Table of Contents

Series Page

Title Page

Copyright

Contributors

Preface

Chapter 1: Development of the Epidemic

Development of the epidemic (Boxes 1.1 and 1.2)

Acknowledgement

Further reading

Chapter 2: Immunology of HIV-1 Infection

Introduction

Primary infection

Antiviral host immune responses

HIV-1 evasion of host immunity

Immunodeficiency

The response to cART

Further reading

Chapter 3: Viral Assays Used in the Diagnosis and Management of HIV Infection

The diagnosis of HIV infection

The window period

Laboratory-based HIV screening tests

Western blot and line immunoassay

Rapid point-of-care HIV screening tests

Serology tests to detect recent HIV-1 infection

Virology tests for HIV detection and characterization

Viral load

HIV proviral DNA testing

Antiretroviral drug resistance

HIV-1 tropism

Further reading

Chapter 4: HIV Testing: Strategies to Prevent Late Diagnosis

Introduction

Who to test for HIV

Frequency of HIV testing

Which test to use

Pre-test discussion (Box 4.3)

Giving HIV test results

Summary

Further reading

Chapter 5: Clinical Staging and Natural History of Untreated HIV Infection

Introduction

Primary HIV infection (PHI)

Asymptomatic infection

Symptomatic HIV infection before the development of AIDS

Constitutional symptoms

HIV and haematological problems

Non-AIDS diagnoses for which cART has treatment benefit irrespective of CD4 count

Risk of progression and the value of surrogate markers

Further reading

Chapter 6: Routine Assessment and Follow-up of the Newly Diagnosed HIV-positive Individual

Introduction

Interventions and discussion

Follow-up

Further reading

Chapter 7: Tumours in HIV

Introduction

AIDS-defining malignancies

Non-AIDS-defining malignancies

Further reading

Chapter 8: The Lung and HIV

Infections

Malignant conditions

Non-malignant, non-infectious conditions

Further reading

Chapter 9: HIV and Tuberculosis Co-infection

Background and epidemiology

Presentation and diagnosis of active disease

Treatment

Immune reconstitution inflammatory syndrome

TB control

Further reading

Chapter 10: The Gut and HIV

Introduction

Dysphagia and odynophagia

Nausea and vomiting

Diarrhoea

Further reading

Chapter 11: Viral Hepatitis and Liver Disease

Introduction

Hepatitis B co-infection

Hepatitis C co-infection

Immune reconstitution

Liver disease in an HIV-infected patient

Management of end-stage liver disease

Conclusions

Further reading

Chapter 12: Neurological Manifestations

Introduction

Primary HIV seroconversion illness

Asymptomatic HIV disease

Advanced HIV disease

Peripheral nerve disorders in HIV infection

Neurological IRIS syndromes

Further reading

Chapter 13: The Eye and HIV

Introduction

Non-infectious HIV retinopathy

Ocular infection associated with HIV

Malignancy associated with HIV

Drug-induced ocular disease

Further reading

Chapter 14: The Skin and HIV

Introduction

Seborrhoeic dermatitis

Kaposi sarcoma

Pruritic papular eruption/eosinophilic folliculitis

Nodular prurigo

Drug rashes

Human papillomavirus (HPV)

Molluscum contagiosum

Herpes simplex virus

Candidiasis

Tinea infections

Scabies

Syphilis

Penicillium marneffei, Cryptococcus neoformans, Histoplasma capsulatum

Conclusions

Further reading

Chapter 15: The Kidney and HIV

Introduction

Evaluating renal disease in HIV

Acute renal failure

HIV-associated nephropathy

Immune complex kidney disease

Antiretroviral drugs and the kidney

Renal monitoring in HIV infection

Renal replacement therapy

Further reading

Chapter 16: Sexually Transmitted Infections and HIV

HIV as an STI

STIs as a cofactor in HIV transmission

HIV and STI co-infection

Diagnosis and management of STIs

Further reading

Chapter 17: Women and HIV

Psycho-social issues

Natural history

Pregnancy management in the developed world

Pregnancy management in the developing world

Gynaecological care

Further reading

Chapter 18: HIV Infection in Children

Epidemiology

Prevention of mother-to-child transmission

Management

Supportive care

Further reading

Chapter 19: Antiretroviral Drugs

Reverse transcriptase inhibitors

Protease inhibitors

Integrase inhibitors

Chemokine receptor antagonists

Fusion inhibitors

Other treatment modalities

Treatment of chronic adult infection

When to start therapy (Table 19.2)

