HIV

Overview

  • Infection with HIV causes chronic immune deficiency which, if untreated, leads to acquired immunodeficiency syndrome (AIDS) after a variable period but on average 10 years after infection.
  • HIV infection is treated by combination antiretroviral therapy (ART) which is life-long.
  • Current evidence suggests that all people living with HIV should start ART as soon as possible after diagnosis. 
  • All patients need regular monitoring visits to assess their immune status, to check on response to therapy and to provide psycho-social support.

Cause

Infection with human immunodeficiency virus (HIV), a single-stranded RNA virus.

Clinical presentation

Symptoms

Acute infection: (in 70% of patients) fever, rash, lymphadenopathy, pharyngitis, myalgia, diarrhoea, about 2 weeks after exposure

Asymptomatic infection: for several years following infection

Immune deficiency: multiple symptoms related to declining CD4 T-cell count such as oral thrush, diarrhoea, weight loss, skin infections, herpes zoster

Complications

AIDS: opportunistic infections such as Pneumocystis (carinii) jiroveci pneumonia, oesophageal candidiasis, cerebral toxoplasmosis and cancers such as Kaposi’s sarcoma

Diagnosis

Decision making tool for HIV

TestSite/SpecimenConsideration
HIV Ag/Ab

Blood

Usually lab will perform a combination HIV Ag/Ab test, usually reactive within 6 weeks of infection but occasionally longer

Western blot

Blood

Confirmatory test

HIV p24 antigen

Blood

High during HIV primary illness

CD4 lymphocyte

Blood

Marker of immune function, usually >500

HIV RNA (viral load)

Blood

Maker of HIV level in serum, should be undetectable if on treatment

HIV point of care test

Blood/saliva

Point-of-care testing with result in 10– 20 minutes but less sensitive or specific than standard test

HIV Ag/Ab – Human immunodeficiency virus antigen/antibody

Investigations

 

Management

See the Antiretroviral Guidelines for more information about treatment options.

Treatment advice

Patients will need considerable advice and support regarding the long-term nature of therapy and the importance of good adherence. See the Antiretroviral Guidelines for more information.

Other immediate management

Special treatment situations

Special considerations

  • Patient unwell consider urgent referral to hospital or specialist centre for assessment.
  • All complex situations should be managed in collaboration with a specialist.
SituationRecommended
Co-infection with hepatitis B or hepatitis C May need to modify treatment choice. Seek specialist advice
Pregnant women 
pregnancy
Should start ART – complex. Seek specialist advice
Allergy to treatment

Check HLAB57 status prior to use of abacavir

HIV primary illness

Urgent commencement of ART

CD4 <200 High risk for opportunistic infection needs urgent treatment. May need chemoprophylaxis with co-trimoxazole/fluconazole - seek specialist advice.
ART – Antiretroviral therapy

Contact tracing

See Australasian Contract Tracing Manual - HIV  for more information.

Follow up

Auditable outcomes

• 100% of patient should have contact tracing performed.
• 100% of patients should be offered treatment at the time of diagnosis.

Last Updated: Wednesday, 11 July 2018