Overview
HIV infection caused by the body’s immune deficiency is infectious, can be transmitted through sexual contact, mother-to-child transmission, blood transmission and other ways of transmission can not be cured, but timely treatment can control the progression of the disease is mainly drug therapy.
Definition
Acquired immunodeficiency syndrome is an infectious disease caused by the human immunodeficiency virus (HIV).
It is also known by the name AIDS, which is based on the pronunciation of the abbreviation (AIDS).
HIV, also known as the AIDS virus, targets the body’s white blood cells and attacks the body’s immune system, reducing the body’s ability to fight off infections and diseases, thus making it more susceptible to less common illnesses such as Pneumocystis carinii pneumonia and Kaposi’s sarcoma, as well as increasing the likelihood of developing various infectious diseases such as tuberculosis and candidiasis.
AIDS, the most advanced stage of HIV infection, has no cure and no vaccine to prevent it, but the likelihood of occurrence can be greatly reduced by pre-exposure prophylaxis and post-exposure prophylaxis.
Incidence
Since the first cases of AIDS were identified in the 1980s, approximately 84.2 million people have been infected with HIV and 40.1 million have died from AIDS-related illnesses. In 2021 alone, 650,000 people will die from HIV-related causes and 1.5 million people will be newly infected with HIV.
As of 2021, an estimated 38.4 million people are living with HIV. Of these, 36.7 million are aged ≥15 years, 51.2% are female, and 1.7 million are children aged 0-14 years.
There are obvious regional differences in the global incidence of AIDS, with the heaviest epidemic in Southeast Africa, where more than 50% of the world’s people are living with HIV/AIDS, followed by Asia and the Pacific, where the number of existing infections accounts for about 15.4%, and is on the rise.
By the end of 2020, the number of people living with HIV in China was 1,053,000, with a cumulative total of 351,000 reported deaths. Among new cases, the proportion of older men is increasing year by year.
Due to the great harm of AIDS, China’s law on prevention and control of infectious diseases classifies it as a Category B infectious disease.
Causes
Causes
Acquired Immune Deficiency Syndrome is caused by HIV infection, and the basic conditions leading to its prevalence are threefold.
Source of infection
Patients with the disease and HIV infection are the main sources of infection.
The virus is mainly present in the body fluids (e.g. blood, semen, vaginal secretions, etc.) of patients or asymptomatic HIV carriers.
Transmission
Mainly unsafe sex, blood transmission and mother-to-child transmission.
It is currently believed that air, water, mosquito bites, handshakes, kissing, hugging, sharing swimming pools, eating together, and daily contact with doorknobs do not transmit HIV.
Sexual contact transmission
This refers to sexual contact, including oral sex, between people of the same or opposite sex.
If condoms or other effective protection are not used, the genitals or other mucous membranes of both partners during sexual intercourse may come into contact with body fluids carrying the virus, leading to infection.
Blood Transmission
Infection is caused through contact with blood contaminated with the HIV virus.
Possible routes include blood transfusion, importation of blood products; undergoing organ transplantation, artificial insemination, interventional procedures, etc.; invasive cosmetic procedures such as tattooing, eyebrow embroidery, etc.; sharing of needles for injecting drugs or skin pricking by HIV-contaminated needles.
Mother-to-child transmission
Also known as perinatal transmission, i.e. HIV-infected mothers pass the virus to their babies through the placenta, birth canal, and postnatal breastfeeding during pregnancy, labor, or breastfeeding.
High-risk groups
People of any age, race, gender, or sexual orientation can become infected with HIV, but are at higher risk of contracting HIV if they
Engage in unprotected sex, especially gay men, because the risk of anal sex is higher than the risk of vaginal sex.
Have other sexually transmitted infections (STIs) such as syphilis, herpes, chlamydia, gonorrhea, and bacterial vaginitis, which often lead to breaks in the mucous membranes of the genital skin through which HIV can enter the body.
Use of illegal injection drugs. Since such people often share needles and syringes, the chances of exposure to another person’s blood are greatly increased.
