AIDSHuman Immunodeficiency Virus

Human immunodeficiency virus (HIV) is a retrovirus that is transmitted through blood or other body fluids. As the HIV destroys the CD4+ helper T-cells, the patient inevitably becomes immunodeficient, at which point the patient is considered to have acquired immunodeficiency syndrome, better known as AIDS. The conversion to the diagnosis of AIDS is met when the CD4+ count drops below 200 or when the patient exhibits any immunodeficient-defining symptom such as Kaposi's sarcoma, candidiasis, CMV disease, toxoplasmosis, or Pneumocystis carinii pneumonia. Initial symptoms are mild, most often fever, night sweats, fatigue, and mild lymphadenopathy. As the virus progresses and the patient becomes immunodeficient, opportunistic infections predominate. Immunosuppres-sion also predisposes patients to neoplasms, particularly Kaposi' s sarcoma and lymphoma. Diagnosis is usually made using an enzyme-linked immunosorbent assay (ELISA) test. If the ELISA test is positive, a Western blot test is performed for confirmation. Together, these two tests result in a sensitivity of over 99.9% in detecting HIV.

Central nervous system disease is present in 69% of cases, with the peripheral nervous system affected in 8% of HIV cases. Of the peripheral nervous system dysfunctions, the facial nerve is most common, found in approximately 5% of patients (61). A similar study of 170 AIDS patients found a 4.1% incidence of facial paralysis (62). Facial paralysis is abrupt in onset and usually unilateral (63). The mechanism of facial nerve injury may be a direct effect of the neurotropic virus, secondary involvement due to parotid or other neoplastic processes, or immunosuppression leading to reactivation of herpes zoster or other viruses. Multidrug therapy is the current standard therapy for HIV infection. Reverse transcriptase and protease inhibitors are effective and block HIV replication; fusion inhibitors are also used and block HIV entry into the cell. The prognosis for facial paralysis is good, with the majority of patients having complete or near-complete recovery of facial function (64).

A detailed discussion of HIV and AIDS can be found in Chapter 16.

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