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Acquired Immune Deficiency Syndrome (AIDS)

Acquired Immune Deficiency Syndrome (AIDS) is an infectious disease characterized by severe deficits in cellular function. The syndrome is manifested clinically by opportunistic infection and unusual neoplasms. The cause of AIDS is human immunodeficiency virus. The disease has a long incubation period, sometimes it takes up to 10 years or more. Manifestations may not appear until late in the infection.

There is such thing as AIDS-related complex. It is similar to AIDS. AIDS-related complex has two or more symptoms or two or more laboratory findings characteristic of immunodeficiency. The person is not as ill as the person with AIDS but AIDS-related complex may lead to AIDS.

High-risk Groups

Acquired Immune Deficiency Syndrome · Male homosexuals or bisexuals

· Intravenous drug users

· Persons receiving blood transfusions such as haemophiliacs and surgical patients

· Those individuals with frequent exposure to blood and body fluids

· Heterosexual contact with high-risk individuals

· Babies born to infected mothers

Signs and Symptoms

· Weight loss and malaise

· Lymphadenopathy for at least three months

· Leukopenia

· Diarrhea

· Fatigue

· Night sweats

· Presence of opportunistic infections

· Pneumocystis carninii pneumonia – major source of mortality

· Kaposi’s sarcoma characterized by purplish or red lesions of internal organs and skin

· Fungal infections

· Candidiasis

· Cytomegalovirus

Diagnostic Tests

· Enzyme-linked immunosorbent assay (ELISA)

The ELISA determines the response of antibodies to the HIV virus. The assay is also useful in children older than 18 months.

· Western blot

Western blot confirms the presence of HIV antibodies. The test is also useful in children older than 18 months. A positive test in children younger than 18 months indicates only that the mother is infected. Other diagnostic test will be used including the virus culture, polymerase chain reaction for detection of proviral DNA, and p24 antigen detection, which is HIV specific.

· p24 antigen

The test is used to detect HIV antigen in children younger than 18 months. Only a positive result is significant. Two or more positive results are diagnostic for HIV infection.

· CD4+

It is used to assess a child’s immune status risk for disease progression and the need for PCP or pneumocystis carinii pneumonia prophylaxis after 1 year of age.

Supportive therapy

· Prophylaxis

Prophylaxis is provided as prescribed against PCP during the first year of life to the infant born to an HIV infected woman. After 1 year of age, the need for prophylaxis is determined by the presence of severe immunosupression or a history of PCP.

Continued prophylaxis is continued through 12 months of age for children diagnosed with HIV. For HIV-infected children older than 12 months, continued prophylaxis is based on CD4+ counts whether PCP has previously occurred.

· Antiretroviral therapy

The goal is to suppress viral replication to preserve immune function and to delay disease progression.

· Highly active antiretroviral therapy

Combination therapy usually includes two neucleoside analogs which target viral replication during the reverse transcription phase, and a protease inhibitor, which targets viral replication at a different phase.

The therapy is usually prescribed for an HIV infected infant or child who exhibits clinical signs of infection or whose immune status in depressed or for an HIV infected infant younger than 1 year of age when the diagnosis is confirmed.

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