People with multiple sexual partners.
Pathogenesis
The pathogenesis of HIV is a complex process involving multiple cellular and molecular interactions.
Invasion
HIV invades the body’s immune cells, such as helper T-lymphocytes (CD4+ T-cells), macrophages, and dendritic cells, by binding to receptors (e.g., CD4 molecules) on host cells.
Viral Replication
HIV releases genetic material (RNA) inside the host cell, transcribes the viral RNA into DNA by reverse transcriptase, and integrates it into the host cell genome. During this process, the virus begins to replicate in large numbers.
Viral release and dissemination
The newly synthesized viral replicon is released from the host cell and continues to infect other immune cells. At the same time, some of the infected cells begin to apoptose.
Immune system damage
As HIV infection continues and the virus replicates, the number of CD4+ T cells in the immune system gradually decreases, leading to weakened immune system function. Other parts of the immune system are also damaged, such as loss of immune memory and imbalance in immune regulation.
Development of AIDS
When the damage to the immune system reaches a certain level and the immune function is severely impaired, the patient is susceptible to infection with various pathogens that are otherwise harmless to the normal population and to serious infections. In addition, patients are prone to developing malignant tumors and so on. This stage is known as AIDS.
Symptoms
From HIV infection to the onset of disease is a long and complex process, and AIDS is the final stage, which is mainly manifested by HIV-related symptoms, various opportunistic infections and tumors.
Virus-related
As the virus continues to multiply rapidly and destroy the immune system, multiple systemic, hard-to-cure or recurrent infections, or chronic fever, malaise, lethargy, diarrhea, and persistent generalized lymph node enlargement, the cause of which is difficult to detect, may develop.
Complications
Pneumocystis carinii pneumonia or infection of the central nervous system is the direct cause of death in most AIDS patients.
Opportunistic infections
Opportunistic infections are pathogens that can cause infectious diseases when the body is immunocompromised, but are less likely to cause disease when the body is immunocompetent.
Pneumocystis carinii pneumonia: gradual worsening of dyspnea with fever, dry cough, and chest tightness.
Mycobacterium tuberculosis and non-tuberculosis infections: there are symptoms or signs such as fever, night sweats, weight loss, enlarged lymph nodes and anemia.
Cytomegalovirus infection: there are symptoms such as loss of vision, cough, difficulty breathing, diarrhea, abdominal pain, and lethargy.
Others are cryptococcal meningitis, tuberculosis, and toxoplasmosis.
Non-tumor skin and mucous membrane lesions
Skin mucosal lesions can occur in 90% of AIDS patients, with various manifestations, such as non-infectious skin lesions, herpes, warts, oral fungal infections, skin abscesses, etc.
Tumors
Deficient immune function caused by the acquired immunodeficiency syndrome virus increases the risk of tumors, most commonly Kaposi’s sarcoma, which manifests as reddish-blue, purplish-red, or dark brown macules, papules, or nodules on the skin, and also ulcers may form.
There may also be lymphoma, cervical cancer, and oral cancer.
Neurological complications
Such as confusion, dementia, amnesia, depression, anxiety and difficulty walking.
Consultation
Department of Medicine
Infectious Diseases
For symptoms such as fever, diarrhea, skin rash, swollen lymph nodes, etc. after high-risk behaviors (e.g., unsafe sex, sharing of needles for drug use, etc.), it is recommended that you consult a doctor promptly.
Preparation
Consultation: registration, preparation of documents, FAQs
Tips for medical consultation
A full physical examination may be required and loose clothing is recommended.
For skin ulcers, cover and bandage the ulcers with clean gauze before seeking medical attention.
For patients with high fever, physical cooling can be done first, such as applying cold compresses to the forehead and wiping the hands, feet and armpits with lukewarm water.
Checklist for medical preparation
Symptom Checklist
Particular attention should be paid to the time of symptom onset, special manifestations, etc.
What are the symptoms of discomfort and for how long?
What were the symptoms like at their worst, e.g. fever, up to what degree?