Choice of therapy

Antiretroviral regimens

Further reading

Chapter 20: Pharmacopoeia of Treatments

The role of cART after diagnosis of an opportunistic infection

Further reading and resources

Chapter 21: Psychological and Mental Health Issues

Psychological wellbeing

Psychological sequelae

Adjustment to diagnosis

Physical health

Treatment regimens

Changes to body shape

HIV-associated neurocognitive disorders

Recognition of psychological symptomatology

Psychological Interventions

Factors impacting on living with HIV

Prevention

Further reading

Chapter 22: Strategies for Preventing HIV Transmission

Introduction

Targeted HIV education

Sexual transmission

Behavioural Interventions

Biomedical and treatment interventions

Risk compensation

Inclusion of people with HIV

High-quality sexual health services

HIV testing

Conclusion

Further reading

Chapter 23: Patient and Community Perspective

Garry Brough

Namatovu Lubega

Late diagnosis

Care and treatment outside of the HIV setting and its implications for HIV patients and their doctors

HIV testing for children

Social and psychological impact: examples of good practice

Chapter 24: The Role of Patient Engagement

Introduction

How can services engage patients? (Box 24.1)

What are the advantages for patients and care providers?

Care providers

Peer support

Representation at management meetings

Workshops

Forums

Newly diagnosed courses

Social events

Conclusions

Index

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First published 1987

Second edition 1991

Third edition 1993

Fourth edition 1997

Fifth edition 2001

Library of Congress Cataloging-in-Publication Data

ABC of HIV and AIDS / edited by Michael W. Adler … [et al.]. – 6th ed.

p. ; cm. – (ABC series)

Rev. ed. of: ABC of AIDS / edited by Michael W. Adler. 5th ed. 2001.

Includes bibliographical references and index.

ISBN 978-1-4051-5700-1 (pbk. : alk. paper)

I. Adler, Michael W. II. ABC of AIDS. III. Series: ABC series (Malden, Mass.)

[DNLM: 1. Acquired Immunodeficiency Syndrome. 2. AIDS-Related Opportunistic Infections. 3. HIV Infections. WC 503]

616.97′92–dc23

2011049093

A catalogue record for this book is available from the British Library.

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Contributors

Michael W. Adler

Emeritus Professor of Genitourinary Medicine/Sexually Transmitted Diseases, University College London Medical School, London, UK

David Asboe

Consultant Physician, Chelsea and Westminster Hospital, London, UK

Paul Benn

Consultant Physician, Mortimer Market Centre, London, UK

John Booth

Specialty Registrar in Nephrology, University College London Centre for Nephrology, Royal Free Hospital, London, UK

Mark Bower

Professor, Department of Oncology, Chelsea and Westminster Hospital, London, UK

Ronan Breen

Consultant Physician, Guy's and St Thomas' Hospital, London, UK

Garry Brough

Bloomsbury Clinic, Mortimer Market Centre, London, UK

John Connolly

Consultant Nephrologist and Honorary Senior Lecturer, Royal Free Hospital, London, UK

Sarah Doffman

Consultant Respiratory Physician, Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Brighton, UK

Simon G. Edwards

Consultant GU/HIV Physician, Camden Provider Services, Mortimer Market Centre, London, UK

Emma Fox

Consultant Physician in Genitourinary Medicine, Kent Community Health Trust, Gate Clinic, Kent and Canterbury Hospital, Canterbury, UK

Patrick French

Consultant Physician in Genitourinary Medicine, Mortimer Market Centre, London, UK

Brian Gazzard

Professor, Imperial College London, London, UK

Anna Maria Geretti

Professor of Virology, Institute of Infection & Global Health, University of Liverpool, London, UK

Richard Gilson

Senior Clinical Lecturer, Centre for Sexual Health and HIV Research, University College London, London, UK

Graham J. Hart

Professor, Director of the Division of Population Health, Faculty of Biomedical Sciences, Centre for Sexual Health and HIV Research, University College London, London, UK

Barbara Hedge

Head of Psychology, St Helens and Knowsley Teaching Hospitals NHS Trust, Merseyside, UK

Elisabeth Higgins

Consultant, Department of Dermatology, Kings College Hospital, London, UK

John Imrie

Assistant Director, Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa; Principal Research Associate, Centre for Sexual Health and HIV Research, University College London, London, UK

Sue Lightman

Professor of Clinical Ophthalmology, Moorfields Eye Hospital, London, UK

Marc Lipman

Senior Lecturer, Royal Free Hospital, University College London, London, UK

Namatovu Lubega

Patient Representative, London, UK

William Lynn

Consultant Physician in Infectious Diseases, Ealing Hospital, London, UK

Hadi Manji

Consultant Physician, National Hospital for Neurology, Queen Square, London, UK

Paddy McMaster

Consultant in Paediatric Infectious Diseases, North Manchester General Hospital, Manchester, UK

Danielle Mercey

Consultant Physician in Genitourinary Medicine, Central and North West London NHS Foundation Trust, London, UK

Robert F. Miller

Professor, Reader in Clinical Infection and Honorary Consultant Physician, University College London Medical School, London, UK

