ID - 5-10 - HIV history

new antiretrovirals and knowledge of how to use them.

this was 1996.

CD4 - tells abt current immune status of the pt (usually 1000 in a normal pt)

Viral load - predicts rate of disease progression (basically tells how quickly your cd4 counts will fall)

using both together is a good predictor of medium term prognosis without therapy

kaposi's sarcoma and pneumocystis carinii in yougn gay men.

after 1985.

1 - chimp. most common
2 - sooty mangabee.

1 is the one we are basically talking about. it spreads quicker. some antiretrovirals don't work on two. both give the same disease.

receptive anal, receptive vaginal.

oral is possible but very unlikely.

needle sharing or occupational exposure.

vertical is 25%!!!! the rest are pretty much under 1%.

there are also some postpartum and breast feeding risks.

condoms,screen blood supply, clean needles, antiretrovirals and c section in mother to bes, post exposure antiretrovirals

all ages. yonug adults most commonly though.

black and male.

all regions really.

male to male intercourse is 1

hetero 2

IVDA 3

for females though - hetero is the most common.

1/2

so this is a big issue bc the ignorant ones are the main ones spreading it.

if you take meds well then you usually die of somethign else

often late - within a year of progression to AIDS

this late dx group is often on the margins of health care too (younger, heterosexual, less educated, black or hispanic)

test based on clinical signs of sx

test for all persons in a population

screening a population bc they are at a higher risk

default is to get the testing.

chronic infectio - abs develop 2-8 weeks after the infection.

ELISA first and then confirm with western blot (to p24, gp41 and gp120/160)

ELISA to rule out, western to rule in.

negative means no bands positive.

positive means >= 2 bands positive

indeterminate means 1 band positive (so the pt is either starting to make antibodies or there is a false positive)

detection of HIV RNA (PCR)

note that this is low specificity so we don't use it for chronic infection.