Do these symptoms go away on their own? Are there any factors that could alleviate or aggravate them?
Medical History Checklist
Have you ever had a blood transfusion from an unregulated health care facility or a transfusion of blood products from an unregulated source?
Have you ever shared needles, syringes, etc. with others?
Has there been any invasive cosmetic operation such as tattooing, eyebrow embroidery, etc. in an irregular small store?
Does the sexual partner have AIDS?
Have you ever had unsafe sex (including anal sex, oral sex, etc.)?
Checklist
Test results in the past six months, which can be brought to the doctor’s office
Laboratory tests: blood test, T-lymphocyte subpopulation test, HIV nucleic acid test, HIV antibody test
Imaging tests: electrocardiogram, abdominal ultrasound, ultrasound of superficial lymph nodes, CT examination of chest
Diagnosis
The diagnosis of AIDS should be made carefully by combining the epidemiological history, clinical manifestations and laboratory tests in a comprehensive analysis.
Diagnosis is based on
Medical history
There may be high-risk factors, such as a history of unsafe sex, intravenous drug use, and importation of blood or blood products that have not been tested for HIV antibodies.
Clinical manifestations
There may be fever, cough, sputum, nausea, vomiting, abdominal pain, diarrhea, dizziness, headache, and rash.
Laboratory Tests
Mainly include HIV1/2 antibody, HIV nucleic acid, CD4+ T-lymphocyte count, HIV genotypic resistance test, etc. Among them, HIV1/2 antibody test is the gold standard for the diagnosis of HIV infection.
HIV1/2 antibody test
Includes initial screening and confirmatory tests, which are used to confirm or exclude HIV.
Positive initial screening is not a basis for confirming the diagnosis, and further confirmatory tests are required.
A negative result in the confirmatory test may mean that the person is not infected or may be in the window period (infected with the virus but has not yet produced antibodies).
A positive result confirms the diagnosis of HIV infection, based on which the diagnosis of AIDS needs to be made in conjunction with an epidemiologic history, clinical symptoms, or laboratory tests.
HIV Nucleic Acid Test
Can screen for the presence of HIV infection.
A positive HIV nucleic acid test can be used as a secondary indicator and cannot be used alone to diagnose HIV infection.
T-lymphocyte subpopulation test
Can be used as an auxiliary test to confirm the diagnosis of viral infection, and can also be used to evaluate the damage to the body’s immune system, as well as to help doctors determine the timing of treatment and evaluate the effectiveness of treatment.
The main evaluation indexes include CD4+T and CD8+T lymphocyte counts and ratios, CD4/CD8 ratios, and CD8+T cell surface activation marker levels.
Confirmed HIV infection and CD4+T lymphocyte count <200/μL can be diagnosed as AIDS stage.
Imaging examination
Mainly abdominal ultrasound and chest radiographs to check for other infections or complications.
Diagnostic criteria
The diagnostic criteria vary slightly depending on age.
Adults and adolescents aged 15 years (or older)
A diagnosis of HIV infection is confirmed when any one of the following criteria is met.
Unexplained persistent irregular fever of 38 ℃ or higher for more than 1 month;
Diarrhea (stools >3 times/d) for more than 1 month;
Weight loss of more than 10% within 6 months.
Recurrent oral fungal infections.
Recurrent herpes simplex virus infection or herpes zoster virus infection.
Pneumocystis carinii pneumonia (PCP).
Recurrent bacterial pneumonia.
Active tuberculosis or non-tuberculous mycobacterial (NTM) disease.
Deep fungal infections.
Occupying lesions of the central nervous system.
Dementia in young and middle-aged adults.
Active cytomegalovirus (CMV) infection.
Toxoplasma encephalopathy.
Malniffian basket mycosis.
Recurrent sepsis.
Kaposi’s sarcoma, lymphoma.
CD4+ T-lymphocyte count <200 cells/μL.
Children under 15 years of age
Confirmed HIV infection with any of the following.
