++
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)
++
++
- 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
++
++
- 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)
++
- 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
++