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AIDS was first reported in 1981 in
previously healthy men. However, it has been reported throughout the world. The World
Health Organization estimates there are 11 million seropositive persons worldwide and more
than 13 million infected since the beginning of the epidemic. More than 1 million cases
are in children. The rate of new infection is rapid.
Transmission
1. Sexual contact with an infected person, (predominant mode of transmission worldwide).
2. Parenteral exposure to infected blood or blood products.
3. Perinatal transmission may occur in utero, during birth, or via breast-feeding.
Etiology
In 1984, a retrovirus was identified as the causative agent of AIDS. After much debate, an
international committee adopted the name human immunodeficiency virus.
Indicators of Infection
Indicators of HIV infection for persons age 13 years or older include (1) repeatedly
reactive screening tests for HIV antibody (2) direct identification of virus in host
tissues by virus isolation; (3) HIV antigen detection; or (4) a positive result on any
other highly specific licensed test for HIV.
Clinical Symptoms
HIV infection should be considered an evolving process. Typically, a patient may progress
from acute infection to a state without any symptoms, through progressive gland swelling
and then to AIDS. Although it has not been determined that all HIV-infected patients will
develop AIDS, studies show that the rate of progression is high and increases as the
length of time from initial infection increases. The time it takes to develop AIDS varies
considerably and, in many patients, the intermediate stages are not identified. The
average time from HIV infection to death is 10 years. Fewer than 5% of infected people are
characterized as having nonprogressive infection because they remain healthy.
Common Symtoms are: (1) Fever, sweats, lethargy,
ill-feeling, headache, avoidance of light, pain in joints and muscles, sore throat, and
diarrhea, (2) characteristic rash, (3) oral ulcers (4) gland swelling, (5) neurologic
manifestations, (6) and other infections.
Routine Evaluation
(1)A complete medical history, with emphasis on specific infections or syndromes
suggestive of opportunistic infections is important. Identify current and past high-risk
behaviors and exposures that may have resulted in HIV infection.
(2)Perform a complete physical examination.
(3)Obtain initial laboratory studies.
Immunizations
Immunizations, including pneumococcus and hepatitis B should be given.
Respiratory complaints
Respiratory complaints include cough, dyspnea, chest pain, and sputum production.
Psychological counseling and stress management may help some patients. Change in mental
status may be seen with a number of infections and other conditions, including systemic
illnesses outside the central nervous system.
Fungi
Fungal infections are also commonly present in patients with AIDS. In particular, oral
thrush, and esophageal candidiasis may present with severe difficulties swallowing.
Parasitic infections
Parasitic infections are also very frequent in patients with AIDS. Example include,
pneumocystis carinii pneumocystitis, and infections with toxoplasma gondii.
Therapy
A lot of progress has been made in the development of antiretroviral agents for the
treatment of HIV infection. Unfortunately, with the approval of each new antiretroviral
drug, the therapy of HIV infection becomes more complex. Combination therapy appears to
hold much promise in enhancing our ability to suppress HIV viral load, delay the
progression of AIDS, and prolong survival. In addition, new classes of drugs are being
developed, and numerous clinical trials are currently under way to help determine optimal
combinations of antiretroviral agents. There is currently no consensus as to when to
initiate antiretroviral therapy and with what drugs, when and how to modify antiretroviral
regimens, and when, if ever, to discontinue antiretroviral medications.
A typical drug used for the treatment is Zidovudine.
Zidovudine, 200 mg, 3 times a day, is considered the standard daily dose; however, the
ideal dose and interval are not known. Other drugs are presently also being used and
tested. However, the final word is not yet out.
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