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General Considerations


Human immunodeficiency virus (HIV) is a retrovirus that primarily infects cells of the immune system, including helper T lymphocytes (CD4 T lymphocytes), monocytes, and macrophages. The function and number of CD4 T lymphocytes and other affected cells are diminished by HIV infection, resulting in profound effects on both humoral and cell-mediated immunity. In the absence of treatment, HIV infection causes generalized immune incompetence, leading to conditions that meet the definition of acquired immunodeficiency syndrome (AIDS) and, eventually, death. The clinical diagnosis of AIDS is made when an HIV-infected child develops any of the opportunistic infections, malignancies, or conditions listed in category C (Table 41–1). In adults and adolescents, the criteria for a diagnosis of AIDS also include an absolute CD4 T-lymphocyte count of 200 cells/μL or less.

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Table 41–1.Centers for disease control and prevention clinical categories of children with human immunodeficiency virus infection.

Highly active antiretroviral treatment (HAART) can forestall disease progression for many years (≥ 20 years) if taken consistently. However, current treatment fails to eradicate the virus and treatment must be lifelong. The full duration of the favorable outcome of therapy is not yet defined, and it is not known whether adverse effects due to medications and incomplete immune restoration will limit use or impact mortality. Nevertheless, HIV infection can be considered a chronic disease for people with access to treatment rather than an acutely terminal disease.


Early diagnosis offers the opportunity to optimize treatment ...

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