HIV Infections and AIDS

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Acquired Immune Deficiency Syndrome (AIDS) is a late stage of infection with the Human Immune Deficiency Virus (HIV). It can affect both adults and children often predisposing them to opportunistic infections and certain malignancies. Co-infection with tuberculosis (TB) and Hepatitis B are particularly frequent in HIV infected individuals and must be screened for in all cases. 

The main risk factors for HIV/AIDS remain transmission by exchange of body fluids and blood products through sexual contact, transfusion, needle-stick injury, non-sterile surgical practices and mother to child transfer.

HIV infection is currently not curable. However, for persons living with HIV infection (PLHIV), effective anti-retroviral therapy (ART) is available country-wide at accredited centres at the regional and district level in both public and private health care facilities to which all diagnosed patients must be referred. 

Prevention of infection remains the key to reducing its spread.  

Cause

  • Human Immunodeficiency Virus 

Symptoms

  • Persistent cough 
  • Persistent or recurrent diarrhoea 
  • Weight loss 
  • Skin rashes 
  • Persistent or recurrent fever 
  • Mouth ulcers 

Signs

  • Weight loss 
  • Chronic diarrhoea
  • Prolonged fever
  • Generalised lymphadenopathy
  • Oropharyngeal candidiasis 
  • Persistent cough 
  • Generalised dermatitis 
  • Recurrent herpes zoster (adults)
  • Chronic progressive and disseminated herpes simplex infections (adults)
  • Finger nail changes e.g. blue discoloration of the nails (adults)
  • Failure to thrive or slow growth (infants and children)
  • Recurrent common infections e.g. otitis media, pharyngitis (infants and children)

Investigations

  • Confirmatory HIV test (HIV1, HIV2, HIV1 and 2)
  • HIV Viral load
  • CD4 count
  • Other tests as required (See Table below)

Other baseline tests for HIV 

Haematological test

Full blood count

Biochemical test

Blood Urea

Electrolytes and Creatinine

Liver Function tests

Fasting Blood Sugar

Cholesterol and lipid profile

Routine examinations

Urinalysis (Urine R/E)

Stool R/E

Respiratory examinations 

TB screening

Chest X-ray

Serological Test

Serological Test Hepatitis B Surface antigen

Supplementary tests
These tests are performed depending on signs and symptoms

Histology on skin and lymph node biopsy

Kidney biopsy

Screening for STIs

Pregnancy test

Pap smear, HPV DNA

TreatmentTreatment Objectives

  • To suppress HIV replication to as low as possible and for as long as possible
  • To preserve and enhance the immune function (CD4 restoration)
  • To improve quality of life
  • To reduce morbidity and mortality related to HIV 
  • To promote growth and neurological development in children  

Pharmacological treatment Standard Treatment 

1st Line Treatment 

Standard Treatment (1st Line Treatment) for HIV-AIDS

Medicines

Caution 

Comment

Preferred Regimen

Tenofovir (TDF) +  Lamivudine (3TC)  (or Emtricitabine) +  Efavirenz (EFV)

Caution with 
Tenofovir in renal 
dysfunction

Monitor renal function including urinalysis

Alternative Regimen

Tenofovir + Lamivudine  (or Emtricitabine (FTC))  + Nevirapine (NVP)

Caution with 
Tenofovir in renal dysfunction
Nevirapine is 
contraindicated in liver dysfunction and NVP hypersensitivity

Monitor renal function including urinalysis

Stop NVP if client develops jaundice or severe rashes and refer to ART centre for further management.

Zidovudine (AZT) + Lamivudine (3TC) + Nevirapine (NVP) 

Zidovudine is 
contraindicated in severe anaemia Nevirapine is 
contraindicated in liver dysfunction and  NVP hypersensitivity

TDF to be used where Hb is < 8 g/dL or drops >25% from the baseline  value in a client on AZT.

Stop NVP if client develops jaundice or severe rashes and refer to ART centre for further management

Zidovudine (AZT) + Lamivudine (3TC) + Efavirenz (EFV)

Zidovudine is 
contraindicated in severe anaemia

TDF to be used where Hb is < 8 g/dL or drops >25% from the baseline  value in a client on AZT.

2nd Line Treatment

Standard Treatment (2nd Line Treatment) for HIV-AIDS

 

Medicines

Comments

First Alternative

Zidovudine + Lamivudine (or Emtricitabine) +  Lopinavir/r (or 
Atazanavir/r)

If TDF based first line. If LPV/r was used for HIV2 in first line, use ATV/r

Second Alternative

Tenofovir +  Lamivudine (or Emtricitabine) + Lopinavir/r (or Atazanavir/r)

If ZDV based first line. Consider Abacavir if patient has used both Tenofovir and Zidovudine

Special conditions

Standard Treatment in special conditions for HIV-AIDS

Condition

Recommendation

Comments

HIV co-infection with Hepatitis B. (See section on ‘Hepatitis B’)

The recommended regimen shall be: Lamivudine + Tenofovir + Efavirenz

Lamivudine and Tenofovir are active against both HBV and HIV 

Dual HIV-1 and HIV-2 or  HIV-2 infections

Due to the ineffectiveness of non-nucleoside drugs (Nevirapine and Efavirenz) in HIV-2 infection combination of nucleosides and protease inhibitors such as LPVr or ATV/r should be used. 

 

Referral Criteria

  • Refer all HIV positive patients to an accredited treatment centre in Ghana.