Human Immunodeficiency Virus (HIV) is a retrovirus that targets CD4+ T-lymphocytes, gradually weakening the immune system. If untreated, HIV infection can progress to Acquired Immunodeficiency Syndrome (AIDS), characterized by opportunistic infections and certain cancers.
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Acute (2–4 weeks post-exposure):
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Fever, sore throat, swollen lymph nodes, rash, muscle aches
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Clinical Latency (years):
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Often asymptomatic but ongoing viral replication and gradual CD4 decline
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Progression to AIDS:
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Persistent fevers, night sweats, chronic diarrhea, rapid weight loss, severe fatigue, opportunistic infections (e.g., oral thrush, PCP pneumonia)
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Bloodborne Exposure: Sharing needles or syringes
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Sexual Transmission: Unprotected vaginal, anal, or oral intercourse with an HIV-positive partner
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Perinatal Transmission: From mother to child during pregnancy, delivery, or breastfeeding
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Occupational Exposure: Needlestick injuries in healthcare settings
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Blood Transfusion (rare in screened supplies): Receiving contaminated blood products
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Poor Adherence to ARV Therapy: Missing doses leads to viral rebound and resistance
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Co-Infections: Tuberculosis, hepatitis B/C can accelerate CD4 decline
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High Viral Set Point: Higher initial viral load predicts faster progression
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Malnutrition & Stress: Weaken overall immune resilience
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Substance Use: Alcohol and drugs that impair adherence and immunity
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Screening Tests:
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Fourth-Generation HIV Antigen/Antibody Assay detects p24 antigen and antibodies by ~2–4 weeks post-infection
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Confirmatory Tests:
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HIV-1/HIV-2 Antibody Differentiation Assay
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Nucleic Acid Test (NAT) for viral RNA if early infection suspected
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Baseline Evaluation:
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CD4 Count: Measures immune status
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HIV Viral Load (RNA PCR): Quantifies active replication
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Resistance Testing: Guides regimen selection
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Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs):
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Tenofovir disoproxil fumarate, Tenofovir alafenamide, Lamivudine, Emtricitabine
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Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs):
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Efavirenz, Rilpivirine
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Integrase Strand Transfer Inhibitors (INSTIs):
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Dolutegravir, Bictegravir, Raltegravir
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Protease Inhibitors (PIs):
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Atazanavir, Darunavir (usually boosted with Ritonavir or Cobicistat)
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Entry/Fusion Inhibitors:
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Enfuvirtide, Maraviroc for resistant or salvage regimens
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Fixed-Dose Combinations:
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Single-tablet regimens (e.g., TDF+FTC+DTG) for once-daily adherence
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Pre-Exposure & Post-Exposure Prophylaxis:
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PrEP (e.g., TDF+FTC) and PEP protocols to prevent acquisition or progression after exposure
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Q1: How soon should antiretroviral therapy (ART) start after diagnosis?
A: Current guidelines recommend initiating ART as soon as possible—ideally within days of diagnosis—to preserve immune function and reduce transmission risk.
Q2: Can HIV be cured?
A: There is no definitive cure; ART suppresses viral replication to undetectable levels, but lifelong therapy is necessary to maintain control.
Q3: What does “undetectable = untransmittable” mean?
A: Consistently undetectable viral load on ART prevents sexual transmission of HIV.
Q4: How often are viral load and CD4 counts monitored?
A: Typically every 3–6 months until stable, then every 6–12 months, depending on clinical status.
Q5: What are common side effects of ARVs?
A: Side effects vary by class—NRTIs may cause nausea or renal effects; NNRTIs can cause rash or CNS symptoms; INSTIs are generally well-tolerated but may induce weight gain. Regular monitoring mitigates