HIV

• Modes of transmission for HIV

  • Sexual activity
  • Needle sharing
  • Maternal
  • Transfusion/transplant
  • Increased risk if mucosal tear
  • Active STI
  • Local inflammation
  • Ulcerative genital diseases
  • Early stage HIV has high viral load
  • Perinatal exposure
• High risk populations for HIV

  • MSM
  • Sex workers
  • IVDU
• Health care workers (HCW) are at risk for occupational exposure
• Transmission risk for HCW


  • Unsuppressed patients with high viral load
  • Hollow bore needles
  • Deep puncture wounds
  • Sharps
  • Non-intact skin
• Treatment for occupational exposure


  1. TX in 1-2 hours

  2. No later than 72 hours

  3. Will treat if high risk after 72 hours
• Treatment for occupational exposure

  • Truvada QD x4 weeks plus Tivicay or Isentress
• Clinical manifestations of HIV infection

  • Sweat
  • Diarrhea
  • Weight loss
  • Wasting
  • Dementia
  • Aseptic meningitis
  • Neuropathy
  • Fatigue
  • Myalgia
  • Rash
  • Headache
  • Pharyngitis
  • Cervical adenopathy
  • Night sweats
  • Nausea/Vomiting
  • Oral/genital ulcers
  • Elevated LFTs
  • Thrombocytopenia
• Symptoms onset 2-6 weeks post-infection
• AIDS defining diseases


  • Low CD4 of <200 or 14%
  • Kaposi’s sarcoma
  • Anemia
  • Pneumocystis
  • Non-Hodgkin’s lymphoma
  • CNS lymphoma
  • Invasive cervical cancer
  • Wasting
  • Liver disease
  • Oral lesions
  • Oral hairy leukoplakia
  • Candida
  • TB
  • Bacterial pneumonias
  • Pulmonary Kaposi sarcoma
  • Meningitis
  • Myelopathy
  • Toxoplasmosis
  • CMV encephalitis
• Means of prevention recommended for HIV infections


  • Success of treatment monitored by viral load in plasma (goal is <50 copies/mL)
  • Increase in CD4+ T-lymphocyte count to normal range
  • Goal of treatment is to reduce morbidity and mortality and prevent transmission
• Treatment considerations


  • Patient adherence is crucial as skipping doses has a direct correlation with HIV drug resistance
  • Need combination of 3-4 medications
• Types of HIV medications

  • Combo Meds
  • NRTIs
  • NNRTIs
  • Protease Inhibitors
  • Integrase Inhibitors
  • Fusion Inhibitors
  • CCR5 Antagonists
  • CD4 Post-Attachment Inhibitor
  • CYP3A Inhibitors
• Treatment for HIV is expensive