HIV INFECTION

LEARNING OBJECTIVES :

MEDICAL KNOWLEDGE - Students should know:

1. Define and describe symptoms and signs of acute HIV seroconversion.
2. Define and describe CDC AIDS case definition
3. Define and describe Specific tests for HIV (e.g. HIV ELISA, confirmatory western blot, quantitative PCR) and their operating characteristics
4. Define and describe relationship of CD4 lymphocyte count to opportunistic infections as well as relationship between CD4 lymphocyte count and viral load to overall disease progression.
5. Define and describe the basic principles of highly active antiretroviral therapy (HAART), including the different classes of antiviral medications and their use, as well as common side effects and drug-drug interactions.
6. Define and describe basics of post-exposure prophylaxis.
7. Define and describe the marked importance of antiretrovital medication adherence and the potential consequences of erratic or poor adherence.
8. Define and describe vaccination recommendation for patients infected with HIV.
9. Define and describe indications for and utility and risks of prophylaxis of HIV-related opportunistic infections.
10. Define and describe pathogenesis, symptoms, signs, typical clinical course, and management of HIV-related opportunistic infectious with a recognition of which are most commons:
    1. Pneumocystic jiroveci
    2. Candidiasis (oral, esophageal, vaginal)
    3. Cryptococcus parvum
    4. Cryptosporidium parvum
    5. Cytomegalovirus infection (gastrointestinal, neurologic, retinal)
    6. Varicella-zoster virus
    7. Isospora belli
    8. Microsporidiosis
    9. Mycobacterium avium complex
    10. Myocbacterium tuberculosis
    11. Toxoplasma gondii
11. Define and describe symptoms and signs of the following HIV-related malignancies:
    1. Kaposi's sarcoma
    2. Non-Hodgkin's lymphoma
    3. Cervical carcinoma
12. Define and describe common skin and oral manifestations of HIV infection and AIDS:
    1. Molluscum contagiosum
    2. Cryptococcus neoformans
    3. Viral warts
    4. Lipodystrophy
    5. Herpes zoster
    6. Seborrheic dermatitis
    7. Buccal candidiasis
    8. Oral hair leukoplakia
13. Distinguish between common etiologies of fever of unknown origin (FUO) in immunocompetent patients and those infected with the human immunodeficiency virus (HIV) (overlap Fever).
14. List appropriate diagnostic tests for HIV-positive patient presenting with fever.

PATIENT CARE SKILLS - Students should be able to:

1. History-taking:   obtain, document, and present an age-appropriate medical history, that includes HIV infection risk factors, HIV serology results and CD4 lymphocyte counts, history of HIV-related opportunistic infections, AIDS dementia, malignancy, and wasting syndrome.
2. Physical Exam:   perform a physical exam to establish the diagnosis and severity of disease, including accurate recognition of evidence of infection, malignancy, neurologic disease, or wasting syndrome.
3. Differential Diagnosis:   generate a differential diagnosis recognizing specific history and physical exam findings that suggest the diagnosis of HIV infection or AIDS and its sequelae.
4. Laboratory:   recommend when to order and be able to interpret the results of serologic and other diagnostic tests for HIV infection, CD4 lymphocyte count as a predictor of disease, sputum gram, acid-fast, KOH and silver stains, liver function tests, CBC, chest X-ray, and serum and cerebral spinal fluid cryptococcal antigen.
5. Develop an appropriate evaluation and treatment plan, including prophylactic antiviral therapy, P. carinii prophylaxis, assessment of PPD status, administration of pneumococcal vaccine, nutritional assessment and supplements, and identification of community health resources.

COMMUNICATION SKILLS

1. Counsel and educate patients about HIV prevention and seroconversion rates.
2. Perform consent for testing, pre and post test counseling.

PROFESSIONALISM:

1. Students should consider the bioethical and social issues concerning patient confidentiality of HIV infection, understand and have tolerance towards alternative life styles, and maintain a non-judgmental attitude.
2. Students should also be able to appreciate end-of-life issues pertaining to AIDS.   Students should respect patients' wishes regarding declining medical treatment (autonomy).

RECOMMENDED READING :

1. HIV infection, Harrison's On-Line.    http://harrisons.accessmedicine.com/server-java/Arknoid/amed/harrisons/co_chapters/ch309/ch309_p01.html
2. CDC website:                http://www.cdc.gov/hiv/bscience.htm