Key facts and checkpoints

HIV is a retrovirus with two known strains that cause a similar spectrum of syndromes: HIV1 and HIV2.

Always consider HIV in those at risk: enquire about history of STDs, injection of illicit drugs, past blood transfusions, sexual activities and partners.

About 50% of patients develop an acute infective illness similar to glandular fever within weeks of acquiring the virus (the HIV seroconversion illness). 2 The main features are fever, lymphadenopathy, lethargy and possibly sore throat, and a generalised rash. If these patients have a negative infectious mononucleosis test, perform an HIV antibody, which may have to be repeated in four weeks or so if negative.

Patients invariably recover to enter a long period of good health for five years or more. 1

• Pneumocystitis pneumonia is the commonest presentation of AIDS.

• Approximately 15-25% of HIV-positive children are infected from HIV-infected mothers. 3

• Infants born to these mothers may develop the disease within a few months, with 30% affected by the age of 18 months.

• The time for the onset of AIDS in HIV-affected adults varies from 2 months to 20 years or longer; the median time is around 10 years.

• In family practice the most common presentation of HIV-related illness is seen in the skin/oral mucosa. 4

• HIV antibody testing is a two-stage process: ELISA test for screening is followed by another method, e.g. Western blot, if ELISA is positive.

• The seroconversion period from acquiring HIV infection to a positive antibody test varies between individuals: this period is known as the 'window period'.

• All HIV infected patients require regular monitoring for immune function and viral load. The viral load test monitors viral activity.

• The level of immune depletion is best measured by the CD4 positive T lymphocyte (helper T

cell) count—the CD4 cell count. The cut-off points for good health and severe disease appear to be 500/^gmL and 200/^gmL respectively. 1

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