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HIV - Coggle Diagram
HIV
Treatment (ART)
Principles
Start ART for everyone, as soon as possible
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Lifelong, adherence is key
NRTIs
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Emtricitabine, lamivudine
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Protease inhibitors
Darunavir, atazanavir, lopinavir
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Preferred regimens
INSTI + 2 NRTIs (e.g. bictegravir/TAF/FTC, dolutegravir + TAF or TDF/FTC)
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Adverse effects
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Efavirenz: vivid dreams, CNS effects
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INSTIs: weight gain, insomnia
Problems
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Drug interactions (boosters, rifampicin)
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Replication cycle
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Blocked by: fostemsavir, ibalizumab, maraviroc
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Error-prone, so rapid mutation
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Blocked by: INSTIs (dolutegravir, bictegravir, cabotegravir, raltegravir)
Latent reservoir persists, hence no cure
- Transcription and translation
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Prevention
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PEP (after exposure)
Start as soon as possible, within 72 hours
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Opportunistic infections
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CD4 <100
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Histoplasmosis, penicilliosis (endemic areas)
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Any CD4
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Herpes zoster, recurrent HSV
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Diagnosis
Screening tests
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Window period: about 18–45 days for lab tests, up to 3 months for older antibody tests
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Baseline work-up
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HBV, HCV, syphilis, TB screening
Renal, liver tests, lipids, glucose
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Monitoring
Viral load: 4–8 weeks after starting, then every 3–6 months
CD4: every 3–6 months, less often when stable
Special situations
HIV and TB
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Start TB therapy first, ART within 2 weeks if CD4 <50, within 8 weeks otherwise
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Coinfections
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HCV: DAAs, high cure rate
Syphilis, HPV, HSV common
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Transmission
Infectious fluids
Blood, semen, pre-ejaculate
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Routes
Sexual (anal highest risk per act, then vaginal)
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Mother to child: pregnancy, delivery, breastfeeding
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Not transmitted by
Casual contact, hugging, sharing utensils
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Raises risk
Other STIs, especially ulcerative
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High viral load, acute infection
Multiple partners, condomless sex
Key populations
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Prisoners, partners of people with HIV
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Long-term complications
Heart and metabolic
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Dyslipidemia, insulin resistance
Weight gain, lipodystrophy
Organs
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Liver disease (coinfection, drug toxicity)
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Neuro and mental health
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Depression, anxiety, substance use
Cancer
Non-AIDS cancers: lung, liver, anal, Hodgkin lymphoma
Virus
Genes
gag: p24 capsid, p17 matrix, p7 nucleocapsid
pol: reverse transcriptase, integrase, protease
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Regulatory: tat, rev; accessory: nef, vif, vpr, vpu
Classification
Retroviridae, genus Lentivirus
Enveloped, 2 copies of +ssRNA (~9.7 kb)
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Types and subtypes
HIV-1 groups M (main), N, O, P
Group M subtypes A–K, plus recombinants (CRFs)
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Target cells
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Macrophages, monocytes, dendritic cells
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Overview
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Types
HIV-1: global pandemic, more virulent
HIV-2: mainly West Africa, slower progression, less transmissible
History
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Virus identified 1983 (Barré-Sinoussi, Montagnier)
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