AIDS

Disease Description (Causes and Symptoms)

• Definition: Acquired immunodeficiency syndrome (AIDS) is an infectious disease caused by human immunodeficiency virus (HIV). It refers to a condition in which HIV destroys immune cells such as CD4+ T lymphocytes, causing a marked reduction in systemic immunity.
• Causes and routes of transmission: Sexual contact (most common), sharing contaminated needles, blood transfusion (almost completely prevented through screening), vertical transmission (mother→fetus/newborn), needlestick injuries in medical institutions, etc. (the risk of infection from a needlestick injury is approximately 0.3%).
• Summary of pathophysiology: HIV invades and replicates in host immune cells, reducing the number of CD4+ cells and impairing cell-mediated immunity, which leads to opportunistic infections, malignant tumors (e.g., Kaposi sarcoma), nervous system damage, and other complications.
• Main symptoms: During the acute phase (2–6 weeks after infection), flu-like symptoms such as fever, sore throat, swollen lymph nodes, rash, headache, muscle and joint pain, nausea/vomiting, and others may occur. After an asymptomatic period (latent period) lasting several years, the condition progresses as CD4 counts decrease, causing weight loss, chronic fever, persistent diarrhea, recurrent infections, opportunistic infections, malignant tumors, neurological symptoms, and others.

Treatment Methods (Standard Treatment, Medications, Lifestyle Management, and Precautions)

• Standard treatment: Antiretroviral therapy (ART, commonly HAART)—a combination of at least three medications to suppress the virus in the body (generally a combination of 2 NRTIs + 1 NNRTI/PI/INSTI, etc.).
• Treatment goals: Suppress plasma HIV RNA (viral load) to an undetectable level, restore CD4 counts, and prevent opportunistic infections.
• Treatment duration: In principle, treatment is continued for life (viral replication may resume within 2–4 weeks after stopping medication).
• Testing before and during treatment: Baseline blood tests, CD4 count, viral load, drug resistance testing, monitoring of liver, kidney, lipid, blood glucose, and bone mineral density, and screening for coexisting infections (HBV/HCV, syphilis, etc.).
• Side effects and complications: Abnormal lipid metabolism, hyperglycemia, abnormal fat distribution (lipodystrophy), hepatotoxicity, abnormal bone metabolism, drug interactions (particularly with protease inhibitors), and others.
• Lifestyle management: Take medications regularly (adherence is important), undergo regular blood tests and viral load monitoring, prevent infections (vaccination is recommended—including influenza and pneumococcal vaccines, but caution is needed with live vaccines), practice safe sex (condoms), do not reuse needles, and during pregnancy, work with a specialist to reduce the risk of vertical transmission through maternal antiviral treatment.
• Precautions: Even after starting treatment, regular follow-up and monitoring for drug interactions and long-term side effects are necessary. Do not stop ART without medical advice, as discontinuation can cause amplification and resistance problems and rapid immune deterioration.

Outpatient Visit Checklist (Including Items to Prepare, Records, and Example Questions)

• Items and information to prepare:
  • A list of all medications currently being taken (including over-the-counter medications, herbal medicines, and supplements)
  • Previous test results (CD4 count, viral load, liver, kidney, lipid, and blood glucose test results, drug resistance test results, etc.)
  • Vaccination history (particularly hepatitis B, influenza, and pneumococcal vaccinations)
  • Recent symptoms (fever, weight loss, diarrhea, cough, shortness of breath, etc.) and records of when they occurred
  • Information about recent sexual contact, needle exposure, the possibility of pregnancy, and other exposure history (if necessary)
• Items that are useful to record during outpatient visits:
  • Whether medication doses have been taken on schedule, and the timing and nature of any side effects
  • Recent hospitalizations, antibiotic use, and vaccination history

Examples of General Questions to Ask the Doctor

• "What antiretroviral combination is recommended, and what are the main side effects of each medication?"
• "Given my current CD4 count and viral load, what prognosis can be expected? What are the risks of stopping treatment?"
• "Are there any medications, supplements, or foods that I should avoid because of drug interactions?"

Examples of Disease-Specific Questions

• Pregnancy-related: "How can I continue ART during pregnancy to minimize the risk of HIV transmission to the fetus? What are the recommendations regarding the mode of delivery or breastfeeding?"
• Resistance and treatment changes: "If my viral load is not suppressed or I need to change medications because of side effects, when should drug resistance testing be performed? What alternative treatment options are available?"