Percentage of CD4+ T lymphocytes <25% (<12 months of age), or <20% (12 to 36 months of age), or <15% (37 to 60 months of age), or a CD4+ T lymphocyte count <200 cells/μL (5 to 14 years of age).
Accompanied by at least one childhood AIDS-indicating disease.
Differential Diagnosis
原发性CD4+T淋巴细胞减少症
Similarities: decreased immune function, increased opportunistic infections, decreased CD4+ T lymphocytes.
Differences: not caused by HIV infection, distinguishable by viral testing.
Other infectious diseases
Similarities: fever, cough, sputum, abdominal pain, diarrhea, etc.
Differences: Respiratory and digestive infections caused by other viral or bacterial pathogens can also have similar symptoms, but the pathogens are different and the immune function can be unaffected. It can be differentiated by pathogenetic examination, etc.
Treatment
Purpose of treatment:
Maximize inhibition of viral replication to reduce viral load to the lower limit of detection and reduce viral mutation.
Re-establish immune function.
Reduce abnormal immune activation.
Reduce transmission of the virus and prevent mother-to-child transmission.
Reduce the morbidity and mortality of HIV infection, reduce the morbidity and mortality of non-AIDS related diseases, so that patients can have a normal life expectancy and improve the quality of life.
Treatment principle: Once HIV infection is diagnosed, it is recommended to start antiretroviral therapy immediately, regardless of the level of CD4+ T-lymphocytes.
Treatment
There is no cure for HIV, but medications can control the infection and prevent disease progression.
Anti-retroviral therapy
Precautions
Antiretroviral therapy (ART) should be started as soon as possible after the diagnosis of HIV infection, regardless of the stage of infection or complications.
For those diagnosed with AIDS, initiation should be accelerated, if possible on the same day of diagnosis.
After initiating ART, lifelong treatment is required.
Patients with severe opportunistic infections and acute exacerbations of previous chronic diseases need to wait for the opportunistic infections to be controlled and their conditions stabilized before starting treatment.
Classification of drugs
Currently, there are more than 30 drugs in six major classes in the international arena, which are nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), integrase inhibitors (INSTIs), fusion inhibitors (FIs) and CCR5 inhibitors.
Domestic antiretroviral therapeutic drugs are available in five major categories (including combination agents): NRTIs, NNRTIs, PIs, INSTIs, and FIs.
The commonly used drugs are:
NRTIs: such as zidovudine, lamivudine, tenofovir/emtricitabine, etc.
NNRTIs: e.g. nevirapine, efavirenz, etc.
PIs: e.g. lopinavir/ritonavir, darunavir/cobicistat, etc.
INSTIs: e.g. raltegravir, dolutegravir, etc.
FIs: e.g. Ebovitae, etc.
Combination agents: e.g. nevirapine zidoramic acid, dolutegravir, etc.
Treatment regimens
Since each type of drug blocks the virus in a different way, a combination of different types of drugs can better address individual drug resistance (viral genotypes), avoid the development of new HIV-resistant strains, and suppress as much of the virus as possible in the bloodstream. This type of therapy is known as a cocktail, or highly active antiretroviral therapy (HAART).
The recommended regimen for first-treatment patients is a combination of 2 backbone drugs from the NRTIs class in combination with a third drug class, with the choice of the third drug class varying with age.
For adults and children 15 years of age and older, the third drug class can be NNRTIs or enhanced PIs (containing ritonavir or cobicistat) or INSTIs; a combination single-tablet formulation (STR) is also available.
A third class of drugs for pediatric patients can be INSTIs or NNRTIs or enhanced PIs (containing ritonavir or cobicistat).
Clinical evaluation and laboratory testing should be performed periodically during ART to evaluate the effectiveness of ART, to detect adverse reactions to antiviral drugs and the development of viral resistance, and to change drugs in a timely manner to ensure the success of ART.
Evaluation of efficacy
The effectiveness of ART is mainly evaluated through the following three aspects: virological indexes, immunological indexes and clinical symptoms, of which virological changes are the most important indexes.
Virological indicators: plasma viral load should decrease by more than 1 log in 4 weeks after ART in most patients, and viral load should reach undetectable level in 3~6 months after treatment.
