Prognosis For Hiv Infection
Risk of AIDS, death, or both is predicted by the
CD4 count in the short term
Plasma HIV RNA level in the longer term
For every 3-fold increase in viral load, mortality over the next 2 to 3 years increases about 50%. HIV-associated morbidity and mortality vary by the CD4 count, with the most deaths from HIV-related causes occurring at counts of < 50/mcL. However, with effective treatment, the HIV RNA level decreases to undetectable levels, CD4 counts often increase dramatically, and risk of illness and death falls but remains higher than that for age-matched populations not infected with HIV infection results from 1 of 2 similar retroviruses that destroy CD4+ lymphocytes and impair cell-mediated immunity, increasing risk of certain… read more ).
Another, less well-understood prognostic factor is the level of immune activation as determined by evaluating the expression of activation markers on CD4 and CD8 lymphocytes. Activation, which may be caused by leakage of bacteria across the HIV-damaged colonic mucosa, is a strong prognostic predictor but is not used clinically because this test is not widely available and antiretroviral therapy changes the prognosis, making this test less important.
Can Hiv Be Prevented Or Avoided
The best way to prevent HIV is to not have sex with a person who has HIV, or share a needle with a person who has HIV. However, there is also a medicine called PrEP that people can take before coming into contact with HIV that can prevent them from getting an HIV infection.
PrEP stands for pre-exposure prophylaxis. It is for people who are at long-term risk of getting HIV either through sexual activity or by injecting drugs. If youre taking PrEP and come into contact with HIV, the medicine makes it difficult for HIV to develop inside your body.
Other ways to prevent HIV include:
- When you have sex, practice safer sex by using a condom. The best condom is a male latex condom. A female condom is not as effective but does offer some protection.
- Do not share needles and syringes.
- Never let someone elses blood, semen, urine, vaginal fluid, or feces get into your anus, vagina, or mouth.
Revision Of Case Definition For Aids For Surveillance Purposes
For national reporting, a case of AIDS is defined as an illness characterized by one or more of the following ”indicator” diseases, depending on the status of laboratory evidence of HIV infection, as shown below.
Without Laboratory Evidence Regarding HIV Infection
If laboratory tests for HIV were not performed or gave inconclusive results and the patient had no other cause of immunodeficiency listed in Section I.A below, then any disease listed in Section I.B indicates AIDS if it was diagnosed by a definitive method .
Causes of immunodeficiency that disqualify diseases as indicators of AIDS in the absence of laboratory evidence for HIV infection
high-dose or long-term systemic corticosteroid therapy or other immunosuppressive/ cytotoxic therapy 3 months before the onset of the indicator disease
any of the following diseases diagnosed 3 months after diagnosis of the indicator disease: Hodgkin’s disease, non-Hodgkin’s lymphoma , lymphocytic leukemia, multiple myeloma, any other cancer of lymphoreticular or histiocytic tissue, or angioimmunoblastic lymphadenopathy
a genetic immunodeficiency syndrome or an acquired immunodeficiency syndrome atypical of HIV infection, such as one involving hypogammaglobulinemia
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Central Nervous System Complications
Advanced HIV infection can lead to opportunistic infections of the brain and spinal cord . Well-known pathogens include Toxoplasma gondii , Cryptococcus neoformans, and JC virus. Primary central nervous system lymphoma may also affect severely immunocompromised patients . Infections and malignancy cause variable neurologic symptoms, usually reflecting the location and severity of disease. For example, patients with solitary lesions often present with headache or focal deficits, whereas patients with increased intracranial pressure from substantial masses may have visual disturbances, nausea, or altered consciousness. Patients with meningitis or encephalitis generally present with one or more of the following: fever, headache, neck pain or stiffness, altered mental status, or seizure. Symptoms of myelopathy include weakness and sensory changes upper motor neuron signs, such as spasticity and hyperreflexia, may also be found.
Infectious and Oncologic Complications of the Central Nervous System in Patients with HIV Infection
CSF = cerebrospinal fluid CT = computed tomography FTA-ABS = fluorescent treponemal antibody absorption HIV = human immunodeficiency virus MRI = magnetic resonance imaging PCR = polymerase chain reaction PET = positron emission tomography SPECT = single-photon emission computed tomography VDRL = Venereal Disease Research Laboratories.
