{"id":10275,"date":"2022-01-28T11:26:49","date_gmt":"2022-01-28T09:26:49","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/infectology\/hiv-infection-malaria\/"},"modified":"2022-01-30T08:08:26","modified_gmt":"2022-01-30T06:08:26","slug":"hiv-infection-malaria","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/infectology\/hiv-infection-malaria\/","title":{"rendered":"HIV infection, malaria"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" id=\"hiv\" class=\"wp-block-heading\" id=\"hiv\" class=\"title_collection title1\">HIV<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">HIV (human deficiency virus) is an infectious disease that leads to a syndrome known as AIDS (acquired immunodeficiency syndrome), severely affecting the body&#8217;s adaptive immune system.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" id=\"phases\" class=\"wp-block-heading\" id=\"phases\" class=\"title_collection title2\">Phases<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\" id=\"phases\">It is a progressive disease that consists of 3 phases:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Infection and acute HIV syndrome<\/strong> (acute HIV, days to weeks). Presents with mononucleosis-like symptoms that start several weeks after infection, and last for several days or weeks.<\/li><li><strong>Asymtomatic phase<\/strong> (chronic HIV, 4-7 years). Progressive decrease in CD4 count (down to 500\/mm^3).<\/li><li><strong>Symptomatic phase<\/strong> (pre-AIDS, 1-3 years). May present with nonspecific symptoms (weight-loss, night sweats, diarrhea), and first evidence of immunodeficiency:<ul><li>Vaginal candidiasis<\/li><\/ul><ul><li>Herpes simplex and zoster<\/li><li>Kaposi sarcoma<\/li><\/ul><\/li><li><strong>AIDS<\/strong>. When the CD4 count is low enough (&lt;200\/mm^3), sever immunodeficiency leads to further opportunistic infections and tumors. <ul><li>Pneumocystis pneumonia (most common)<\/li><li>Oral candidiasis<\/li><\/ul><ul><li>Pneumocystosis<\/li><li>Toxoplasmosis<\/li><li>Cryptococcosis<\/li><li>Cryptosporidiosis<\/li><li>Histoplasmosis<\/li><li>Disseminated mycobacterium avium complex infection<\/li><li>CMV<\/li><li>CNS lymphoma<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" id=\"characteristics\" class=\"wp-block-heading\" id=\"characteristics\" class=\"title_collection title2\">Characteristics<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li>Most commonly due to HIV type 1.<\/li><li>The virus targets CD4 lymphocytes and macrophages.<\/li><li>It is trasmitted through blood, sexual contact, and vertically (mother-fetus).<\/li><li>Increases the risk for several types of tumors:<ul><li>Kaposi sarcoma<\/li><li>NHL<\/li><li>Cervical cancer<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">Commercially-available HIV tests are classified into 4 generations:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>First-generation EIA<\/strong> (~1.5 month after infection)<\/li><li><strong>Second-generation EIA<\/strong> (~1 month)<\/li><li><strong>Third-generation EIA<\/strong> (~3-4 weeks)<\/li><li><strong>Fourth-generation EIA<\/strong> (~2 weeks)<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The first three generations detect antibodies to the HIV virus after seroconversion. The fourth generation also detects the presence of the p24 antigen. Additional information:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Viral load test<\/strong> (PCR RNA) detects the amount of HIV antigens, used for the assessment of HIV therapy.<\/li><li><strong>p24 antigen assay<\/strong> is cheaper but less sensitive than viral load test.<\/li><li><strong>ELISA tests<\/strong> (essentially the EIA tests) are confirmed using a Western blot test.<\/li><li><strong>CD4 count and percentage<\/strong> are used for staging of the disease.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">Antiretroviral therapy includes HAART (highly active antiretroviral therapy) using two NRTIs along with an NNRTI, PO, or INSTIs (see below).<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Nucleoside\/Nucleotide Reverse Transcriptase Inhibitors (<strong>NRTIs<\/strong>)<ul><li>Avacabir, lamivunide, tenofovir<\/li><\/ul><\/li><li>Non-nucleoside Reverse Transcriptase Inhibitors (<strong>NNRTIs<\/strong>)<ul><li>Delavirdine, efavirenz<\/li><\/ul><\/li><li>Protease inhibitors (<strong>PIs<\/strong>)<ul><li>Atazanavir, indinavir<\/li><\/ul><\/li><li>Integrase Strand Transfer Inhibitors (<strong>INSTIs<\/strong>)<ul><li>Raltegravir, elvitegravir<\/li><\/ul><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Treatment of the opportunistic infections includes:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Pneumocystic pneumonia.<\/strong> Trimethoprime\/sulfamethoxazole<\/li><li><strong>Toxoplasmosis<\/strong>. Trimethoprime\/sulfamethoxazole<\/li><li><strong>Tuberculosis<\/strong>. Rifampin, isoniazid, pyrazinamide, ethambutol<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h3 class=\"wp-block-heading\" id=\"malaria\" class=\"wp-block-heading\" id=\"malaria\" class=\"title_collection title1\">Malaria<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<p class=\"wp-block-paragraph\">Malaria is an infectious disease caused by the Plasmodium species.