Drug Information

This chapter is about pharmacology, side effects, and drug interactions of various drugs, including abacavir (ABC), acyclovir, Amphotericin B, atazanavir (ATV), atorvastatin, atovaquone, azithromycin, azoles, bedaquiline, bictegravir (BIC), bupropion, buspirone, caspofungin, cidofovir, ciprofloxacin, clarithromycin, clindamycin, clotrimazole, cobicistat (COBI), dapsone, darunavir (DRV), daunorubicin citrate liposome, didanosine (ddI), dolutegravir (DTG), doxycycline, efavirenz (EFV), emtricitabine (FTC), elvitegravir (EVG), enfuvirtide (T-20), entecavir, erythropoietin, ethambutol, etravirine (ETR), fentanyl, fluconazole, flucytosine, fluoxetine, fosamprenavir (FPV), ibalizumab-uiyk (Trogarzo), indinavir (IDV), itraconazole, lamivudine (3TC), leucovorin, lopinavir/ritonavir (LPV/r), maraviroc (MVC), methadone, nelfinavir (NFP), nevirapine (NVP), oxandrolone, paromomycin, pegylated interferon, pentamidine, pravastatin, pyrazinamide, pyrimethamine, raltegravir (RAL), ribavirin, rifabutin, rifampin, rilpivirine (RPV), ritonavir (RTV), saquinavir (SQV), stavudine (d4T), sulfadiazine, tenofovir (TDF and TAF), testosterone, thalidomide, tipranavir (TPV), trazodone, trimethoprim, trimethoprim-sulfamethoxazole, voriconazole,zidovudine, and Hep C antiviral agents.

Laboratory Tests

This chapter covers the following topics: HIV viruses including viral variants (group O and group N); immune responses to HIV and detection markers; HIV serologic tests; initial tests to detect HIV antibody; confirmatory tests to detect antibody, antigen, or RNA; false-negative and false-positive results; testing strategies and algorithms; alternative testing strategies for resource-limited countries; home tests; tests that use oral fluids; molecular tests to detect and monitor HIV infection; kinetics of viral nucleic acid production (including qualitative and quantitative RNA tests); HIV DNA assessment; uses of viral load tests; rapid molecular tests; resistance testing (including purpose and scope); resistance test methods; tests for sexually transmitted infections (STIs); screening tests for other infectious agents; and recommended reading.

Infection Management

This chapter is about management of infections in HIV-infected persons and covers aspergillosis, bartonellosis, mucocutaneous candidiasis, esophageal candidiasis, cytomegalovirus, Cryptococcus neoformans, cryptosporidiosis, herpes simplex virus, microsporidiosis, progressive multifocal leukoencephalopathy, Mycobacterium avium complex infection, Mycobacterium tuberculosis, toxoplasmosis, and herpes zoster. Although the advent of highly active antiretroviral therapy (HAART) has somewhat ameliorated some opportunistic infections that carried a dire prognosis in patients with advanced HIV infection, infection remains a serious threat to those living with HIV. Prompt assessment, testing, diagnosis, and treatment are essential to maintaining the health of those with compromised immune systems.

HIV in Resource-Limited Settings

This chapter reviews the diagnosis, assessment, testing, and treatment of HIV in resource-limited settings around the world. The chapter covers the current status of the HIV pandemic, diagnosis of HIV (i.e., who to test), HIV testing, HIV diagnostic tests, World Health Organization (WHO) guidelines and treatment recommendations, monitoring ART efficacy and toxicity, treatment and prophylaxis of opportunistic infections and other comorbid conditions, treatment of tuberculosis and cryptococcal meningitis, co-trimoxazole prophylaxis, HIV vaccines, differentiated service delivery models of HIV care, important global trials, and further recommended reading.

Systems Review

This chapter is a systems overview involving people living with HIV, and covers cardiovascular disease, dermatologic complications, gastrointestinal complications, hematologic complications, immune reconstitution inflammatory syndrome (IRIS), liver and pancreatic disease, hepatitis B and C, Kaposi sarcoma, non-Hodgkin lymphoma (NHL), neurologic complications, ophthalmic complications, psychiatric complications, pulmonary disorders, and renal complications.

Antiretroviral Therapy

This chapter is about antiretroviral therapy (ART). It includes the goals of antiretroviral therapy (according to the 2018 Department of Health and Human Services [DHHH] guidelines), and it covers recommendations for antiretroviral therapy, special co-factor considerations, and what antiretroviral regimen to start. The chapter includes a detailed discussion on the selection of the initial third ART drug, individualized selection of the initial regimen, initiating ART in a patient with HIV-associated complications, treatment of HIV-2 infection, factors that influence the probability of prolonged viral suppression and regimen tolerability, the rapidity of virologic response, clinical failure, treatment strategies in selected situations, and treatment strategies in the setting of immunologic failure. The chapter concludes with a summary of pivotal antiretroviral trials.

Prevention of HIV and Prevention of Infection in PLWH

This chapter is about the prevention of HIV and the prevention of opportunistic infections in people living with HIV/AIDs (PLWH). It covers treatment as prevention (TasP), HIV pre-exposure prophylaxis (PrEP) (including indications, initial assessment, and contraindications to PrEP), HIV post-exposure prophylaxis (PEP) (including estimating risk of transmission, timing of PEP initiation, counseling at time of PEP evaluation, and overlap of PEP and PrEP), Mycobacterium tuberculosis (MTB), infections due to bacteria, Treponema pallidum (syphilis), infections due to viruses, human papilloma virus (HPV), influenza A and B, JC polyomavirus (JCV), cryptosporidiosis, mycobacterium avium complex infection, and Pneumocystis jiroveci (formerly Pneumocystis carinii) pneumonia.

Natural History and Classification

Classification of the natural history of untreated HIV infection into discrete disease stages helped to optimize the treatment approach to those infected with HIV. Due to the advancements in antiretroviral treatment and current treatment recommendations some of the subdivisions of chronic HIV infection are now seemingly more of historical than clinical value, but the clinically important stages are discussed in further detail in this chapter. It is important to note that although antiretroviral therapy has completely changed the disease course of HIV and altered the relevance of some of the disease stages there remains a gap in the life expectancy of treated HIV-infected individuals compared to uninfected controls in the general population. This chapter defines the various stages of HIV, beginning with primary HIV infection before moving onto chronic HIV infection and its complications. The diagnosis and staging of HIV is also discussed in detail, allowing it to be looked at from both clinical and research perspectives.