Immunologic indicators: Within 1 year after initiation of ART, a 30% increase in CD4+ T-lymphocyte count or an increase of 100 cells/μL compared with pretreatment suggests that treatment is effective.
Clinical signs: The incidence of opportunistic infections and the mortality rate of AIDS can be greatly reduced in patients after ART. For children, height, nutrition and developmental improvement can be observed.
Criteria for drug change
HIV viral load is said to be virologically suppressed if it is less than the lower limit of detection (<20 or 50 copies/mL) after more than 24 weeks of regular antiretroviral therapy. For patients with persistent virologic suppression, regimen modification or optimization may be considered on an as-needed basis, which will need to be determined on a case-by-case basis.
If ART is continued and the plasma viral load is persistently >200 copies/mL 24 weeks after initiation of therapy (initiation or adjustment); or if virologic rebound: a viral load ≥200 copies/mL occurs after achieving complete virologic suppression, it is considered virologic failure, and ART regimen adjustments should be made based on the results of the HIV drug resistance test.
Treatment of complications
When complications occur, antiviral therapy alone is not sufficient. For example, opportunistic infections, such as Pneumocystis carinii pneumonia and tuberculosis, require targeted anti-infective therapy.
Pneumocystis carinii pneumonia
Pathogenic treatment: compound sulfamethoxazole is preferred, orally in mild-moderate patients and intravenously in severe cases. Clindamycin combined with primaquine orally, ampicillin, or combined application of methotrexate can also be used for treatment.
Hormonal therapy: Prednisone may be applied to moderate to severe patients.
Assisted ventilation: assisted ventilation may be used if significant progressive dyspnea is present.
Tuberculosis
The principles of treatment for tuberculosis in HIV patients are the same as those for non-HIV patients.
Therapeutic drugs include isoniazid, rifampicin, rifabutin, ethambutol, pyrazinamide, and depending on the situation, sodium para-aminosalicylate, amikacin, quinolone antimicrobials and streptomycin.
Cytomegalovirus (CMV) infection
Commonly used drugs are ganciclovir, also can use phosphonate sodium.
When the disease is critical or single drug treatment is ineffective, the two can be used in combination.
CMV retinochoroiditis can be injected with ganciclovir after the ball.
Herpes simplex and varicella zoster virus infections
Primary therapeutic agents include acyclovir, famciclovir, valaciclovir, and phosphinothricin, with varying courses of treatment for different sites and types of infection.
Toxoplasmic Encephalopathy
A combination of acetamiprid and sulfadiazine is preferred.
Symptomatic treatment includes cranial pressure lowering, anticonvulsant and antiepileptic.
Fungal infections
Clinically common are Pseudomonas albicans infections and novel cryptococcal infections.
According to the different parts and types of fungi, choose the appropriate drugs, commonly used, such as caspofungin, itraconazole and so on.
Special Reminder
The emergence and application of ART has greatly reduced the number of AIDS-related opportunistic infections and tumors, turned AIDS into a chronic disease that can be treated but is still difficult to be cured, and changed the diagnosis, treatment and care mode of HIV/AIDS patients accordingly.
At present, it is advocated to carry out the whole management of HIV infection, including prevention and early diagnosis of HIV infection, diagnosis, treatment and prevention of opportunistic infections, initiation and follow-up of personalized ART, screening and treatment of non-AIDS-defined diseases, and comprehensive psychosocial care.
Among them, comprehensive psychosocial care is getting more and more attention.
High-risk groups can seek help from local AIDS prevention and treatment organizations, as well as answering counseling questions through the 12320 public health service hotline and WeChat.
Prognosis
Cure
So far, there is no drug that can cure AIDS.
Early detection, early diagnosis, early treatment, adherence to antiretroviral therapy under the guidance of a doctor and regular review can effectively control the virus, improve the quality of life and prolong survival time.
The life expectancy of AIDS patients with standardized treatment and high adherence can be comparable to that of normal people.
