Prevalence of AIDS and HIV infection

Certain individuals are 'at risk' of infection:

and heterosexual partners

- Babies born to infected individuals

- Recipients of blood products, e.g. haemophiliacs.

The incidence of HIV infection in 'at risk' groups varies considerably. Sex education, supply of clean needles to addicts, active drug-dependence programmes and specific precautions in the preparation of blood products are necessary to limit its spread. Current prevalence of HIV - USA 140/million (New York 991/million).

CLINICAL COURSE OF HIV INFECTION

ACUTE INFECTION

± glandular fever-like symptoms

Seroconversion to

HIV antibody + ve (4-12 weeks)

ASYMPTOMATIC

Detected on antibody screening

- counselling _

- prevention of spread

PERSISTENT GENERALISED LYMPHADENOPATHY

months or years

AIDS RELATED COMPLEX (ARC)

Symptoms -

- weight loss

- diarrhoea

- lethargy

- minor opportunistic infections, e.g. impetigo, oral Candida

Symptoms

Range of severe opportunistic infections and tumours. Presenting illness:

- PNEUMOCYSTITIS CARINII PNEUMONIA - 50%

- KAPOSI'S SARCOMA (multiple violaceous skin lesions) - 20%

CNS LYMPHOMA NON-HODGKIN LYMPHOMA

- hyperplasia of neck lymph glands

Investigations

- HIV isolation

- lymphopenia

- thrombocytopenia

- lack of response to skin antibody tests

Investigations

Results as in ARC but cellular immunity impaired. - T cell lymphocyte suppression especially CD4 (helper subset) with reversal of normal CD4: CD8 ratio

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