TAILIEUCHUNG - Ebook Evidence‐Based infectious diseases (3/E): Part 2

Part 2 book “Evidence‐Based infectious diseases” has contents: Human immunodeficiency virus, infection prevention and control, antimicrobial stewardship, infections in neutropenic hosts, infections in general surgery, infections in healthcare workers, and other contents. | 149 Chapter 12 Human Immunodeficiency Virus (HIV) Ali Amini, Monique Andersson, Ravindra Gupta, and Brian Angus  ­Primary HIV Infection Case Presentation 1  A 52‐year‐old homosexual man is feeling unwell with fever, malaise, a diffuse maculopapular rash, and lymphadenopathy. He holidays regularly in Thailand and has had unprotected receptive anal sexual intercourse with a regular Thai partner as well as contact with five commercial sex workers in Bangkok. You suspect he has primary HIV infection, and ask how best to make the diagnosis and whether he should be treated with antiretroviral drugs immediately.   Diagnostic Confirmation Primary HIV infection (PHI) is important both for the individual and at a population level given the high early risk of transmission and implications for contact tracing. Routine universal laboratory screening is now recommended given appreciation of the limited diagnostic utility of clinical features [1]. A meta‐analysis (16 studies; 24,745 patients) evaluating the accuracy of clinical assessment in identifying 1,253 persons with early HIV (defined as infection within 6 months), found only a modest association with the presence of genital ulcers (Likelihood Ratio [LR] , 95% Confidence Interval [CI] –12), weight loss (LR , 95% CI –), vomiting (LR , 95% CI –), and swol­ len lymph nodes (LR , 95% CI –) [2]. In a prospective Swiss cohort (n = 290; 93% men), atypical manifestations of PHI were found in 30% and included GI or neurologi­ cal complaints. PHI was only suspected in 38% initially [3]. Laboratory testing algorithms recommend screening with a fourth‐generation assay for p24 antigen and HIV‐1/HIV‐2 IgG/M anti­ bodies, followed by a confirmatory immuno­ assay able to differentiate HIV‐1 and HIV‐2 [4,5]. The HIV‐1 western blot and HIV‐1 indirect immunofluorescence assay (IFA) are no longer recommended for confirmation of reactive initial immunoassay results, given false negative results .

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• Evidence‐Based infectious diseases
• Human immunodeficiency virus
• Infection prevention
• Antimicrobial stewardship
• Infections in neutropenic hosts
• Infections in general surgery