Chapter 51 Sexually Transmitted Infections: Human Immunodeficiency Virus
INTRODUCTION
Description: Infection by the human immunodeficiency virus (HIV) preferentially involves the immune system and leads to progressive deterioration in immune function. Infection produces a spectrum of disease that progresses from a clinically latent, asymptomatic state to acquired immune deficiency syndrome (AIDS) as a late manifestation. The speed of this progression varies. In untreated patients, the time between infection and the development of AIDS ranges from a few months to 17 years (median: 10 years). Women make up the fastest-growing group of individuals with HIV. Many states have specific laws governing HIV screening, reporting, disclosure, and breach of confidence. All care providers should become familiar with the requirements imposed in their area.
Predominant Age: Median age 35 years; 84% of cases occur at ages 15 to 44. In the United States in 2004, HIV/AIDS was the leading cause of death among African American women ages 25 to 34 years.
ETIOLOGY AND PATHOGENESIS
Causes: Infection with HIV, a retrovirus that preferentially infects helper lymphocytes but may infect macrophages, cells of the central nervous system, and possibly the placenta. Incubation from infection to clinical symptoms ranges from 5 days to 3 months, with an average of 2 to 4 weeks.
Risk Factors: Sexual activity (multiple partners or infected partner—37% of all infections), parenteral exposure to blood (sharing needles, inadvertent needle stick), perinatal exposure of infants. There is no evidence that HIV infection may be transmitted by casual contact, immune globulin preparations, hepatitis B vaccine, or contact with biting insects. HIV infection following donor insemination has been reported.
CLINICAL CHARACTERISTICS
Signs and Symptoms
• Nonspecific symptoms, often mimicking mononucleosis with aseptic meningitis (90%) (Febrile pharyngitis is the most common, with fever, sweats, lethargy, arthralgia, myalgia, headache, photophobia, and lymphadenopathy lasting up to 2 weeks.)
• Signs of loss of immune function: fever, weight loss, malaise, lymphadenopathy, central nervous system dysfunction, abnormal Pap test result, recurrent cervical intraepithelial neoplasia (CIN), oral or vaginal candidiasis