*Listed in order from lowest to highest typical CD4 lymphocyte count.
Information from reference6.
Other Health Conditions Associated With Hiv
Thanks to improvements in HIV treatment, people living with HIV are living longer than ever. But even when HIV is well controlled with medication, it causes chronic inflammation. Over time, that takes a toll on the body, putting people living with HIV at greater risk for health conditions such as cardiovascular disease, kidney disease, diabetes, bone disease, liver disease, cognitive disorders, and some types of cancer. Your health care provider will work with you, or may refer you to a specialist, to treat any of these conditions you may develop.
Some people also experience side effects from HIV medicines that can continue for a long time. See your health care provider regularly and discuss any side effects you experience. Never cut down, skip, or stop taking your HIV medications unless your health care provider tells you to. Your provider will work with you to develop a plan to manage the side effects, or may recommend that you change medication.
Be sure to take care of your emotional wellness, eat a healthy diet, exercise, and quit smoking. These all play an important role in living healthy with HIV.
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Malignancies Not Otherwise Specified
Cancers in people living with HIV/AIDS can be fatal and can lead to high levels of morbidity. These conditions have been classified into two groups: AIDS-defining cancers and non-AIDSdefining cancers. AIDS-defining cancers, as identified by the Centers for Disease Control and Prevention, are Kaposis sarcoma, invasive cervical cancer, and non-Hodgkins lymphoma, both those arising within the central nervous system and ones arising peripheral to that site. Non-AIDSdefining cancers are all other cancers that manifest in HIV-infected persons. Some malignancies are specifically discussed in prior chaptersprimary CNS lymphomas , Kaposis sarcoma , and primary effusion lymphoma because of the aggressive nature of the condition or because they are still relatively common clinical conditions despite the wide use of antiretroviral therapy.
Since the development of potent combination antiretroviral therapy, the incidence of AIDS-defining cancers has dramatically decreased . However, non-AIDSdefining cancers are increasingly common, whether simply reflecting the now aging cohort of HIV-infected persons benefiting from HIV therapy or growing at an increased rate caused by HIV infection and immune deficiency or inflammation or even as an adverse effect of antiretroviral drugs. The standardized incidence rate for all non-AIDSdefining cancers is about twice that of the general population, although this is an area of active, ongoing investigation .
Stigma Of Hiv Infection
A considerable amount of stigma has been attached to HIV infection, mostly because of the virus’s association with sexual acquisition and the inference of sexual promiscuity. Consequences of this stigma have included discrimination and reluctance to be tested for HIV infection. The stigma of HIV infection is also associated with a fear of acquiring a rapidly fatal infection from relatively casual contact.
Such attitudes are inappropriate because HIV is poorly transmissible without sexual contact or blood contact. In addition, the expected survival is long in patients with HIV infection who are receiving treatment. HIV is not transmitted during casual contact and is readily inactivated by simple detergents. Much of the concern regarding HIV infection is due to the incurability of the infection and the relentless immune decline and eventual premature death in the vast majority of infected people.
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What Are The Symptoms Of Hiv
After the first month or so, HIV enters the clinical latency stage. This stage can last from a few years to a few decades.
Some people dont have any symptoms during this time, while others may have minimal or nonspecific symptoms. A nonspecific symptom is a symptom that doesnt pertain to one specific disease or condition.
These nonspecific symptoms may include:
- headaches and other aches and pains
- swollen lymph nodes
- recurrent oral or vaginal yeast infections
As with the early stage, HIV is still transferable during this time even without symptoms and can be transmitted to another person.
However, a person wont know they have HIV unless they get tested. If someone has these symptoms and thinks they may have been exposed to HIV, its important that they get tested.
HIV symptoms at this stage may come and go, or they may progress rapidly. This progression can be slowed substantially with treatment.
With the consistent use of this antiretroviral therapy, chronic HIV can last for decades and will likely not develop into AIDS, if treatment was started early enough.
