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Updated: Jul 23 2019

Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome


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Images course.jpg virus ccrs5.jpg
  • Overview
  • Snapshot
    • A 24-year-old man presents to his primary care physician with fever, headache, sore throat, and myalgias. He reports his symptoms began a few days ago and believes it is from a "cold." Social history is significant for having multiple male partners. He does not consistently use condoms. His last sexual encounter was 2 months ago. Physical exam is significant for cervical lymphadenopathy. An HIV-1/2 antigen/antibody combination immunoassay is positive for p24 antigen and an elevated HIV viral load. HIV-1/2 antibody differentiation immunoassay shows that he is solely HIV-1 reactive.
  • Introduction
    • Human immunodeficiency virus (HIV), an RNA retrovirus, can result in
      • acquired immunodeficiency syndrome (AIDS) via
        • gradually losing competence of the host's immune system, which results in
          • opportunistic infections such as
            • Pneumocystis jiroveci
            • Toxoplasma gondii
            • Mycobacterium avium-intracellulare
            • HHV-8
    • Pathogenesis
      • HIV infects CD4+ cells via binding to the CD4 receptor and
        • co-receptors such as
          • CCR5 on macrophages
            • in early infection
            • clinical correlate
              • homozygous CCR5 mutations leads to
                • immunity against HIV infection
              • heterozygous CCR5 mutations leads to
                • a slower infectious course
          • CXCR4 on T cells
            • in late infection
      • the infected cells (CD4+ T-cells, dendritic cells, and macrophages) eventually serve as a reservoir for the virus which
        • delivers the virus throughout the body
    • HIV structure
      • the viral particle contains
        • two copies of an RNA genome as well as
          • gp120 and gp41
            • result from the cleavage of
              • gp 160
            • arise from the env gene
            • gp120
              • allows for the attachment to
                • the host's CD4+ cells
              • allows for antigenic drift leading to
                • evasion of antibody-mediated destruction
            • gp41
              • allows for viral
                • fusion and entry into the host cell
          • p24 and p17 arise from the
            • gag gene and serves as
              • the viral capsid (p24) and
                • viral matrix protein (p17)
          • the pol gene leads to the synthesis of
            • reverse transcriptase which
              • synthesizes dsDNA from
                • RNA in order to
                  • integrate the reversed transcribed viral DNA into host's DNA
            • aspartate protease
            • integrase which
              • integrates the reverse transcribed DNA into the host's genome
    • Diagnosis
      • HIV-1/2 antigen/antibody combination immunoassay
        • if positive for HIV-1/2 antibodies or HIV p24 antigen then
          • perform an HIV-1/2 antibody differentiation immunoassay
      • viral load
        • determines the
          • HIV RNA amount in the patient's plasma
      • Opportunistic Infections Based on CD4+ Cell Count
      • Cell Count (cells/mm3)
      • Pathogen & Disease(s)
      • < 500/mm3
      • Candida albicans
        • oral thrush
      • Bartonella henselae
        • bacillary angiomatosis
      • Epstein–Barr virus (EBV)
        • oral hairy leukoplakia
      • HHV-8
        • Kaposi sarcoma
      • HPV
        • squamous cell carcinoma of theanus and cervix
      • < 200/mm3
      • Pneumocystis jirovecii
        • pneumonia
      • Reactivation of the JC virus
        • progressive multifocal leukoencephalopathy
      • Histoplasma capsulatum
        • nonspecific symptoms such as
          • fever, weight loss, and cough along with
            • oval yeast cells within macrophages
      • < 100/mm3
      • Candida albicans
        • esophagitis
      • Aspergillus fumigatus
        • hemoptysis and pleurisy
      • Mycobacterium avium-intracellulare and mycobacterium avium complex
        • nonspecific findings such asfever, weight loss, and night sweats
      • Toxoplasma gondii
        • brain abscesses that can appear as
          • ring-enhancing lesions on MRI
      • Cryptococcus neoformans
        • meningitis
      • Cryptosporidium species
        • watery diarrhea
      • Epstein–Barr virus (EBV)
        • B-cell lymphoma
      • Cytomegalovirus
        • retinitis
        • esophagitis
        • colitis
        • encephalitis
        • pneumonitis
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