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The risk of occupational infection after exposure to infected blood from needle injuries is less than 0.5% for HIV compared to about 25% for hepatitis B. FINDINGS: The two phases of HIV infection are primary and chronic. The chronic phase has an asymptomatic period followed by a symptomatic period. About 1/2 to 2/3 of patients experience an acute HIV syndrome 1-6 weeks (usually about 3 weeks) after exposure. The illness usually lasts about 10-15 days. Common findings are fever, sweats, lymphadenopathy, sore throat, rash, myalgia, arthralgia, thrombocytopenia, leukopenia, diarrhea, and headache. Less common symptoms are nausea/vomiting, elevated liver enzymes, hepatosplenomegaly, and thrush. About 6% of patients with acute HIV syndrome have neuropathy and encephalopathy. The rash resembles measles, roseola, or urticaria. During the chronic infection, HIV RNA assay can be used to measure the viral load and CD4 counts to measure the risk for opportunistic infections. The average length of the asymptomatic period is about 10 years. AIDS is defined by a CD4 count of less than 200 and an immunocompromised state in which the patient is susceptible to many cancers and infections. Possible indicators of AIDS include generalized adenopathy, chronic diarrhea, generalized herpes simplex, chronic candidiasis, and unexplained weight loss, fever, or dementia. Very common pulmonary diseases affecting AIDS patients are P. jirovecii, S. pneumoniae, H. influenza, and TB. Very common neurological diseases are cryptococcosis, toxoplasmosis, drug reaction, HIV encephalopathy, progressive multifocal leukencephalopathy, and CNS lymphoma. Very common diarrheal diseases are microsporidia, cryptosporidia, M. avium complex, drug side effects, and AIDS enteropathy. [PPID, p. 1465-1720; CCDM, p. 1-9; Lexi-ID, p. 173-5; ID, p. 163, 2363; Merck Manual, p. 246, 733, 1630, 1855, 2341; Guerrant, p. 22; Lederman, RJ, Winshall JS. Tarascon Internal Medicine & Critical Care Pocketbook, 2nd ed. p. 96-7; Stevens LM, Lynm C, Glass RM. HIV Infection: The Basics. JAMA, July 14, 2004--Vol 292, No. 2] |
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