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Patient Stories

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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.

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FIGURE 182-1

Oral thrush in an infant with human immunodeficiency virus (HIV) infection. (Used with permission from David Effron, MD.)

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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.

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FIGURE 182-2

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.)

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Introduction

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HIV is a retrovirus that causes disseminated infection resulting in suppression of T-cell mediated immunity and development of opportunistic infections.

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Synonyms

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Acquired Immunodeficiency Syndrome (AIDS) refers to clinical syndrome seen with advanced disease.1

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Epidemiology

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  • 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

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Etiology and Pathophysiology

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  • 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 ...

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