, David W., Brady, Michael T., Jackson, Mary Anne, Long, Sarah S..; Red Book 2018 : Report of the Committee on Infectious Diseases Account: s4595122.main.emed 460 HUMAN IMMUNODEFICIENCY VIRUS INFECTION decrease in frequency of all OIs. The frequency of different OIs in the pre-cART era var- ied by age, pathogen, previous infection history, and immunologic status. In the pre- cART era, the most common OIs observed among children in the United States were in- fections caused by invasive encapsulated bacteria, Pneumocystis jirovecii (previously called Pneumocystis carinii pneumonia, hence the still-used acronym PCP), varicella-zoster virus, cytomegalovirus, herpes simplex virus, Mycobacterium avium complex, and Candida species. Less commonly observed opportunistic pathogens included Epstein-Barr virus (EBV), My- cobacterium tuberculosis, Cryptosporidium species, Cystoisospora (formerly Isospora) species, other enteric pathogens, Aspergillus species, and Toxoplasma gondii. Immune reconstitution inflammatory syndrome (IRIS) is a paradoxical clinical deteri- oration often seen in severely immunosuppressed individuals that occurs shortly after the initiation of cART. Local and/or systemic symptoms develop secondary to an inflamma- tory response as cell-mediated immunity is restored. Underlying infection with mycobac- teria (including Mycobacterium tuberculosis), herpesviruses, and fungi (including Cryptococcal species) predispose to IRIS. Malignant neoplasms in children with HIV infection are relatively uncommon, but leiomyosarcomas and non-Hodgkin B-cell lymphomas of the Burkitt type (including some that occur in the CNS) occur more commonly in children with HIV infection than in im- munocompetent children. Kaposi sarcoma, caused by human herpesvirus 8, is rare in children in the United States but has been documented in HIV-infected children who have emigrated from sub-Saharan African countries. The incidence of malignant neo- plasms in HIV-infected children has decreased during the cART era. The incidence of HIV encephalopathy is high among untreated HIV-infected infants and young children. In the United States, pediatric HIV encephalopathy has decreased substantially in the cART era, although other neurologic signs and symptoms have been appreciated, such as myelopathy or peripheral neuropathies, sometimes associated with antiretroviral therapy. Without cART, the prognosis for survival is poor for untreated infants who acquired HIV infection through mother-to-child transmission (MTCT) and who have high viral loads (ie, >100 000 copies/mL) and severe suppression of CD4+ T-lymphocyte counts (see Table 3.30) 1. In these children, AIDS-defining conditions developing during the first 6 months of life, including PCP, progressive neurologic disease, and severe wasting, are predictors of a poor outcome. ETIOLOGY: HIV-1 and HIV-2 are cytopathic lentiviruses (genus Lentivrus) belonging to the family Retroviridae and are related closely to the simian immunodeficiency viruses, which infect a variety of nonhuman primate species in sub-Saharan Africa. Retroviruses are characterized by the presence of a viral reverse transcriptase (RT) enzyme that con- verts the single-stranded viral RNA genome into a double-stranded DNA copy. The dou- ble-stranded genome copy, termed the provirus, integrates into the host cell genome in a reaction catalyzed by the viral integrase enzyme. Three distinct genetic groups of HIV exist worldwide: M (major), O (outlier), and N (new). Group M viruses are the most prevalent worldwide and comprise 8 genetic subtypes, or clades, known as A through K, each of which has a distinct geographic distribution. 1 Centers for Disease Control and Prevention. Revised surveillance case definition for HIV infection—United States, 2014. MMWR Recomm Rep. 2014;63(RR-3):1–10 EBSCOhost - printed on 8/17/2021 6:25 AM via UNIV OF SOUTH ALABAMA. All use subject to https://www.ebsco.com/terms-of-use HUMAN IMMUNODEFICIENCY VIRUS INFECTION 461 Table 3.30. HIV Infection Stage, Based on Age-Specific CD4+ T-Lymphocyte Count or CD4+ T-Lymphocyte Percentage of Total Lymphocytesa,b Age on Date of CD4+ T-Lymphocyte Test

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