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HIV infection and AIDS: diagnosis
Last reviewed: 23.04.2024
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Indications for consultation of other specialists
Before the conduct of highly active antiretroviral therapy (HAART) of all patients with HIV infection, the therapist, neurologist, otorhinolaryngologist and ophthalmologist are examined to determine the contraindications to the prescription of certain drugs. In addition, patients who have previously used or are constantly using psychoactive substances are referred to a consultation with a narcologist. All patients with pulmonary pathology, especially when the antibiotic therapy is ineffective, is examined by a phthisiopneumologist. Consultations of other specialists are carried out according to the indications, depending on the revealed pathology (secondary or concomitant diseases), to determine the amount of additional examinations or to resolve the issue of transferring the patient to a highly specialized department or hospital.
Clinical diagnosis of HIV infection
The correct diagnosis of HIV infection is based on laboratory confirmation. Clinical diagnosis of secondary or concomitant diseases is carried out against the background of HIV infection: it allows to determine the severity of the patient's condition, indications for hospitalization and develop tactics of treatment.
Specific and nonspecific laboratory diagnosis of HIV infection
To clarify the diagnosis of HIV infection in the centers for the prevention and control of AIDS immunoblotting is carried out. To confirm the diagnosis of HIV infection, virological, molecular-genetic (PCR) and serological methods (ELISA) and immunoblotting are used.
Antibodies to HIV are determined after 2 weeks from the date of infection. When the first positive result is recorded using ELISA, the analysis is duplicated. After receiving a second positive response, this blood serum is sent to a study at the AIDS Prevention and Control Center, where immunoblotting is carried out. The results of immunoblotting are evaluated as positive, questionable or negative.
When serum samples of antibodies to any two or three glycoproteins of the HIV envelope are found in the serum of the patient (gp41, gpl20 and gpl60), both samples are considered positive. In the absence of antibodies to all antigens in the serum of the blood, the samples are evaluated as negative. If antibodies to one HIV glycoprotein or any of its proteins are found in the blood, then the samples are considered questionable, requiring re-examination.
Isolation and identification of HIV culture (virological method) is a reliable criterion for assessing infection. Because of the complexity of the study, this study is used only in extremely difficult cases for diagnosis.
The quantitative variant of PCR allows to estimate the replicative activity of the virus; determine the "viral load". In the stage of primary manifestations, the "viral load" is usually several thousand copies per 1 ml of blood. At the stage of secondary diseases, the HIV level reaches hundreds of thousands of copies in 1 ml of blood serum and a million copies of the virus in AIDS.
A persistent high concentration of HIV at an early stage of the disease is an unfavorable prognostic sign, indicating an extreme aggressiveness of the virus.
Primary diagnosis of HIV infection is a responsible procedure that requires careful analysis of the data, for the setting of an incorrect diagnosis can have severe consequences for the patient (depressive reaction, suicide attempt, AIDSophobia).
Laboratory confirmation of the diagnosis is mandatory. Most often used methods of detecting antibodies (first in ELISA, then in immunoblotting). If a dubious result is obtained during immunoblotting, the patient needs a follow-up and re-examination.
Standard for diagnosing HIV infection
Detection of antibodies to the immunodeficiency virus with the help of ELISA with subsequent confirmation of their specificity by immunoblotting is a standard procedure.
Example of the formulation of the diagnosis
At the time of diagnosis, the nosological unit of the disease is indicated - HIV infection by ICD-10. Then - stage of HIV infection, phase and secondary diseases. If against the background of HIV infection, at least one of the secondary diseases has a degree of manifestation corresponding to the criteria of acquired immunodeficiency syndrome, then after the phase of the disease indicate AIDS.
For example
Z21. HIV infection, stage III (subclinical).
B20.4. The disease caused by HIV, with manifestations of candidiasis.
HIV infection, stage IVA, remission phase. Oropharyngeal candidiasis (in the anamnesis).
B20.6. A disease caused by HIV. With manifestations of pneumonia caused by Pneumocystis carinii.
HIV infection, stage IVB, progression phase (AIDS). Pneumocystis pneumonia, candidiasis of the oral cavity and esophagus.
B20.2. The disease caused by HIV, with manifestations of cytomegalovirus disease.
HIV infection, stage IVB, remission phase (AIDS). Manifest cytomegalovirus infection with retinal lesion (in the anamnesis).
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