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Differential Diagnosis
- Influenza
- Gastroenteritis
- Streptococcal pharyngitis
- Mononucleosis
- Syphilis
- Upper respiratory infection
- Viral hepatitis
Complications
- AIDS is diagnosed when the CD4 count falls below 200 cells/mm3 or in the setting of a diagnosis of any AIDS-defining illnesses.
- The CDC has identified 20 opportunistic infections, including but not limited to the following:
- Candidiasis of the esophagus, trachea, bronchi, or lungs
- Cytomegalovirus
- Toxoplasmosis
- HIV wasting syndrome
- Pneumocystis carinii pneumonia
- Lymphoma, numerous forms
- Kaposi sarcoma
- Medications are available that can be taken on a regular basis to prevent opportunistic infections, depending on the individual’s CD4 count.
- Studies have shown that individuals living with HIV have higher rates of osteoporosis, kidney disease, and cardiovascular disease (lipodystrophy), as well as an overall decreased immune system.
Management
- There is growing evidence to support the benefit to starting individuals on antiretroviral therapy (ART) as soon as they are diagnosed with HIV to improve mortality rates.
- There are 6 main classes of drugs used to treat HIV: non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), monoclonal antibodies, integrase inhibitors, and entry inhibitors.
- Recommended therapy consists of a multidrug regimen from at least 2 different drug classes (typically an NNRTI, PI, or integrase inhibitor-based regimen).
- Medication side effects are still present today, but studies indicate that <10% of ART-naive patients have treatment-limiting adverse reactions.
- Adherence is a major factor when treating individuals; lack of adherence to treatment can result in drug resistance.
- When choosing HIV treatment for a patient, multiple factors may guide finding the right options:
- Drug interactions with non-HIV medications the patient may be taking
- Comorbidities
- Side effects
- Drug resistance
- Cost and adherence
Prognosis
- Abstinence is the recommended method for stopping the spread of sexually transmitted HIV/AIDS.
- Without treatment, the average life span of someone living with AIDS is 3 years.
- With treatment, those infected with HIV are living much longer and healthier lives.
- Treatment has significantly reduced the rate of mother-child transmission when the mother is treated prenatally.
- Barriers to treatment can be difficult to overcome and include cost of medication, drug adherence/resistance, and lack of medical care.
