Human Immunodeficiency Virus

Aka: Human Immunodeficiency Virus, HIV Infection, Acquired Immunodeficiency Syndrome, AIDS, Retrovirus, Retroviridae

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II. Definitions

  1. Retrovirus
    1. Virus that generates complementary DNA from RNA via reverse transcriptase enzyme
    2. Virus then inserts its DNA into the host DNA via integrase enzyme
    3. Human Retroviruses include HIV-1, HIV-2 and HTLV
  2. Human Immunodeficiency Virus (HIV)
    1. Single-stranded RNA Retrovirus, a Sexually Transmitted Infection as well as bloodbourne pathogen
    2. HIV 1 is the most common worldwide HIV form and is the major cause of AIDS
    3. HIV 2 causes a similar presentation to HIV 1 and is found in South Africa and India
  3. Acquired Immunodeficiency Syndrome (AIDS)
    1. Acquired Immunodeficiency of cellular Immunity (T-Helper Cell reduction) resulting from HIV Infection
    2. Onset typically occurs years after Acute HIV Infection (esp. delayed with current Antiretroviral therapy)
    3. Complicated by opportunistic infections (e.g. PCP Pneumonia, Tuberculosis, Candidiasis)
    4. Complicated by malignancy (e.g. Kaposi Sarcoma)

III. Epidemiology: Global Statistics: WHO

  1. HIV Prevalence: 36.7 M people worldwide (2015)
    1. Africa alone accounts for 25.5 M cases
    2. Women account for 50% of cases worldwide
    3. Children (age<15) account for 1.8 Million cases worldwide
    4. U.S. Cases: 1.2 M (in 2019)
  2. HIV Incidence: 2.1 M new cases worldwide (2015)
    1. Children (age <15) account for 150,000 new cases per year
  3. AIDS
    1. AIDS Deaths 1.1 M, of which 110,000 were children (2015)
  4. References
    1. (2015) WHO Global Summary (accessed 11/01/2016)
      1. http://www.who.int/hiv/data/epi_core_2016.png?ua=1

IV. Epidemiology: United States Statistics (CDC)

  1. HIV Incidence: 44,000 new cases per year (2014)
    1. Annual new cases has fallen 19% since 2004
  2. HIV new infection rates growing in specific groups
    1. Young persons aged 18 to 24 years
    2. Heterosexual patients
    3. Rural areas
    4. African-American and Latino women
  3. HIV Prevalence
    1. Overall in U.S.: 1.2 Million HIV infected persons as of 2014 (1 in 8 are unaware of status)
    2. Prevalence rate in ages 15-49: 0.6%
  4. AIDS Mortality
    1. Annual deaths due to AIDS: 12,963 deaths (2013)
    2. Leading cause of death in adults ages 25-44 years
  5. AIDS
    1. Incidence: 20,896 new cases per year (2014)
  6. Transmission (as of 2014)
    1. Highest rates of new cases are Men who have Sex with Men
    2. Black heterosexual women also represent a disproportionate number of new cases
    3. New cases in white gay and bisexual men has fallen, while black and latino new cases have risen
    4. Black patients represent 12% of U.S., but account for 44% of new cases per year (2014)
  7. Intravenous Drug Abuse
    1. Accounts for 6% of new cases per year (2014)
  8. Gender
    1. Women living with HIV in U.S.: 284,000 or 23% (in 2012)
    2. Race and Ethnicity (2014)
    3. Caucasian (22% of new cases)
    4. Asian American (2% of new cases)
    5. African Americans (44% of new cases) - disproportionate to 12% of total U.S. population
    6. Latino (24% of new cases) - disproportionate to 17% of total U.S. population
  9. References
    1. (2016) CDC - HIV in the U.S. at a glance (accessed 11/1/2016)
      1. http://www.cdc.gov/hiv/statistics/overview/ataglance.html

V. Pathophysiology

  1. See HIV Exposure
  2. See HIV Transmission
  3. HIV infects T Helper Cells (CD4+ Cells)
    1. CD4+ Cell to CD8+ Cell ratio is normally 2:1
    2. CD4+ Cell to CD8+ Cell ratio drops as low as 0.5 : 1 in HIV and AIDS

VI. Risk Factors

  1. See HIV Risk Factor
  2. See HIV Screening Questions

VII. Findings

  1. See HIV Presentation (Acute Retroviral Syndrome)
  2. See AIDS-Defining Illness

VIII. Labs

  1. See HIV Screening

IX. Course

  1. See HIV Course

X. Complications

  1. See HIV Complications
  2. See AIDS-Defining Illness
  3. See HIV Course

XI. Management

  1. Anti-Retroviral Therapy

XII. Prevention

  1. See Sexually Transmitted Disease
  2. See HIV Preexposure Prophylaxis
  3. See Bloodborne Pathogen Exposure
  4. Regularly screen for Suicidality
    1. Significantly higer risk of Suicidality in patients living with HIV
    2. Tsai (2022) Psychosom Med 84(8): 924-39 [PubMed]
    3. Pelton (2021) Gen Psychiatr 34(2): e100247 [PubMed]

XIII. References

  1. WHO Global Summary (accessed 11/01/2016)
    1. https://www.who.int/data/gho/data/themes/hiv-aids
  2. (2016) CDC - HIV in the U.S. at a glance (accessed 11/1/2016)
    1. http://www.cdc.gov/hiv/statistics/overview/ataglance.html

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