Harmful
Impact on life
After HIV invades the human body, it will destroy the immune function of the human body, lowering the immunity of the body and increasing the risk of other diseases of the patient, such as Pneumocystis carinii pneumonia, Toxoplasma gondii encephalitis, brain abscess, Kaposi’s sarcoma and so on.
The fear of disease will bring great psychological pressure and produce many negative emotions, such as depression and anxiety.
At present, discrimination and prejudice against AIDS patients still exist in the society, which can also cause great obstacles to life.
Infection to others
If the virus is inadvertently transmitted to others, they may be infected with HIV or develop Acquired Immune Deficiency Syndrome.
The virus in the mother’s body can be transmitted to the fetus in the womb or to the baby while breastfeeding.
Daily
Daily Management
Dietary management
There are no special dietary contraindications. A light diet with balanced nutrition is sufficient.
Eat less or no excessively oily, sweet or salty food, such as fried food, pastries and cured meat.
Eat more fresh fruits and vegetables, especially foods rich in carotenoids (e.g. sweet potatoes, pumpkin, carrots), vitamin C (e.g. oranges, broccoli), vitamin E (e.g. pine nuts, pistachios) and zinc (e.g. oysters, shellfish, cereals).
Avoid skipping breakfast, partiality and overeating, which cause nutritional imbalance and affect immune function.
Life Management
Pay attention to personal hygiene
Do not share personal items that can easily come into contact with blood, such as manual razors, nail clippers and toothbrushes.
Personal items can be sterilized if necessary, usually by boiling (100°C) or soaking in 70% alcohol (medical alcohol) for 20 minutes , to inactivate the virus.
Have safe sex
People who are receiving antiretroviral therapy (ART) and have no detectable virus in their blood will not transmit HIV to their sexual partners, but protection is still recommended.
Regular sexual partners are recommended and made aware of the condition, and can take psychological and behavioral precautions.
Condoms should be used throughout when engaging in sexual intercourse and not taken for granted.
Spouses should go to the hospital regularly for screening and timely treatment if they are infected with HIV.
Other Precautions
There is no evidence to support that nutritional supplements are helpful in controlling the condition of HIV. Some health foods or medications may even interact with antiviral drugs, thus reducing their efficacy, so it is advisable to consult a doctor before using any nutritional supplements or other medications.
Clearly inform medical staff of your condition of Acquired Immune Deficiency Syndrome when you visit a doctor, especially before undergoing examinations or treatments such as blood draws, gastroscopies, colonoscopies, vaginal exams, anal exams, dental cleanings, extractions, and so on, so as to avoid spreading the disease to others.
Do not perform blood donation, sperm donation, organ donation, etc., which may lead to HIV transmission.
Vaccination is available, but you need to be aware of the type of vaccine – inactivated vaccines are usually safe, and in the case of live attenuated vaccines, you need to seek advice from a medical professional before vaccination.
Exercise
Asymptomatic or mildly symptomatic people can engage in appropriate physical exercise, such as swimming, jogging, etc., but be careful not to overexert yourself.
If the physical condition does not allow the above exercises, you can do activities that are physically possible, such as slow walking and housework.
Meditation and yoga may also help reduce stress and relax.
Psychological support
Whether waiting for diagnosis or after diagnosis, the (suspected) patient and his/her relatives and friends may experience great psychological stress and need to have a correct understanding of the disease and build up confidence in overcoming the disease.
In the meantime, there are many public services and resources available to people living with HIV, and you can contact your local medical and public health organizations for details.
Prevention
Although there is no vaccine to prevent AIDS, it is still considered a preventable disease, mainly by preventing HIV infection.
General prevention
Applies to all people and focuses on reducing the risk of HIV infection by reducing high-risk factors and blocking transmission routes. It includes, but is not limited to, the following measures:
Do not transfuse blood and blood products from unknown sources, and receive blood transfusions in regular hospitals.
Do not share personal items such as toothbrushes, razors, shavers, etc. with others.
Do not share syringes and other hygiene products with more than one person.
Avoid unclean sex and unsafe sex.