Adrian Mindel

Professor and Head of STI Research Centre, Westmead Hospital, Westmead, Sydney, NSW, Australia

June Minton

Lead Pharmacist HIV/GUM and Infectious Diseases, University College London Hospitals NHS Foundation Trust, Mortimer Market Centre, London, UK

Rachael Morris-Jones

Consultant Dermatologist, Department of Dermatology, Kings College Hospital, London, UK

Mark Nelson

Consultant Physician, Chelsea and Westminster Hospital, London; Senior Lecturer, Imperial College London, London, UK

Mahdad Noursadeghi

Senior Lecturer, University College London, Honorary Consultant University College Hospital, London, UK

Adrian Palfreeman

Consultant, University Hospitals of Leicester, Leicester, UK

Felicity Perrin

Consultant Physician, King's College Hospital, London, UK

Deenan Pillay

Professor of Virology, University College London; Honorary Consultant Virologist at University College London Hospital, University College London, London, UK

Huw Price

Clinical Research Fellow, University College London, London, UK

Chris Sandford

Patient Representative, Mortimer Market Centre, London, UK

Gulshan Sethi

Consultant Physician in Sexual Health and HIV, Department of Sexual Health, Guy's and St Thomas' NHS Foundation Trust, London, UK

Suzy Stokes

Emergency Medicine Trainee, Oxfordshire Deanery, UK

Binta Sultan

Academic Clinical Fellow in HIV and GU Medicine, University College London, Mortimer Market Centre, London, UK

Melinda Tenant-Flowers

Consultant in GU and HIV Medicine at King's College Hospital, Honorary Senior Lecturer at King's College London Medical School, London, UK

Paola Vitiello

Research Assistant, Department of Virology, University College London Royal Free Hospital, London, UK

Laura Waters

Consultant Physician, Mortimer Market Centre, London, UK

Chris Wilkinson

Lead Consultant in Sexual and Reproductive Healthcare, Central and North West London NHS Foundation Trust, Margaret Pyke Centre, London, UK

Ian G. Williams

Senior Lecturer and Honorary Consultant Physician, University College London Medical School, London, UK

Christine Younan

Clinical Fellow, Moorfields Eye Hospital, London UK and Consultant Ophthalmologist, Westmead and Sydney Eye Hospitals, Sydney, Australia

Preface

It is now over 30 years since the first recognized cases of AIDS were reported in the USA. There are estimated to be over 30 million persons living with HIV worldwide. Closer to home, the Health Protection Agency estimated that the number of individuals living with HIV in the UK will exceed 100 000 for the first time in 2012. There have been major advances in HIV therapy and where access to appropriate treatment and care is available, the clinical picture has evolved from a terminal illness to a manageable life-long chronic condition. In resource rich settings the major cause of death is due to the sequelae of late diagnosis. In the UK, it is estimated that a quarter of individuals with HIV are unaware of their infection. In addition, approximately half continue to be diagnosed with HIV at a late stage of infection. Early diagnosis of HIV is paramount, delivering both individual health gains, i.e. prevention of opportunistic infections with associated morbidity and mortality, and public health benefits in the prevention of HIV transmission through behaviour modification.

Following HIV diagnosis in the UK, we can be reassured that the quality of HIV care received is high. Based on London data, 80% of newly diagnosed patients were seen in an HIV clinic within 1 month of diagnosis; 90% had an undetectable viral load (less than 50 copies/mL) 1 year after starting therapy; and 93% of those in care for more than a year had a CD4 count above 200 cells per mm³. Antiretroviral regimens have become more convenient to take with the advent of coformulated medications and greater tolerability. HIV-infected patients spend most of their time out of hospital and in the community. It is likely that primary care will play a greater role in the testing and subsequent management of HIV-infected individuals.

The aim of the sixth edition of the ABC of HIV/AIDS is to provide those healthcare professionals not routinely dealing with HIV-infected patients to develop an up-to-date knowledge base and feel more skilled and comfortable about caring for these patients.

This revised edition not only contains updated chapters but has new sections which reflect the latest recommendations on HIV testing, routine monitoring, antiretroviral treatment and the patient's perspective.

Chapter 1

Development of the Epidemic

B. Sultan¹ and M. W. Adler²

¹University College London, Mortimer Market Centre, London, UK

²University College London Medical School, London, UK

Overview

The commonest mode of transmission of the virus is through sexual intercourse

The growth of the epidemic has appeared to stabilize

HIV continues to exhort a huge public health and economic burden

In 2009, there were 33.3 million people living with HIV worldwide

Sub-Saharan Africa has experienced a disproportionate burden of the global HIV epidemic

10 million people who are eligible for treatment under World Health Organization guidelines are still in need of treatment

Development of the epidemic (Boxes 1.1 and 1.2)

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