Core Curriculum

While the number of newly diagnosed HIV infections is declining in many countries, the number of people living with HIV continues to increase, largely due to improved access to antiretroviral medications.

HIV can be transmitted in any interaction where blood or bodily fluids are intimately exchanged. That includes sexual contact, injection drug use, and pregnancy, childbirth, and breastfeeding.
 

Effective strategies to prevent HIV transmission combine several types of interventions, including behavioral, structural, and biomedical; targeted at both HIV-infected and HIV-uninfected persons.

After HIV infection occurs, chronic inflammation results in translocation of microbial products across gut mucosa, lymph node scarring, and dysregulation of T-cell homeostasis and antigen presentation.

Antiretroviral therapy (ART) has evolved greatly in the thirty-years since its inception from a single toxic agent to highly tolerable, highly effective, triple-drug therapy.

A complete ARV regimen combines drugs targeting different steps in the HIV lifecycle. Guideline committees examine evidence to recommend first-line and later treatment.

Both US and European HIV treatment guidelines recommend antiretroviral therapy for all HIV-infected persons, starting as soon after diagnosis as the patient is ready. 

Viral-load testing is an important aspect of treatment monitoring. When virologic failure occurs, a regimen may be modified to support continued suppression of viral replication.

HIV-positive pregnant women, infants, children, injection drug users, and older adults present specific and important challenges for treatment and monitoring.

Mediated by mutations allowing HIV replication in the presence of ART, ARV resistance can be transmitted at infection or acquired in periods of nonsuppression.

Drug-drug interactions are common with all classes of the ARVs. Avoiding DDIs may be difficult in patients who have other comorbidities or coinfections.

Understanding the epidemiology and risk factors for renal disease in HIV+ patients helps distinguish among a broad spectrum of renal diseases in this population.

HIV+ persons are at higher risk for bone loss and subsequent fractures than uninfected persons. Demographic, lifestyle, HIV-specific, and ART-specific risk factors contribute to bone loss.

The HIV+ population exhibits a higher prevalence of traditional cardiovascular risk factors, including smoking, poor diet, sedentary lifestyle, substance abuse, stress, and mental illness.

An array of neurologic complications may be caused by, or affected by the HIV virus and its treatment. These issues can impact choice and timing of antiretroviral therapy.

Hepatitis B and hepatitis C are common coinfections in HIV+ patients. Liver disease related to these infections is a frequent cause of mortality in coinfected patients.