A 6-month-old girl is seen by her pediatrician for because her mother is concerned about a white coating on the infant’s tongue and poor feeding. On exam, the child appears cachectic and has thrush visible throughout her oropharynx (Figure 182-1). Palpable cervical and axillary lymph nodes are noted as well. A human immunodeficiency virus (HIV) antibody test is obtained and is positive. Diagnosis is confirmed with a HIV DNA polymerase chain reaction (PCR). The mother of the baby also tests positive for HIV. The child is treated with antiretroviral (ARV) therapy and improves with treatment.
Oral thrush in an infant with human immunodeficiency virus (HIV) infection. (Used with permission from David Effron, MD.)
A 15-year-old male presents to a community clinic with penile discharge and anal itching due to anal warts (Figure 182-2). On further questioning, he admits to being homeless. He supports himself through commercial sex work, mainly with male partners. A urine nucleic acid test is positive for chlamydia and the oral rapid HIV antibody test is positive as well. Diagnosis of HIV is confirmed via Western Blot testing.
Anal warts (condyloma) caused by Human Papilloma Virus in an adolescent male with HIV infection and a history of anal receptive intercourse. (Used with permission from Richard P. Usatine, MD.)
HIV is a retrovirus that causes disseminated infection resulting in suppression of T-cell mediated immunity and development of opportunistic infections.
Acquired Immunodeficiency Syndrome (AIDS) refers to clinical syndrome seen with advanced disease.1
Humans are the only known reservoir for HIV-1 and HIV-2.
HIV lives in peripheral blood mononuclear cells, brain cells, bone marrow, and genital tract cells.
Transmission occurs via sexual contact, blood exposure, mucous membrane exposure to blood or breast milk, and mother to child transmission.2
Risk of mother to child transmission at birth without intervention is approximately 30 percent;2 with current therapy this risk is now 1 to 2 percent in the US. High maternal HIV viral load at delivery, primary maternal infection during pregnancy, and breast feeding all increase transmission risk.3
Risk of sexual transmission varies from 0.1 to 30 percent per encounter with highest risk from receptive anal sex.4
Etiology and Pathophysiology
Lentivirus of the family Retroviridae.
Two forms—HIV-1 and HIV-2. HIV-2 causes a milder form of disease and is found predominantly in West Africa.
RNA virus that requires conversion of viral RNA to DNA to incorporate into host cell genome.2
Major enzymes and regulatory genes required for replication, assembly, and release viral ...