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Upon completion of the chapter, the reader will be able to:
Explain the routes of transmission for human immunodeficiency virus (HIV) and its natural disease progression.
Identify typical and atypical signs and symptoms of acute and chronic HIV infection.
Identify the desired therapeutic outcomes for patients living with HIV.
Recommend appropriate first-line pharmacotherapy interventions for patients with HIV infection.
Recommend appropriate second-line pharmacotherapy interventions for patients with HIV infection.
Describe the components of a monitoring plan to assess effectiveness and adverse effects of pharmacotherapy for HIV infection.
Educate patients about the disease state, appropriate lifestyle modifications, and drug therapy required for effective treatment.
Human immunodeficiency virus (HIV) is the cause of acquired immunodeficiency syndrome (AIDS). HIV primarily targets CD4+ T-lymphocytes, which are critical to proper immune system function. If left untreated, patients experience a prolonged asymptomatic period followed by rapid, progressive immunodeficiency. Therefore, most complications experienced by patients with AIDS involve opportunistic infections and cancers. AIDS occurs when a patient with HIV has a CD4+ cell count below 200 cells/mm3 (200 × 106/L), a CD4+ cell percentage of total T-lymphocytes less than 14% (0.14), or one of the Centers for Disease Control and Prevention (CDC) AIDS defining conditions.1
Although the global incidence of HIV has fallen 39% since 2000, HIV prevalence has increased, largely due to life-extending antiretroviral therapy. Combination antiretroviral therapy (cART) has increased both the length and quality of life for HIV-infected patients; however, to date, there are no treatments that eradicate HIV from the body.2
As of 2016, approximately 36.7 million people are infected with HIV worldwide. Approximately 70% of these cases are in Sub-Saharan Africa, with a prevalence of approximately 4%. In 2016 alone, approximately 1 million people worldwide died from HIV-related illnesses and 1.8 million people were newly infected with HIV. Most of these infections were acquired through heterosexual transmission. As of 2016, women accounted for 48.5% of all people living with HIV worldwide.2
In the United States, at the end of 2014, an estimated 1.1 million persons (aged 13 years or older) were living with HIV/AIDS. Approximately 15% of these are undiagnosed and unaware of their HIV infection and could be unknowingly transmitting the virus to others.3
In 2015, 45% of HIV diagnoses were in African Americans although this population comprises only 12% of the US population. Although HIV/AIDS rates in African American women dropped by 42% from 2005 to 2014, incidence in this population is three times the rate for Caucasian females and four times the rate for Hispanic females.3
PATHOPHYSIOLOGY AND ETIOLOGY