The cause of the rash determines:
- how it looks
- how it can be treated depends on the cause
Side Effects And Costs
Side effects of antiretroviral therapy vary and may include nausea, headache, and dizziness. These symptoms are often temporary and disappear with time.
Serious side effects can include swelling of the mouth and tongue and liver or kidney damage. If side effects are severe, the medications can be adjusted.
Costs for antiretroviral therapy vary according to geographic location and type of insurance coverage. Some pharmaceutical companies have assistance programs to help lower the cost.
To develop AIDS, a person has to have contracted HIV. But having HIV doesnt necessarily mean that someone will develop AIDS.
Cases of HIV progress through three stages:
- stage 1:acute stage, the first few weeks after transmission
- stage 2: clinical latency, or chronic stage
- stage 3: AIDS
As HIV lowers the CD4 cell count, the immune system weakens. A typical adults CD4 count is 500 to 1,500 per cubic millimeter. A person with a count below 200 is considered to have AIDS.
How quickly a case of HIV progresses through the chronic stage varies significantly from person to person. Without treatment, it can last up to a decade before advancing to AIDS. With treatment, it can last indefinitely.
Theres currently no cure for HIV, but it can be managed. People with HIV often have a near-normal lifespan with early treatment with antiretroviral therapy.
Also, treatment can typically help manage opportunistic infections.
HIV and AIDS are related, but theyre not the same thing.
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Interruption Of Antiretroviral Therapy
Interruption of ART is usually safe if all drugs are stopped simultaneously, but levels of slowly metabolized drugs may remain high and thus increase the risk of resistance. Interruption may be necessary if intervening illnesses require treatment or if drug toxicity is intolerable or needs to be evaluated. After interruption to determine which drug is responsible for toxicity, clinicians can safely restart most drugs as monotherapy for up to a few days. NOTE: The most important exception is abacavir patients who had fever or rash during previous exposure to abacavir may develop severe, potentially fatal hypersensitivity reactions with reexposure. Risk of an adverse reaction to abacavir is 100-fold higher in patients with HLA-B*57:01, which can be detected by genetic testing.
Chronic Kidney Disease Including Hiv
Chronic kidney disease includes HIV-associated nephropathy and end-stage renal disease . About 30 percent of HIV patients experience abnormal kidney functioning. Defined in Listing 6.00 as kidney damage or a glomerular filtration rate 60 mL/min for 3 or more months , chronic kidney disease can leave people at greater risk for faster progression to AIDS-defining illnesses and death . The disease is similar between seropositive and seronegative populations. Although the literature about the relationship between chronic kidney disease and HIV and its treatment is still developing, the incidence of chronic kidney disease appears to be slowing. Incidence of chronic kidney disease decreased significantly after the introduction of combination antiretroviral therapy. Although prevalence increased, this increase is potentially due to longer survival times .
Chronic kidney failure is diagnosed through screening urine analysis, calculated estimates of renal function , and kidney biopsy. These tests are recommended by the Infectious Disease Society of Americas Guidelines for the Management of Chronic Kidney Disease in HIV-Infected Patients .
In addition to HIV infection, renal functioning can be impaired by diabetes and hypertension. Hepatitis C is also a risk factor for chronic kidney disease. Nephrotoxicity can be induced by HIV treatments, such as indinivir and tenofovir .
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Whats The Hiv Window Period
As soon as someone contracts HIV, it starts to reproduce in their body. The persons immune system reacts to the antigens by producing antibodies .
The time between exposure to HIV and when it becomes detectable in the blood is called the HIV window period. Most people develop detectable HIV antibodies within 23 to 90 days after transmission.
If a person takes an HIV test during the window period, its likely theyll receive a negative result. However, they can still transmit the virus to others during this time.
If someone thinks they may have been exposed to HIV but tested negative during this time, they should repeat the test in a few months to confirm . And during that time, they need to use condoms or other barrier methods to prevent possibly spreading HIV.
Someone who tests negative during the window might benefit from post-exposure prophylaxis . This is medication taken after an exposure to prevent getting HIV.
PEP needs to be taken as soon as possible after the exposure it should be taken no later than 72 hours after exposure but ideally before then.
