In the 1980s, the primary concern was identification and treatment of advanced HIV disease and AIDS. Whereas in the 1990s, emphasis is on the early diagnosis of HIV infection, starting treatment to suppress it and delay progression to AIDS.
HIY infection is a chronic viral infection that gradually destroys the immune system. It is a chronic medical condition like diabetes or hypertension. Today the management of HIV infection involves:
1.Good doctor patient communication,
2,Careful observation.
3.Laboratory monitoring.
4 Staging of disease progression.
5 Appropnate therapy and prophylaxis.
The spectrum of HIV infection ranges from asymptomatic HIV infection to AIDS. The rate of progression is determined by many factors, The experience shows that progression of HIY infection does not follow a well defined path. This disease evolves through four Stages established by specific laboratory markers combined with clinical signs and symptoms,
1,Primary or acute HIV infection The primary may be associated with a flulike viral disease within 2 to 4 weeks of exposure. The CD4 cell count may drop dramatically.
- Asymptomatic HIV infection It is a long period with slow, persistent erosion of the immune sys tem with decline in CD4 cell counts.
3.Mildly symptomatic HIV dis ease This is charactenzed by constitutional symptoms like fever, weight loss, diarrhea, night sweats and fatigue. They may also, have oral thrush, herpes or skin manifestations.
4 Advanced HIY disease this is a late stage characterized by the development of life threatening opportunistic infections and malignancies. The CD4 cell count continues to decline, Wasting and dementia occur in many individuals.
The patient with HIV infection may remain relatively free of clinical symptoms for several years. Those with stable CD4 counts above 500 should see a physician ever3 to 6 months. The frequency should be increased if the level goes below 500. The CD4 lymphocyte count is the single most powerful tool in tracking progressive deterioration of immune function in HIV disease. Prophylaxis:
There is considerable research going on to come up with vaccine which may be given to at risk individuals, At the present time no such vaccine is available, and prophylaxis is given to HIV patients to delay the progression of the disease.
When the CD4 cell count drops to 500 cells/cubic mm, initiation of Zidovudine commonly known as AZT is indicated for both asymptomatic and symptomatic individuals. The complete blood count is monitored closely.
A CD4 cell count of 200 cells/ cubic mm is the signal to begin prophylaxis for Pneumocystiscarinii pneumonia (PCP). Various medications for this purpose include Septra or Pentamidine.
Treatment:
As with other viral diseases, the traditional treatment consist of supportive and symptomatic therapy while the immune system copes with the invading virus.
Zidovudine (AZT) in the dose of 500 or 600 mg /day is the only agent licensed for treatment of HIV infection. It protects uninfected cells from HIV infection. Other medicines active against HIV include ddc and ddi, available to individuals who cannot tolerate AZT. Investigational drugs under clinical trials are d4T, AzdU and TIBO derivatives.
Since there is no cure, HIV infection must be suppressed to delay or prevent complications. Opportunistic Infections:
Suppressing the HIV infection with AZT or other medicines slows the development of immune dysfunction and delays the appearance of the life threatening opportunistic diseases both infections and cancers, characteristic of advanced HIV disease or AIDS. Common infections are PCP, Toxo, Giardia, Candida, Histoplasmosis, Tuberculosis, Bacterial infections, CMV, Herpes etc. whereas cancers include Kaposi’s sarcoma or lymphoma.
Chemoprophylaxis is very important because pathogens in advanced HIV disease can often be controlled or suppressed but not eradicated in the immunocompromised host.
Healthcare Professionals:
HIY is transmitted by percutaneous inoculation or contact of an open wound, non-intact skin, blood or blood contaminated body flu ids. In healthcare settings, there is exposure to blood and other body fluids, sharp objects such as needles used in patient care, healthcare workers should take prudent steps to minimize their exposure to HIV,
Healthcare workers exposed to HIV should be counseled about transmission of HIV and should be tested for antibody to HIV immediately to establish a baseline and then at6 weeks, 12 weeks and 6monthsafterexposure. The policies on post exposure prophylaxis with AZT vary widely at different institutions. National AIDS hotline (24 hours a day) 1800342AIDS (18003422437) This information provides a general overview on AIDS and may not apply in each individual case. Consult your physician to deter mine whether this information can be applied to your personal situation and to obtain additional information.
Article extracted from this publication >>July 2, 1993
