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The number of children living with HIV has increased from 1.5 million to 2.5 million since 2001, with over 90% living in resource-poor countries. In the last 2 years, however, the rates of new infections and mortality due to AIDS have started to decrease. This is in part due to the implementation of strategies to prevent mother-to-child transmission during pregnancy, delivery and breast-feeding. In...
With access to highly active antiretroviral therapy (HAART) during pregnancy, most mother-to-child transmissions of HIV may be prevented. Single-dose nevirapine with, if available, 4–7 days of zidovudine plus lamivudine, is an option in resource-limited settings. Pre-labour Caesarean section further reduces transmission with zidovudine monotherapy but not with HAART.
HIV is a treatable condition and the physician should be alert to its varied neurological manifestations at all stages of the disease. Seroconversion can be associated with Guillain–Barré syndrome with characteristic cerebrospinal fluid changes. Tuberculosis can present at any CD4 count. Advanced HIV is associated with a variety of opportunistic infections, including progressive multifocal leukoencephalopathy,...
Approximately one-third of HIV-infected persons in Europe and North America are unaware of their infection. There has been a call for doctors to improve the uptake of HIV testing, and for testing to be ‘normalized’ and incorporated into routine practice. Current screening tests allow the combined detection of HIV antibodies and p24 antigen, and can detect the infection within 6–8 weeks. Simple and...
Prior to the advent of highly active antiretroviral therapy, patients with advanced HIV disease presented with cardiovascular complications such as dilated cardiomyopathy and pericardial effusions. HIV is now a manageable chronic disease with patients more likely to present with complications related to treatment including coronary artery disease, diabetes, dyslipidaemia, lipodystrophy and osteopaenia...
Immunodeficiency, regardless of the underlying cause, is associated with an increased risk of malignancy. In the case of HIV infection, the majority of these cancers are associated with oncogenic virus infection. Whilst the overall risk of all cancers is increased two to three times in people living with HIV infection, there are three AIDS-defining cancers whose relative risk is dramatically higher...
AIDS was first recognized in 1981 and is caused by HIV-1. HIV-2 causes a similar illness to HIV-1 but is less aggressive and restricted mainly to West Africa. In 2007, the World Health Organization (WHO) estimated that there were 33.2 million people living with HIV/AIDS, with 2.5 million new cases (including 330,000 children) and 2.1 million deaths. Whilst the death toll remains high, in the last...
An estimated 33 million people were living with HIV worldwide at the end of 2007. Overall global declines in the rate of new HIV infections and AIDS deaths, notably in sub-Saharan Africa, indicate some successes in prevention and greater access to antiretroviral therapies. Nevertheless, a staggering 2.7 million people became infected with HIV in 2007. Moreover, the declines in some regions were partially...
The world of cardiology continues to evolve at a rapid pace. Novel treatments are continually being developed, proven in clinical trials and absorbed into mainstream practice. Despite this, cardiovascular disease continues to be the main cause of death in the western world. Morbidity from seemingly relatively benign cardiac conditions is also significant. For example, atrial fibrillation and its complications...
The pattern of gastroenterological manifestations of HIV infection has changed greatly since the advent of highly active antiretroviral therapy (HAART). The previous almost inevitable viral, protozoal and fungal opportunist infections now occur only in those presenting with very low CD4 counts. The prompt institution of HAART is probably the most effective treatment for such individuals and with immune...
Respiratory problems continue to be a major burden of disease in HIV-infected patients, with more than 50% suffering at least one respiratory episode. In early HIV infection, respiratory infections are similar to those found in the general population, but more common. Progressive HIV-induced immunosuppression increases the risk of opportunistic infections and tumours. Highly active antiretroviral...
In the 25 years since its identification HIV has become the world’s largest public health problem. The immunodeficiency it causes renders individuals susceptible to a wide variety of opportunistic infections and cancers and from the earliest stages of infection it increases the risks and consequences of infection by the other top infectious killer tuberculosis. Vaccine studies have proved disappointing...
HIV-related liver dysfunction can be categorized as three types: that related to the immunocompromised state, co-infection with hepatitis viruses or drug-related adverse events. A low CD4 lymphocyte count is linked to biliary tract disease caused by cytomegalovirus and cryptosporidia, granulomatous hepatitis with infections such as tuberculosis and leishmaniasis, and malignant hepatic infiltration...
UK national guidelines have been issued for the use of antiretroviral drugs as HIV post-exposure prophylaxis (PEP) following occupational exposure in healthcare workers and, in certain circumstances, after sexual exposure. The evidence that PEP is effective is scanty, but prompt antiviral therapy may reduce the risk of HIV transmission by as much as 80%. The decision to prescribe PEP involves risk...
Expanded treatment options and improved monitoring tools have dramatically improved the prognosis of persons presenting with HIV-1 infection. Five oral and one injectable drug class are now available giving multiple options for managing initial therapy, toxicity and treatment failure. Furthermore, many new therapies show low rates of short- and medium-term adverse events and few serious safety concerns...
Despite the universal applicability of generic codes of ethical and professional conduct in medical practice HIV remains a stigmatizing condition and certain aspects of care require particular consideration. Confidentiality is of particular concern for patients who may be anxious about others being made aware of an HIV diagnosis. At the same time, safe clinical care may require information to be shared...
There are now some 22 drugs available in the UK which can be used in the treatment of HIV infection. Most are given in combination to delay the onset of drug resistance and to improve patient adherence to an often complex regimen. Six combinations of these drugs are also currently available in fixed-dose preparations. The 22 drugs fall into six main categories which act either to prevent the HIV virion...
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