Acquired Immunodeficiency Syndrome (page 58) AIDS is a chronic infectious disease caused by HIV, which destroys helper T-lymphocytes,

es, causing loss of the immune response and increased susceptibility to secondary infection and cancer. An individual is considered HIV positive when the virus is known to be present in the body, but few if any clinical signs have developed. AIDS is the stage of active infection, with marked clinical manifestations and multiple complications.

The Agent (page 60) HIV refers to human immunodeficiency virus (type 1 or type 2), a retrovirus, which contains RNA. . . . the virus primarily infects the CD4 T-helper lymphocytes, leading t a decrease in function and number of these cells, which play an essential role in both humoral and cell-mediated immune responses.

Transmission (page 61) When transmitted, the virus must find entry into the circulating blood f the recipient. The virus is transmitted in body fluids, such as blood, semen, and vaginal secretions. Health care workers should assume there is a risk of some infection (there is a higher risk of transmitting other infections such as hepatitis B or C) from contact with body fluids from any individual and follow universal precautions. Currently the greatest increase in cases of HIV infection is occurring in women, either by heterosexual contact or intravenous drug use. HIV is not transmitted by casual contact (touching or kissing an infected person), sneezing and coughing, fomites such as toilet seats or eating utensils, or insect bites.

Diagnostic Tests (page 62) The presence of HIV infection is determined by using a blood test for HIV antibodies, using HIV antigen from recombinant HIV or the enzyme-linked immunoassay (ELISA) for the primary test. A diagnosis of AIDS depends on a major decrease in CD4+ to CD8+ ration in the presence of opportunistic infection or certain cancers.

Clinical Signs and Symptoms (page 62-63) The clinical effects of HIV infection vary among individuals, and differences are also apparent between men, women, and children. Many persons are asymptomatic. In the prolonged second, or latent phase, many patients demonstrate no clinical signs, whereas some have a generalized lymphadenopathy or enlarged lymph nodes. The categories include general manifestations of infection, gastrointestinal effects, neurologic effects, secondary infections, and malignancies. Secondary infections and cancer are caused by the immunodefiencdey.