CHAPTER 13: Human Immunodeficiency Virus Infection

HUMAN IMMUNODEFICIENCY VIRUS INFECTION

Human Immunodeficiency Virus (HIV) may lead to Acquired Immune Deficiency Syndrome (AIDS). Progression to AIDS is associated with opportunistic infections, cancers, and death. Advances in highly active antiretroviral treatments (HAART) have transformed HIV infection to a chronic illness with near normal life expectancy for those with access and adherence to life-long therapy. See Table 13-1 for currently approved antiretroviral drugs.

EPIDEMIOLOGY IN THE UNITED STATES

• Maternal to Child Transmission (MTCT): In the United States, advances in HIV-testing, HAART use in pregnant HIV-infected women, and post-exposure prophylaxis of HIV-exposed infants have reduced MTCT to between 1% and 2%. In 2011, 53 U.S. infants were perinatally infected with HIV

• Pediatric Infection: There are about 3,000 children under the age of 13 years with HIV infection in the United States. This number will increase because the ban on HIV immigration to the United States was lifted, resulting in increased adoption of foreign born HIV-infected children by U.S. families and immigration of HIV-infected children and families

• Adolescent and Young Adult Infection:

  • ✓ Perinatally Acquired Infection: With changes to the HIV immigration laws in 2010 and improvements in antiviral therapies leading to prolonged life expectancies, the number of HIV-infected adolescents is increasing

  • ✓ Behaviorally Acquired Infection: The Centers for Disease Control and Prevention (CDC) classifies modes of transmission as: male-to-male (men who have sex with men, MSM) sexual contact; injection drug use (IDU); MSM and IDU; heterosexual contact; or other. The incidence of HIV infection has remained stable or decreased except in MSM

    • ▪ 60% of youth who tested HIV-positive are previously unaware of their diagnosis

DIFFERENTIAL DIAGNOSIS

• Infancy and childhood:

  • ✓ Congenital immunodeficiencies; congenital infections, infections, such as Mycobacterium tuberculosis; malignancies; malnutrition; or other causes of failure to thrive, such as inflammatory bowel disease, celiac disease, or cystic fibrosis

• Adolescents and young adults:

  • ✓ Acute infection: Any viral syndrome such as influenza, mononucleosis (EBV, CMV); primary HSV; bacterial or viral meningitis; arbovirus infections; gastrointestinal infections; malignancy; rheumatologic disease, such as idiopathic rheumatoid arthritis; primary or secondary syphilis

  • ✓ Advanced infection: Differential will vary depending on presentation, some examples are included below:

    • ▪ Infectious: Pneumonia (bacterial, viral, fungal, parasitic); meningitis (bacterial, viral, fungal); sepsis, chronic fatigue syndrome; syphilis, tuberculosis , chronic vaginal candidal infection

    • ▪ Wasting: Malignancy, anorexia ...