HIGH-RISK POPULATIONS IN HIV INFECTION
● Key populations at increased risk of HIV infection include the following (CDC, 2022). ● Men who have intercourse with men. ● People who inject drugs. ● People in prisons and other closed environments. ● Sex workers and their clients. ● People who are transgender. ● Transgender women who have sex with men. ● Individuals who have either anal or vaginal sex with an HIV-positive partner. ● People who have had more than one partner since last HIV test. ● People who exchange sex for drugs or money. ● Individuals diagnosed with or treated for another STI. ● Anyone diagnosed with, or treated for, hepatitis or tuberculosis. ● Anyone with an unknown sexual history.
Healthcare Consideration : Healthcare professionals should be cognizant of the fact that gay and bisexual men represent the demographic with the highest incidence of new HIV diagnoses within the U.S. Furthermore, it is crucial to recognize that African Americans and Hispanics/ Latinos experience a disproportionate burden of HIV infection relative to other racial and ethnic populations. Several behaviors are associated with the high risk of HIV infection and/or transmission. These include the following (CDC, 2019a, 2020e; WHO, 2023a): ● Having multiple sexual partners. ● Using injectable drugs. ● Sharing needles. ● Having unprotected sex. ● Having another STI. ● Being an uncircumcised man. ● Experiencing accidental needlestick injuries, including healthcare workers. ● Having procedures that involve needles and other equipment from unreliable sources where unsanitary practices may exist (e.g., an unlicensed tattoo artist).
PATHOPHYSIOLOGY
individuals and may decline more quickly once the count falls below 200 cells/mL (Waymack & Sundareshan, 2023). HIV has two subtypes. HIV-1 is the most common and is responsible for AIDS throughout the world. HIV-2 is found primarily in western Africa. It is much less common in the U.S., although there are documented cases (Waymack & Sundareshan, 2023). Healthcare Consideration : Individuals infected with HIV can remain asymptomatic for a duration exceeding eight years (HIV.gov, 2020). This extended asymptomatic phase may lead to reduced rates of screening, as individuals might erroneously assume that the absence of symptoms equates to the absence of infection. Healthcare professionals are advised to actively promote screening practices in alignment with the guidelines set forth by the CDC. A typical course of HIV infection is defined by three phases, which usually occur over 8 to 12 years: Acute (primary), chronic asymptomatic (latency), and AIDS (Norris, 2022).
HIV is a spherical retrovirus that attaches to host cells using glycoproteins. It then infects the body’s CD4 T cells and macrophages. Although HIV is an RNA virus, it is converted into DNA before integrating copied chromosomal material into the host cell. There it takes over mechanisms that generate more viral proteins and genetic material, eventually killing the host cell (Waymack & Sundareshan, 2023). HIV causes cellular immune deficiency that results in the depletion of helper T lymphocytes (CD4+ cells), which are necessary for normal immune function. Once the CD4+ count is impaired, cell-mediated responses are unable to deter opportunistic infections and associated malignancies (Waymack & Sundareshan, 2023). The progression from HIV to AIDS starts with a specific decline in the CD4+ helper T cells that results in inversion of the normal CD4/CD8 T-cell ratio and dysregulation of B-cell antibody production. Without treatment, CD4 cell counts fall by approximately 50 to 80 cells/mL per year in affected Acute The acute phase is the earliest stage in HIV and generally develops two to four weeks after the initial infection (HIV. gov, 2021). During this time, the body is producing HIV antibodies that can be detected by an HIV antibody test. Individuals may also demonstrate flulike symptoms such as: ● Fever ● Fatigue ● Myalgias ● Sore throat ● Night sweats Chronic During the chronic or latent phase, HIV continues to multiply in the body but at much lower levels. The individual has no signs or symptoms of HIV, a situation that may last up to 10 years. The CD4+ count falls from a normal range of 800 to 1,000 cells/mL to 200 cells/mL. During this time, the individual may have persistent lymphadenopathy (3 or more months) in two or more places that may be visibly
● Gastrointestinal problems ● Lymphadenopathy ● Maculopapular rash ● Headache
An increase in viral replication leads to very high viral loads and decreasing CD4+ counts. During this time, transmission risks for HIV are very high. After several weeks, the immune system acts to control the viral load, which can remain lower over several years.
swollen. However, many individuals may not have any HIV- related symptoms. Individuals undergoing ART therapy taken exactly as prescribed and whose viral loads are undetectable have virtually no risk of transmitting HIV to a negative partner through sexual contact.
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