Another way to prevent getting HIV is pre-exposure prophylaxis . A combination of HIV drugs taken before potential exposure to HIV, PrEP can lower the risk of contracting or transmitting HIV when taken consistently.
Timing is important when testing for HIV.
Talk To A Healthcare Provider
If a person has HIV, theyâll probably experience one or more of these skin conditions and rashes.
However, getting diagnosed in the early stages of HIV, starting treatment soon after, and adhering to a treatment regimen will help people avoid the more severe symptoms. Keep in mind that many skin conditions associated with HIV will improve with antiretroviral therapy.
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Preventing Other Health Conditions
Its especially important to look after your general health when you have HIV as it increases your risk of getting certain conditions. Many health conditions are preventable and certain habits can help you to stay healthy. Some of the main ways you can prevent disease are:
- adhering to ART
- eating a healthy diet
- limiting your alcohol intake
- quitting smoking.
All of these lifestyle changes can reduce your risk of getting certain health conditions known as non-communicable diseases. Non-communicable diseases are illnesses that are not infectious, and include cancers, diabetes and heart disease. For more information on how to keep your body and brain healthy, see our page on health and wellbeing.
Hiv And Aids Timeline
From the bleakest early days of the epidemic, Johns Hopkins has been a leader in understanding, treating and preventing HIV and AIDS. Explore 35 years of progress, here and around the world, including the nations first HIV-positive to HIV-positive organ transplants, performed at The Johns Hopkins Hospital in 2016.
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Do People Living With Hiv Have Other Health Conditions
Yes. Its common for people living with HIV to have other health issues.
Some of these issues may be directly related to HIV or its treatment. Others may be completely unrelated.
These health conditions can mean more doctors visits, lab tests, and medications to keep up with.
Taking HIV medication daily as prescribed, and staying in regular medical care is the best way for people living with HIV to stay healthy.
Antiretroviral Therapy: General Principles
Reduce the plasma HIV RNA level to undetectable
Restore the CD4 count to a normal level
A poor CD4 count response is more likely if the CD4 count at initiation of treatment is low and/or the HIV RNA level is high. However, marked improvement is likely even in patients with advanced immunosuppression. An increased CD4 count correlates with markedly decreased risk of opportunistic infections, other complications, and death. With immune restoration, patients, even those with complications that have no specific treatment or that were previously considered untreatable , may improve. Outcomes are also improved for patients with cancers and most opportunistic infections.
ART can usually achieve its goals if patients take their drugs > 95% of the time. However, maintaining this degree of adherence is difficult. Partial suppression may select for single or multiple accumulated mutations in HIV that make viruses partially or completely resistant to a single drug or entire classes of drugs. Unless subsequent treatment uses drugs of other classes to which HIV remains sensitive, treatment is more likely to fail.
Patients with most acute opportunistic infections benefit from early ART . However, for some opportunistic infections, such as tuberculous meningitis or cryptococcal meningitis, the evidence suggests that ART should be delayed until the first phase of antimicrobial therapy for these infections is finished because of the increased frequency of adverse events and death.
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Hiv Infection Associated With 68% Increased Risk For Hf
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Individuals with HIV were at elevated risk for developing HF compared with individuals without HIV, according to new research published in Mayo Clinic Proceedings.
The retrospective cohort study included 38,868 individuals with HIV frequency-matched based on age, sex, race, primary treating facility and first year of follow-up with 386,586 individuals without HIV from 2000 to 2016. Researchers evaluated incident HF risk and the association with HIV infection overall and by left ventricular systolic function and whether HF risk varied by demographics.
Mayo Clin Proc
The rate of incident HF was 0.23 per 100 person-years among individuals with HIV compared with 0.15 per 100 person-years among individuals without HIV following a median follow-up of 3.8 years . There was a higher adjusted rate for incident HF of 68% among individuals with HIV , which remained after further adjustment for CV medication use . Further adjustment for ACS hospitalizations modestly attenuated the results .
Among individuals with HIV, the adjusted incident HF risk was most prominent among those aged 40 years and younger , women and Asian/Pacific Islander individuals .
Alan S. Go, MD
The results did not vary by systolic function category.