References:
- Global Infectious Diseases and Epidemiology Online Network: Infectious Diseases of the Philippines, 2013 eBook Edition, ISBN 978-1-61755-582-4, by Stephen Berger. Accessed here.
Human Immunodeficiency Virus Infection (Initial Illness)
| Agent | VIRUS - RNA. Retroviridae, Lentivirinae: Human Immunodeficiency Virus |
| Reservoir | Human |
| Vector | None |
| Vehicle | Blood Semen Sexual Transplacental Breastfeeding |
| Incubation Period | 1 week to 6 weeks |
| Diagnostic Tests | HIV antibody (ELISA, Western blot) HIV or HIV antigen assays Nucleic acid amplification |
| Typical Adult Therapy | Supportive; ‘prophylactic’ Zidovidine + additional drugs (DDI, 3TC, etc) should be considered, particularly during pregnancy |
| Typical Pediatric Therapy | Supportive; role for ‘prophylactic’ Zidovidine + additional drugs (DDI, 3TC, etc) should be considered |
| Clinical Hints | Fever, diarrhea, sore throat and a mononucleosis-like illness in a ‘high risk’ patient (eg, men who have sex with men, drug abuser, etc). |
| Synonyms | HIV, HIV infection. |
The clinical features of acute HIV infection are protean and often characterized by fever, generalized lymphadenopathy, headache, fatigue, myalgia, rash, nausea, vomiting, night sweats, sore throat, diarrhea or weight loss.
- 40% to 90% of persons have symptoms suggestive of an acute viral infection.
- Symptoms tend to subside within two weeks; however, some patients continue to be ill for as long as ten weeks.
- In most cases, a history of likely acquisition within the past several weeks can be established: unprotected sex, extra-medical injection, transfusion, etc.
Acquired Immunodeficiency Syndrome
| Agent | VIRUS - RNA. Retroviridae, Lentivirinae: Human Immunodeficiency Virus, HIV |
| Reservoir | Human |
| Vector | None |
| Vehicle | Blood Semen Sexual Transplacental Breastfeeding |
| Incubation Period | 2 months to 10 years (50% within 10 years) |
| Diagnostic Tests | HIV antibody (ELISA, Western blot) Nucleic acid amplification Tests for HIV antigen & viral load as indicated |
| Typical Adult Therapy | Two nucleosides + 1 protease inhibitor; or two nucleosides + 1 non-nucleoside; or 2 nucleosides + Ritonavir (alone or with lopinavir) + (indinavir, amprenavir, saquinavir or nelfinavir) |
| Typical Pediatric Therapy | As for adult |
| Clinical Hints | Most often associated with drug abuse, blood products, men who have sex with men, hemophilia. Hints: severe herpes simplex or moniliasis, chronic cough, diarrhea, weight loss, lymphadenopathy, retinitis, encephalitis or Kaposi’s sarcoma. |
| Synonyms | ARC, Gay cancer, GRID, HIV-1, HIV-2, HIV-AIDS, SIDA, Slim disease. |
CDC Case Surveillance Definition
As of 1993, the CDC (The United States Centers for Disease Control) surveillance case definition for AIDS includes all HIV-infected persons age 13 or over who have either:
- <200 CD4+ T-lymphocytes
- CD4+ T-lymphocyte percentage of total lymphocytes of <14%
- Any of the following: pulmonary tuberculosis, recurrent pneumonia, or invasive cervical cancer; or any of the 23 clinical conditions defined in the case definition published in 1987.
The clinical features of AIDS are protean and often characterized by multisystem illness, evidence of immune suppression and the presence of one or more superinfections (tuberculosis, Cytomegalovirus infection, cerebral toxoplasmosis, pneumocystosis, penicilliosis, severe or recalcitrant candidiasis, disseminated Acanthamoeba infection, etc).