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Human immunodeficiency virus (HIV)
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Richard Basilan, William Salzer
The most common mode of HIV infection is sexual transmission through the genital mucosa (14), with initial infection of a small number of T lymphocytes, macrophages, and dendritic cells located in the lamina propria. Initial replication occurs in the regional lymph nodes, followed by migration of infected T lymphocytes or virions into the bloodstream, where secondary amplification in the gastrointestinal tract, spleen, and bone marrow results in massive infection of susceptible cells (15). The period of peak viremia, which occurs in the first 6 weeks, results in a symptomatic illness in 40% to 90% of patients, termed acute HIV infection. The most common symptoms include fever, fatigue, pharyngitis, lymphadenopathy, and myalgias. A maculopapular rash involving the trunk also occurs in 40% to 80% of patients (16). Oral or genital ulcers can also occur. Given the nonspecific mononucleosis like symptoms of acute HIV infection, the diagnosis is often missed. A high index of suspicion is required to make the diagnosis, because commonly used screening tests for HIV antibody are negative for the first 4 weeks following infection. Detection of the p24 antigen or HIV RNA by PCR in the absence of HIV antibodies would confirm the diagnosis. This has important public health implications as the patient is unaware of being infected with HIV and yet is highly infectious because of the very high viral load.
HIV and AIDS
Published in Rae-Ellen W. Kavey, Allison B. Kavey, Viral Pandemics, 2020
Rae-Ellen W. Kavey, Allison B. Kavey
There are three stages of HIV infection: acute infection, clinical latency, and AIDS, the acquired immunodeficiency syndrome as shown in Figure 6.2. Acute HIV infection is characterized by a non-specific flu-like illness with fever, sore throat, large tender lymph nodes and rash. Much less frequently, there are sores in the mouth and on the genitalia, and GI or neurologic symptoms. These initial symptoms are transient, only one or two weeks. During this time, immune function is severely compromised and viral counts are extremely high. Due to their mild and non-specific character, these symptoms are often not recognized as signs of HIV infection.63
HIV neurological complications
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
Acute HIV infection (as defined by HIV viremia in the absence of seroconversion) can manifest with a non-specific viral syndrome with common symptoms including fever, lethargy, rash, myalgia, headache, and pharyngitis [48]. A meningoencephalitic clinical phenotype with headache, fever, meningism, and confusion has also been reported [49–51]. A Spanish study reported a series of 10 cases of meningitis/meningoencephalitis (the latter with obtundation/confusion/seizures) occurring in the acute phase of HIV infection, as defined by negative Western blot, detectable plasma HIV RNA, and complete seroconversion after the episode [51]. CSF analysis of these cases revealed a leukocytosis (25–270 cells/mL) with predominantly lymphocytes, an elevated protein (typically 100–200 mg/dL), normal glucose, and no other responsible organism. Notably, the vast majority of patients presented with fever and headache, with meningeal signs relatively uncommon (10%), and focal neurology (50%) and obtundation/confusion (50%) relatively more common features. A similar clinical and biochemical syndrome has also been described in patients with known HIV within weeks following cessation of antiretroviral therapy [51,52].
Benefits of antiretroviral therapy initiation during acute HIV infection
Published in Acta Clinica Belgica, 2022
Jozefien De Clercq, Sofie Rutsaert, Marie-Angélique De Scheerder, Chris Verhofstede, Steven Callens, Linos Vandekerckhove
Successful treatment during early HIV infection greatly relies on early diagnosis, which requires efficient screening and identification of individuals during acute HIV infection. Acute HIV infection is the earliest stage of HIV infection, often defined as the period between the detection of HIV RNA in the plasma and the development of anti-HIV-antibodies [6]. Between transmission and the first detection of viral RNA in the plasma, there is an eclipse phase of ± 10 days, in which all diagnostic tests are negative. The subsequent progression of acute HIV infection into early chronic infection has been classified into six clinical stages by Fiebig et al., based on the sequential detection of HIV RNA, p24 antigen, anti-HIV IgM antibodies, and increasing Western blot reactivity in the plasma [7,8] (Table 1). According to this classification, acute HIV infection can last up to 100 days, until full antibody reactivity is seen on Western blot [7]. The Fiebig classification has been widely adopted in studies assessing the benefits of treatment initiation during acute HIV infection.
Age at first HIV test for MSM at a community health clinic in Los Angeles
Published in AIDS Care, 2020
Emily M. Maitino, Shira C. Shafir, Matt R. Beymer, Chelsea L. Shover, Nicole J. Cunningham, Risa P. Flynn, Robert K. Bolan
The data used in this study were collected at the Los Angeles LGBT Center (“the Center”) from August 2014 to May 2018 and analyzed retrospectively. When patients visited the clinic for HIV screenings during this period, demographic characteristics including age and race/ethnicity were collected on registration forms. The patients were then administered an in-person sexual health risk assessment by a trained HIV/STI counselor that consisted of 42 questions. The questions covered sexual risk behaviors and substance use. Sexual risk behaviors considered for our analysis included instances of vaginal and anal sex without condoms in the past three months, overall number of partners in the last three months with or without use of condoms, and condom use during last sexual experience. Types of condomless anal sex were classified as anal penetrative intercourse (APIC) or anal receptive intercourse (ARIC). Substance use variables included the use of ecstasy, methamphetamine, inhalant nitrites (“poppers”), erectile dysfunction (ED) medication without prescription, gamma-hydroxybutyric acid (GHB), prescription drugs without prescription in the past 12 months, and alcohol in the past 30 days. An acute HIV infection is defined as one where the viral load PCR test is positive and HIV antibody test is negative; it does not refer to time since infection transmission. A non-acute HIV infection is defined as one that produces a positive HIV antibody test and a positive PCR test result.
HIV-1 RNA testing of pooled dried blood spots is feasible to diagnose acute HIV infection in resource limited settings
Published in Southern African Journal of Infectious Diseases, 2018
Wentzel Dowling, Kirsten Veldsman, Mary Grace Katusiime, Jean Maritz, Peter Bock, Sue-Ann Meehan, Marije Van Schalkwyk, Mark F Cotton, Wolfgang Preiser, Gert U Van Zyl
According to the 2012 Human Science Research Council South African National HIV Prevalence, Incidence and Behaviour Survey, the overall HIV incidence in 2 – 49-year-old individuals was 1.07%. However, as the epidemic is generalised, it is difficult to define risk groups, apart from a higher incidence among young black female survey participants.25 Moreover, as symptoms of acute HIV infection are nonspecific, it is challenging to identify those cases. One approach is to perform two parallel rapid tests and, when discordant, test individuals for acute infection.26 Another is to use epidemiologic and clinical scoring algorithms to identify which patients with negative rapid tests are more likely to have acute HIV, warranting point-of-care (PoC) HIV NAT testing.7 However, such individual PoC NAT testing remains costly.