may test positive despite not being infected with the virus. Kittens born to infected or vaccinated queens may ingest anti-FIV antibodies in the colostrum or milk, despite not actually being infected with the virus. Therefore, it is recommended that any kittens that test positive for FIV be retested after four months of age to confirm their infection status. Kittens that test negative before four months of age can be regarded as truly negative (Little, 2013) testing only needs to be repeated for kittens that test positive. FIV infection does not significantly impact life expectancy in infected cats despite the increased susceptibility to infections seen in these cats (Addie, 2000; Ravi, 2010). In cases of FIV-associated stomatitis, performing full-mouth extractions is often the most effective way to restore quality of life (Fenimore, 2014). Antibiotics, including clindamycin, may offer some benefits; however, these benefits are often short-lived and full-mouth extractions are typically more effective. All FIV-positive cats, regardless of their current stage of infection, should receive regular preventive veterinary care. Routine physical exams will allow ongoing monitoring of overall health and early detection of secondary infections so that these infections can be treated early with a better prognosis. Cats infected with FIV should also receive fecal examinations twice yearly to assess for the presence of intestinal parasites and remain on year-round broad- spectrum parasite prevention. If bacterial infections are detected, bactericidal antibiotics may be more effective than bacteriostatic antibiotics because of the cat’s immunodeficiency. Additionally, antibiotic choices should be guided by culture and sensitivity when possible in order to decrease the likelihood of resistant infections, which may be more difficult to control than in immunocompetent cats. Vaccination strategies in FIV-positive cats can prove controversial. Some believe that FIV-infected cats should only receive inactivated vaccines, due to concerns of pathogenicity if a modified live vaccine is given to an immunosuppressed cat (Hartmann et al., 2022). Fortunately, this does not appear to be a significant concern (Hartmann et al., 2022). Although vaccine type is not likely to be important to consider in the presence of FIV infection, it is important to consider that the cat’s immune response to vaccination will likely rely upon their current stage of infection. Cats in the early stage of FIV infection are typically able to mount an effective immune response to vaccines, while cats in the terminal stages of infection are often unable to do so (Hartmann et al., 2022). Given the likely inadequate immune response, paired with the potential risk of immunostimulation (potentially causing progression of FIV infection), some organizations, including the European Advisory Board on Cat Diseases (ABCD), recommend foregoing vaccines in indoor cats, especially those that demonstrate adequate titers against feline panleukopenia virus (Hartmann et al., 2022). offer some protection to at-risk cats, but it did not reliably prevent infection. Therefore, its use was controversial and it was not regarded as a core vaccine in cats (American Association of Feline Practitioners, 2013a). In addition to a lack of efficacy, FIV vaccination also made testing of exposed cats complicated. Vaccination against FIV produced antibodies detectable in commercially available FIV antibody tests, creating a diagnostic
When performing FIV testing in kittens, it is important to remember that not all kittens born to an infected queen will be infected. Therefore, when a pregnant queen or a litter of kittens is found or relinquished, each individual kitten should be tested. It is not appropriate to test only the mother, to test only one of the kittens, or to test a pooled blood sample containing a small amount of blood from each kitten (Little, 2013). Kittens also present an additional complication regarding FIV testing. Because the FIV test is an antibody test, kittens Management of FIV Cats that test positive for FIV may go on to live long, healthy lives for many years. For this reason, it is never appropriate to euthanize a cat solely based on positive FIV testing (American Association of Feline Practitioners, 2009). The management of FIV-infected cats relies largely upon managing the cat’s environment, in an effort to decrease infectious disease risks and decrease stress. Infected cats should be kept indoors, both to prevent FIV transmission and to decrease exposure to infectious agents. These cats should be maintained on a high-quality commercial diet to decrease the risk of foodborne illness and should receive year-round parasite prevention to protect against vector- borne parasites, such as Mycoplasma haemofelis (Gunn- Moore, 2014). If FIV-positive cats develop significant anemia or neutropenia, so fresh whole blood transfusions may be beneficial. Unfortunately, repeated blood transfusions can cause anaphylaxis; therefore, this treatment is of limited utility. Plasma transfusion carries similar risks and benefits. Recombinant human erythropoietin (rHuEPO) can also be used in cats with FIV that have clinical signs associated with anemia, usually when hematocrit (HCT) is less than 20%. This drug is used in FIV as it is used in FeLV, which is every 48 hours (100 U/kg SQ) for three to four weeks of treatment, before seeing an effect and is continued long- term if it is beneficial for the patient. Successful treatment should elevate the HCT to 30% or higher. Approximately 20% to 30% of treated cats will develop anti-erythropoietin antibodies that will adversely affect the therapy’s efficacy, decreasing the long-term benefits of this treatment. These antibodies typically develop 6 to 12 months into treatment, rendering further therapy ineffective (Litster, 2015a). In cats with neutropenia, recombinant human granulocyte colony- stimulating factor (rHuG-CSF, filgrastim) may be used to stimulate neutrophil production. Like rHeEPO, however, antibody development often occurs and limits the benefits of this product (Litster, 2015a). There are few published reports examining treatments for the immunodeficiency that develops in FIV-infected cats. Recombinant feline interferon therapy has been attempted in other countries; however, it is unavailable in the United States. Human interferon has shown some promising results, as have azathioprine and 9-(2-phosphonylmethoxyethyl) adenine (PMEA), but none of these products is widely used at this time (Litster, 2015b). Interestingly, multiple studies have shown that Prevention of FIV From 2002 to 2015, an FIV vaccine was commercially available for cats in the United States (Stone et al., 2020). This vaccine contained inactivated whole virus isolates from clades A and D combined with infected cells and an adjuvant. The FIV vaccine induced both antibody formation and cell-mediated immunity, effective against many, but not all, subtypes of clades A and B (American Association of Feline Practitioners, 2013a). This vaccine was thought to
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