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The disease is endemic to parts of Africa, Asia, and South America.<\/li><li>Presents with fever and chills, abdominal pain, sweating, diarrhea, vomiting, abdominal pain, myalgia, hepatomegaly and jaundice (negative prognostic sign).<\/li><li>Certain conditions render patients to be somewhat immune to some forms of malaria (Duffy blood group, G6PD deficiency, and hemoglobinopathies).<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" id=\"types-and-characteristics\" class=\"wp-block-heading\" id=\"types-and-characteristics\" class=\"title_collection title2\">Types and characteristics<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<p class=\"wp-block-paragraph\">Malaria is classified based on the infectious agent. There are 5 members of the Plasmodium species that are infectious to humans.<\/p>\n\n\n\n<ul class=\"wp-block-list\" id=\"block-9e3de5aa-d8fc-48c8-987d-e1ff53c99251\"><li><strong>P. falciparum<\/strong><ul><li>Most severe form.<\/li><\/ul><ul><li>It causes continuous fever.<\/li><li>It is able to occlude vessels, leading to ischemia in different organs, including the CNS.<\/li><\/ul><\/li><li><strong>P. ovale<\/strong><ul><li>Tertian fever cycles (every 48 hours).<\/li><li>They infect the liver and can remain dormant (hypnozoits).<\/li><\/ul><\/li><li><strong>P. vivax<\/strong><ul><li>Same characteristics as P. ovale.<\/li><\/ul><\/li><li><strong>P. knowlesi<\/strong><ul><li>Zoonotic (from monkeys).<\/li><li>Daily fever cycles.<\/li><li>Relatively severe, may cause death.<\/li><\/ul><\/li><li><strong>P. malaraei<\/strong><ul><li>Quartan fever (every 4th day).<\/li><li>Chronic infection lasting years.<\/li><\/ul><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Apart from P. falciparum and to a lesser degree, P. knowlesi, the rest of the Plasmodium agents are rarely fatal (if no jaundice is present).<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" id=\"diagnosis-1\" class=\"wp-block-heading\" id=\"diagnosis-1\" class=\"title_collection \">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<ul class=\"wp-block-list\"><li>Identify the organism on a thick blood smear, identify the type using a thin smear and Wright-Giemsa stain.<\/li><li>Rapid antigen tests<\/li><li>PCR tests<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h4 class=\"wp-block-heading\" id=\"treatment-1\" class=\"wp-block-heading\" id=\"treatment-1\" class=\"title_collection \">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Artemether-lumefantrine<\/strong> is the most rapidly-active treatment.<\/li><li><strong>Chloroquine <\/strong>in areas without resistance.<\/li><li><strong>Quinine <\/strong>with <strong>tetracycline <\/strong>or <strong>doxycycline <\/strong>in areas with resistance.<\/li><li><strong>Primaquine<\/strong> for P. ovale and P. vivax for the elimination of hypnozoits (not in use in pregnancy or G6PD deficient patients).<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" id=\"hiv\" class=\"wp-block-heading\" id=\"hiv\">HIV<\/h3><h4 class=\"wp-block-heading\" id=\"phases\" class=\"wp-block-heading\" id=\"phases\">Phases<\/h4><h4 class=\"wp-block-heading\" id=\"characteristics\" class=\"wp-block-heading\" id=\"characteristics\">Characteristics<\/h4><h4 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\">Treatment<\/h4><h3 class=\"wp-block-heading\" id=\"malaria\" class=\"wp-block-heading\" id=\"malaria\">Malaria<\/h3><h4 class=\"wp-block-heading\" id=\"types-and-characteristics\" class=\"wp-block-heading\" id=\"types-and-characteristics\">Types and characteristics<\/h4><h4 class=\"wp-block-heading\" id=\"diagnosis-1\" class=\"wp-block-heading\" id=\"diagnosis-1\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" id=\"treatment-1\" class=\"wp-block-heading\" id=\"treatment-1\">Treatment<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>HIV HIV (human deficiency virus) is an infectious disease that leads to a syndrome known as AIDS (acquired immunodeficiency syndrome), severely affecting the body&#8217;s adaptive immune system. Phases It is a progressive disease that consists of 3 phases: Infection and acute HIV syndrome (acute HIV, days to weeks). Presents with mononucleosis-like symptoms that start several [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":10247,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-10275","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>HIV infection, malaria &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/infectology\/hiv-infection-malaria\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/infectology\\\/hiv-infection-malaria\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/infectology\\\/hiv-infection-malaria\\\/\",\"name\":\"HIV infection, malaria &#8211; 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