Editing HIV/AIDS


== Epidemiology ==

* 26800 people with HIV in Australia
* Highest concentration amongst gay men and IVDU
* <0.1% female sex workers

== Risk factors ==

* High viral load for all forms of transmission
* Risky sexual behaviour

== Aetiology ==

* HIV virus acquired through sexual contact, exposure to infected blood or perinatal transmission

== Pathophysiology ==

* Retrovirus
* Binds to CD4+ cells (T-helper lymphocytes, monocytes and macrophages)
* Capsid is released into the cell and reverse transcriptase returns viral RNA to DNA incorporated into the cell genome
* Viral replication by the normal cell mechanisms releases more capsids and increased viral load
* Cytotoxic T cells recognise infected T-cells and cause lysis or induce apoptosis causing reduced CD4+ cells and overall immunity

== Classification (CDC) ==

* Stage 1 - CD4 count >500microL
* Stage 2 - CD4 could 200-499
* Stage 3 - CD4 count <200
* '''AIDS is the presence of confirmed HIV infection with stage 3 disease and the presence of opportunistic infections'''

== Presentation ==

* Asymptomatic 10-60%
* Acute retroviral syndrome (seroconversion)
** Fever, lymphadenopathy, pharyngitis, rash, headache
** Self-resolving
* Clinical latency period (3-20 years)
* Development of AIDS

== Diagnosis ==

* HIV immunoassay
* HIV PCR (viral load assessment if positive immunoassay)
* Pre and post-test counselling

== Management ==

* Antiretroviral combination therapy for all HIV+ patients regardless of immune status
** Improves symptoms
** Improved immune function
** Reduced transmission risk
* Drug resistance testing can improve regimen selected

== Opportunistic infections ==

* Pneumocystis pneumonia
* Cachexia
* Oesophageal candidiasis
* Encephalitis/meningitis/retinitis
* Kaposi's sarcoma
* Burkitt's lymphoma

== Surgical issues ==

* Upcoming elective surgery
** Current opportunistic infections
** Viral load
** Nutritional status
** Continue antiretrovirals
* Post-op risks
** Poor wound healing
** Sepsis
** Poor nutrition
* Risk of HIV transmission to the health worker

[[Category:Infectious diseases]]