HIV INFECTION: DETECTION,
INITIAL MANAGEMENT AND REFERRAL
Infection with HIV produces a spectrum of disease that progresses from a
clinically latent or asymptomatic state to AIDS as a late manifestation. The
pace of disease progression is variable. The time between infection with HIV
and the development of AIDS ranges from a few months to as long as 17 years
(median: 10 years).
Most adults and adolescents infected with HIV remain symptom-free for long
periods, but viral replication is active during all stages of infection,
increasing substantially as the immune system deteriorates.
AIDS eventually develops in al-most all HIV-infected persons; in one study
of HIV-infected adults, AIDS developed in 87% (95% confidence interval
[CI]=83%–90%) within 17 years after infection. Additional cases are
expected to occur among those who have remained AIDS-free for longer periods.
Greater awareness among both patients and health-care providers of the risk
factors associated with HIV transmission has led to increased testing for HIV
and earlier diagnosis of the infection, often before symptoms develop. The
early diag-nosis of HIV infection is important for several reasons. Treatments
are available to slow the decline of immune system function.
HIV-infected persons who have altered immune function are at increased risk
for infections for which preventive measures are available (e.g., Pneumocystis
carinii pneumonia [PCP], toxoplasmic encephalitis [TE], disseminated
Mycobacterium avium complex [MAC] disease, tuberculosis [TB], and bacterial
pneumonia). Because of its effect on the immune system, HIV affects the
diagnosis, evaluation, treatment, and follow-up of many other diseases and may
affect the efficacy of antimicrobial therapy for some STDs.
Finally, the early diagnosis of HIV enables the health-care provider to
counsel such patients and to assist in preventing HIV transmission to others.
Proper management of HIV infection involves a complex array of behavioral,
psychosocial, and medical services. Although some of these services may be
available in the STD treatment facility, other services, particularly medical
services, are usually unavailable in this setting.
Therefore, referral to a health-care provider or facility experienced in
caring for HIV-infected patients is advised. Staff in STD treat-ment facilities
should be knowledgeable about the options for referral available in their
communities. While in the STD treatment facility, the HIV-infected patient
should be educated about HIV infection and the various options for HIV care
that are available.
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