Acute retroviral syndrome
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Acute Retroviral Syndrome. Dr. Jennifer Veltman. Acute Retroviral Syndrome (ARS). Definitions Epidemiology Basic course of Primary HIV Symptoms Diagnosis Treatment. What is Acute Retroviral Syndrome???. Definitions:.

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Acute Retroviral Syndrome

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Acute Retroviral Syndrome

Dr. Jennifer Veltman


Acute Retroviral Syndrome (ARS)

  • Definitions

  • Epidemiology

  • Basic course of Primary HIV

  • Symptoms

  • Diagnosis

  • Treatment


What is Acute Retroviral Syndrome???


Definitions:

Acute HIV Infection: Phase of HIV disease immediately after infection during which the initial burst of viremia in newly infected patients occurs: anti-HIV antibodies are undetectable at this time, while HIV RNA or p24 antigen are present.

Recent Infection: considered the phase up to 6 months after infected during which anti-HIV antibodies are detectable.

Early HIV: either acute or recent HIV infection

Acute retroviral syndrome: patient w/ acute HIV infection w/ symptoms.


Epidemiology

  • 1/2 -2/3 of people infected with HIV develop ARS

  • Reported more in those infected via sexual exposure or health care related (needle stick) compared to IVDU

  • Onset 1-6 weeks after exposure. Peak onset is 3 weeks after exposure.


  • Day 0

    • exposed to HIV, and infection begins.

  • Day 8

    • virus is detectable in blood using (PCR)

    • antibody test are negative.

    • amount of virus in the blood more than doubles every day.

    • The CD4 cell count (and total white blood cell count) begins to drop

    • Weeks 2-9

      • viral load peaks and begins to decline as the immune system begins to battle the virus

      • highly infectious!!!

  • Weeks 10-24

    • HIV viral load drops to its lowest point, also known as the set point, which is different in each person.

    • antibody tests become positive for HIV. Seroconversion is now complete, and chronic HIV infection begins.


Window period


What are the symptoms of Acute Retroviral Syndrome?


Symptoms


What are some other diseases that can cause similar signs/symptoms?

  • “MONO” (EBV or CMV infection)

    • Sore throat, fatigue, enlarged glands, fever, muscle or joint aches, rash, enlarged liver/spleen, elevated liver enzymes, low platelets

  • Influenza

    • Muscle aches, fevers, nausea, vomiting, diarrhea, fatigue

  • Acute HSV (Primary Herpes Infection)

    • Fever, fatigue, sore throat, headache, rash, sore muscles, enlarged glands near ulcer

  • Secondary Syphilis

    • Fatigue, headache, poor appetite, nausea, joint aches, fever, (rarely) meningitis and liver inflammation

  • Acute Hepatitis

    • Fever, fatigue, elevated liver enzymes, enlarged liver


  • Symptoms resolve 10-15 days

  • Acute opportunistic infections have been reported

    • Examples: P. jirovecii pneumonia, Cryptococci meningitis, and Candida esophagitis.

    • Likely caused by the depression of the CD4+cell count generally seen in acute HIV infection.


Diagnosis:

  • high-level HIV RNA viral load in the absence of anti-HIV antibodies.

    • (+)viral load. (–)ELISA

  • ELISA remains negative for an average of 2 to 6 weeks after the onset of symptoms, despite the appearance of specific antibodies on a Western blot of the patient’s serum.

  • If VL <10,000, may be false positive b/c usually VL >100,000 copies/mL

  • Pt should have elisa repeated over next 3-6 months to document seroconversion


Should your patient get on treatment?


Pros of starting treatment during Acute Retroviral Syndrome

  • Pros:

    • evidence treatment initiated during acute retroviral syndrome may lower the viral set point, which can affect disease progression rates in the event therapy is stopped

    • Decreases mortality

    • Reduce viral reservoir

    • Decrease rate of viral mutation by suppressing viral replication

    • Prevent immune destruction

    • Symptom relief

    • Public health, reduces transmission to serodiscordant sexual partners


Cons of starting treatment during Acute Retroviral Syndrome

  • Cons:

    • Toxicity of medications

    • Risk of developing drug resistance

    • Development of drug resistance

    • Quality of life w/ daily medication in which strict adherence is necessary

    • Cost


Guidelines say…

  • Treatment optional , unless pregnant, then recommended


Now, how much do you remember?

  • Definitions

  • Epidemiology

  • Basic course of Primary HIV

  • Symptoms

  • Diagnosis

  • Treatment


references

  • DHHS guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents; considerations for antiretroviral use in special patient populations. Acute and recent HIV infection. Last updated 2/12/13. http://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/20/acute-and-recent--early---hiv-infection

  • Mendel's

  • http://www.thebody.com/content/art16805.html

  • Emedicine accessed 8/10/13


Family Feud

What are the most common signs/ symptoms in Acute Retroviral Syndrome?


Symptoms


Family Feud

What are the Pros of treating patients during Acute Antiretroviral Syndrome?


Pros of starting treatment during Acute Retroviral Syndrome

  • Pros:

    • evidence treatment initiated during acute retroviral syndrome may lower the viral set point, which can affect disease progression rates in the event therapy is stopped

    • Decreases mortality

    • Reduce viral reservoir

    • Decrease rate of viral mutation by suppressing viral replication

    • Prevent immune destruction

    • Symptom relief

    • Public health, reduces transmission to serodiscordant sexual partners


Family Feud

What are the Cons of treating patients during Acute Antiretroviral Syndrome?


Cons of starting treatment during Acute Retroviral Syndrome

  • Cons:

    • Toxicity of medications

    • Risk of developing drug resistance

    • Development of drug resistance

    • Quality of life w/ daily medication in which strict adherence is necessary

    • Cost


Family Feud

How do you diagnosis Acute Retroviral Syndrome?


Diagnosis:

  • high-level HIV RNA viral load in the absence of anti-HIV antibodies.

    • (+)viral load. (–)ELISA

  • ELISA remains negative for an average of 2 to 6 weeks after the onset of symptoms, despite the appearance of specific antibodies on a Western blot of the patient’s serum.

  • If VL <10,000, may be false positive b/c usually VL >100,000 copies/mL

  • Pt should have elisa repeated over next 3-6 months to document seroconversion


Family Feud

When are HIV patients the most infectious?


  • Day 0

    • exposed to HIV, and infection begins.

  • Day 8

    • virus is detectable in blood using (PCR)

    • antibody test are negative.

    • amount of virus in the blood more than doubles every day.

    • The CD4 cell count (and total white blood cell count) begins to drop

    • Weeks 2-9

      • viral load peaks and begins to decline as the immune system begins to battle the virus

      • highly infectious!!!

  • Weeks 10-24

    • HIV viral load drops to its lowest point, also known as the set point, which is different in each person.

    • antibody tests become positive for HIV. Seroconversion is now complete, and chronic HIV infection begins.


Family Feud

What is the window period?


Window period


Thank you!


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