Primary HIV infection: a medical and public health emergency requiring rapid specialist management

Fidler, Sarah; Fox, Julie

doi:10.7861/clinmedicine.16-2-180

Cited by 5 publications

(1 citation statement)

References 32 publications

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“…Most of the efforts towards timely detection of new infections in Mexico are targeted at the first level of care, with up to 86.4% of HIV tests performed in nonspecialized centres in 2016 . We have shown that specialized care centres represent areas of opportunity for HIV diagnosis that also happen to possess the necessary tools for the identification of acute HIV infection and immediate ART initiation . Moreover, multidisciplinary task forces and specialized instant action algorithms have been created and successfully used for the detection of other medical conditions in these settings, such as cerebrovascular disease .…”

Section: Discussionmentioning

confidence: 85%

Immediate treatment of acute HIV in a tertiary healthcare center: bridging gaps in communication using smartphones

et al. 2019

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Objectives Early initiation of antiretroviral therapy (ART) during acute HIV infection is associated with favourable clinical and epidemiological outcomes. Barriers to prompt treatment initiation limit the benefits of universal access to ART in Mexico. We sought to create an algorithm for the immediate detection and treatment of patients with acute HIV infection. Methods A nationwide cohort of patients with acute HIV infection was created in 2015. In order to identify cases and treat them promptly at our centre, an interdisciplinary group coordinated through an instant‐messaging tool using smart phones was established. When a probable case was detected, a discussion was initiated to confirm the diagnosis and facilitate the administrative processes to initiate ART as soon as possible. We compared time to ART initiation with that in a comparison group of patients with chronic HIV infection enrolled during the same period (May 2015 to February 2017) through routine care, using survival analysis estimators and log‐rank tests. Results We recruited 29 patients with acute HIV infection. The median time to ART initiation was 2 days in these patients, in contrast to 21 days for patients with chronic infection. There were no significant differences in the percentages of patients engaged in care, on treatment or virologically suppressed at 1 year of follow‐up. Conclusions Implementing immediate ART initiation programmes is feasible in Mexico, in spite of the substantial administrative barriers that exist in the country. More extensive replication of this model in other centres and in patients with chronic infection is warranted to evaluate its effect on the continuum of care.

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Section: Discussionmentioning

confidence: 85%

Immediate treatment of acute HIV in a tertiary healthcare center: bridging gaps in communication using smartphones

et al. 2019

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HIV and the Skin

Bunker,

Piguet

2024

Rook's Textbook of Dermatology

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Within 2 years of defining acquired immune deficiency syndrome (AIDS) as a distinctive syndrome in 1981, human immunodeficiency virus (HIV) was identified as the causative agent. Dermatological involvement in AIDS has been appreciated since the disease was first recognised. Mucocutaneous involvement establishes criteria for diagnosis and staging; the prognostic significance of some complications, for example pruritic papular eruption/eosinophilic folliculitis, hairy leukoplakia and Kaposi sarcoma (KS), was well recognised before specific treatments were introduced. The proportion of patients with skin complications and the number of these manifestations in any one patient increase as HIV infection progresses and AIDS develops. The incidence and severity of several common cutaneous diseases (such as mollusca, herpes simplex and seborrhoeic dermatitis) are increased in patients with HIV and this correlates in many instances with the absolute numbers of CD4+ T cells. The effect HIV infection may have on some dermatological conditions such as psoriasis and leprosy is less clear‐cut. The advent of highly active combined antiretroviral therapy (ART) has been incalculably beneficial to patients with HIV, but novel side effects of these drugs (such as lipodystrophy) have emerged, and the skin can be affected by manifestations of the immune reconstitution inflammatory syndrome/immune reconstitution associated disease. The dermatological complications of HIV and AIDS may be distressing to patients and difficult for dermatologists to diagnose and manage. Also, many dermatoses presenting in the population at large need to be regarded as ‘indicator conditions’ to prompt advice about, and initiation of, HIV testing.

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