Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

730 Human Immunodeficiency Virus Type 1 (HIV-1)

risk is about 0.3% per percutaneous exposure and 0.09% per muco-

cutaneous exposure

■Other modes of transmission such as orogenital sex are infrequent

routes of transmission; organ transplants and sports contact are

exceedingly rare modes of transmission; in about 7% of HIV+cases

the risk group is either unidentified or not reported.

Signs & Symptoms

■Acute antiretroviral syndrome (reported rates vary greatly, 20% vs.

50%-90%) seen in some individuals at time of seroconversion (6–

12 wks); consists of non-specific mononucleosis-like syndrome of

fever, skin rashes, headaches, meningismus, myalgias, arthralgias,

lymphadenopathy, pharyngitis, oral ulcers, abdominal complaints,

genital ulcers, other constitutional complaints and other less com-

mon findings.

■Often asymptomatic until develop AIDS (CD4 count <200 or AIDS

defining opportunistic infections, OI); often thrush, oral hairy leuko-

plakia, intermittent fevers, weight loss, skin rashes, and other sys-

temic symptoms

tests

Laboratory

■Basic blood studies:

➣acute seroconversion: low CD4 count, extremely high HIV-1 viral

load (100,000’s)

➣early-intermediate chronic stage: variably low CD4 count,

detectable but variable levels of HIV-1 viral load (different ‘set

points’ for each patient that lasts for years)

➣advanced/late stage: CD4 <200, high viral load

■Basic urine studies:

➣may be abnormal if HIV nephropathy present (proteinuria,

hematuria)

Screening

■Anti-HIV antibody (Ab) positive 2 months after infection in most;

positive by EIA in 95% by 6 months

Confirmatory Tests

■Blood

➣Enzyme immunoassay (EIA) followed by Western Blot (WB) is

standard; 99.9% sensitive, 99.9% specific