Stay away from drugs.
Pre-Exposure Prophylaxis (PrEP)
When faced with a high risk of HIV infection, medication can be taken to reduce the chance of being infected.
Primarily for individuals such as men who have sex with men (MSM), men who have sex with both men and women and men who do not use condoms, transgender people, commercial sex workers, multiple sex partners, people with STIs, people who share needles or syringes or other devices.
Must be done under medical supervision.
Post-exposure prophylaxis (PEP)
People who are not yet infected with HIV can significantly reduce their risk of HIV infection by taking specific anti-HIV medications as early as possible (no more than 72 h) after exposure to a high risk of infection if they engage in definitive bodily fluid exchange behaviors with HIV-infected persons or persons of unknown infection status.
HIV exposure is categorized into occupational and non-occupational exposure.
Occupational exposure
This refers to health care workers or people’s police or other people who are at risk of HIV infection due to contact with blood, tissues or other body fluids of HIV-infected people in the course of their occupational work.
Wash the contaminated area with soap and running water. When contaminating mucous membranes such as the eyes, the mucous membranes should be rinsed repeatedly with large amounts of saline.
When a wound exists, gently squeeze the wound from proximal to distal to squeeze out as much blood as possible from the injury, then rinse the wound with soap and running water, and disinfect the wound locally with 75% alcohol or 0.5% iodophor.
Prophylactic medication is administered for the shortest time possible (within 2 hours if possible), preferably within 24 hours, but not more than 72 hours, for 28 days. The preferred recommended regimen is tenofovir/emtricitabine + raltegravir (or dolutegravir).
Test for HIV antibodies immediately, 4 weeks, 8 weeks, 12 weeks, and 24 weeks after an HIV occupational exposure occurs.
Non-HIV occupational exposure
Refers to HIV exposure that occurs through personal behavior other than occupational exposure.
The principles of exposure assessment and management, especially blockade medication, are the same as for occupational exposure.
Any blockade is carried out and implemented on the premise that the person concerned is voluntary and signs an informed consent form.
Standardized follow-up is emphasized for early detection of infected persons.
Special Reminder
HIV Vertical Mother-to-Child Transmission Interruption
Effective measures to prevent mother-to-child transmission of HIV are: early intervention with ARVs + safe assisted delivery + postnatal feeding guidance.
All HIV-infected pregnant women should receive antiretroviral therapy (ART) as early as possible and for the rest of their lives, regardless of their CD4+ T lymphocyte count or clinical stage of disease.
For pregnant women with established HIV infection, proactive counseling and assessment for prevention of mother-to-child transmission (PMTCT) is provided, and the decision to terminate or continue the pregnancy is made by the mother and her family on the basis of informed consent.
For HIV-infected pregnant women who choose to terminate their pregnancies, safe artificial termination of pregnancy services should be provided, and surgery should be performed as early as possible to minimize the occurrence of complications.
For pregnant women who choose to continue the pregnancy, they should be given high-quality counseling on pregnancy care and postpartum breastfeeding, and appropriate interventions should be taken.
Artificial feeding should be promoted for children born to HIV-infected mothers, avoiding breastfeeding and eliminating mixed feeding.
For those who have the conditions for artificial feeding, artificial feeding should be provided as much as possible, and guidance and support should be given.
For infected mothers and their families who choose breastfeeding because artificial feeding is not available, they should be fully counseled and instructed to insist on proper exclusive breastfeeding, and to adhere to ART throughout the period of breastfeeding, preferably for a period of no more than 6 months.
Birth choices for single-positive families
ART for the HIV-positive partner with sustained viral suppression is the key to preparing for pregnancy in HIV mono-positive families.
For male-to-female families, either spontaneous insemination at ovulation or in vitro fertilization may be an option if the female partner is receiving ART and has sustained viral control.
In male-positive female-negative families, natural conception at ovulation may also be possible after the male partner has undergone ART and the virus is consistently controlled. Spousal transmission of HIV is not thought to occur in this situation.
Consult your specialist for details.