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Chapter 52: Hematologic Manifestations of the Acquired Immunodeficiency Syndrome

DEFINITION AND HISTORY

  • Patients with serologic evidence of infection with the human immunodeficiency virus (HIV) can be diagnosed as having acquired immunodeficiency syndrome (AIDS) based on AIDS-defining conditions (Table 52–1).

  • Patients with HIV are living longer in the era of highly active antiretroviral therapy (HAART).

  • The United Nations estimated that 38 million (range 32–45 million) people worldwide were living with HIV infection in 2019, with the majority being infected by heterosexual contact.

TABLE 52–1AIDS-DEFINING CONDITIONS
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TABLE 52–1 AIDS-DEFINING CONDITIONS

Bacterial infections, multiple or recurrenta

Candidiasis of bronchi, trachea, or lungs

Candidiasis of esophagusb

Cervical cancer, invasivec

Coccidioidomycosis, disseminated or extrapulmonary

Cryptococcosis, extrapulmonary

Cryptosporidiosis, chronic intestinal (>1 month’s duration)

Cytomegalovirus disease (other than liver, spleen, or nodes), onset at age >1 month

Cytomegalovirus retinitis (with loss of vision)b

Encephalopathy, HIV related

Herpes simplex: chronic ulcers (>1 month’s duration) or bronchitis, pneumonitis, or esophagitis (onset at age >1 month)

Histoplasmosis, disseminated or extrapulmonary

Isosporiasis, chronic intestinal (>1 month’s duration)

Kaposi sarcomab

Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complexa,b

Lymphoma, Burkitt (or equivalent term)

Lymphoma, immunoblastic (or equivalent term)

Lymphoma, primary, of brain

Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonaryb

Mycobacterium tuberculosis of any site, pulmonary,b,c disseminated,b or extrapulmonaryb

Mycobacterium, other species or unidentified species, disseminated,b or extrapulmonaryb

Pneumocystis jirovecii pneumoniab

Pneumonia, recurrentb,c

Progressive multifocal leukoencephalopathy

Salmonella septicemia, recurrent

Toxoplasmosis of brain, onset at age >1 monthb

Wasting syndrome attributed to HIV

AIDS, acquired immunodeficiency syndrome; HIV, human immunodeficiency virus.

aOnly among children younger than age 13 years. (Centers for Disease Control and Prevention. 1994 Revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR Morb Mortal Wkly Rep. 1994;43(RR-12). Available at http://www.cdc.gov/mmwr/PDF/rr/rr4312.pdf.)

bCondition that might be diagnosed presumptively.

cOnly among adults and adolescents older than age 13 years.

ETIOLOGY AND PATHOGENESIS

Human Immunodeficiency Virus 1

  • The primary cause of AIDS is infection with HIV-1.

  • HIV-1 is a member of the Lentivirinae subfamily of retroviruses.

    — Retroviruses are RNA viruses that induce a chronic cellular infection by converting their RNA genome into a DNA provirus that is integrated into the genome of the infected cell.

  • Infection by these lentiviruses is characterized by long periods of clinical latency followed by gradual onset of disease-related symptoms.

Transmission of HIV

  • The four main routes of HIV infection are:

    — Sexual contact with an infected partner

    • The risk for HIV transmission through sexual contact may be increased in persons with other concurrent sexually transmitted diseases.

    — Parenteral drug use

    • Sharing needles and syringes is the main mode of transmission.

    — Exposure to infected blood or blood products

    • Ninety percent of those who ...

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