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Incidence of HIV Infection & AIDS: 56,000 individuals in U.S. infected annually: 21% with HIV unaware of HIV + status; 31% progress to AIDS w/in 12mo of HIV diagnosis; strongly consider testing in those with risk factors: male-to-male sexual contact, IV drug use, heterosexual contact (http://www.cdc.gov/hiv/topics/surveillance/resources/reports/; JAMA 2008;300:520)

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Table 35-1 Common Presenting Signs & Symptoms of Acute HIV Infection
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  • Signs & symptoms of acute HIV infection present w/in days to weeks of viral exposure & typically last <14d (N Engl J Med 1998;339:33)
  • Consider acute HIV infection in persons presenting with STD; differential diagnosis if unexplained, severe febrile illness
  • Newly diagnosed with HIV (N Engl J Med 2005;353:1702): care primarily based on sx; counsel patient regarding disease process/progression to AIDS; limit risk of secondary transmission; ensure proper support established; perform baseline lab testing prior to HIV management

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Table 35-2 Recommended Baseline Tests at Entry into Care
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Pathophysiology

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  • Day 0: exposure to HIV at the mucosal surface → Day 0–2: virus collected by dendritic cells, carried to lymph nodes → Day 4–11: HIV replication in CD4 cells, then released into the blood → Day 11 onward: viral spread to various organs (Ann Intern Med 1996;125:257)

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Treatment & Follow-Up

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  • Preferred initial regimens in treatment-naïve patients(as of March 27, 2012):
    • Efavirenz/tenofovir/emtricitabine
    • Raltegravir + tenofovir/emtricitabine
    • Ritonavir-boosted atazanavir + tenofovir/emtricitabine
    • Ritonavir-boosted darunavir + tenofovir/emtricitabine
  • Alternative regimens(as of March 27, 2012)
    • Efavirenz + abacavir/lamivudine
    • Rilpivirine/tenofovir/emtricitabine
    • Rilpivirine + abacavir/lamivudine
    • Raltegravir + abacavir/lamivudine
    • Ritonavir-boosted atazanavir + abacavir or zidovudine + lamivudine
    • Ritonavir-boosted darunavir + abacavir/lamivudine
    • Ritonavir-boosted fosamprenavir + [abacavir or zidovudine + lamivudine] or tenofovir/emtricitabine
    • Lopinavir/ritonavir + (abacavir or zidovudine + lamivudine) or tenofovir/emtricitabine

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Table 35-3 Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

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