Physiological Adaptation Q 139
Nurse Maureen knows that the positive diagnosis of HIV infection is made based on which of the following:
A. A history of high-risk sexual behaviors.
B. Positive ELISA and western blot tests
C. Identification of an associated opportunistic infection
D. Evidence of extreme weight loss and high fever
Correct Answer: B. Positive ELISA and western blot tests
These tests confirm the presence of HIV antibodies that occur in response to the presence of the human immunodeficiency virus (HIV). When there is a possibility of acute or early HIV infection, the most sensitive screening immunoassay available (ideally, a combination antigen/antibody immunoassay) in addition to an HIV virologic (viral load) test is performed. RT-PCR based viral load test is favored. A positive HIV virologic test generally indicates HIV infection.
Option A: History of high-risk sexual behavior is one of the risk factors that predisposes a patient to HIV. In the United States, a critical risk factor for HIV propagation among young people is the use of drugs before having sex, including marijuana, alkyl nitrites (“poppers”), cocaine, and ecstasy. Other risk factors associated with acquiring HIV infection include men who have sex with men, unsafe sexual practices, the use of intravenous drugs, vertical transmission, and blood transfusions or blood products.
Option C: An associated opportunistic infection is one of the complications of HIV. In individuals with chronic HIV infection not on treatment with antiretroviral agents, as the CD4+ count drops they are vulnerable to a multitude of infections which rarely occur in an immunocompetent host, hence the term opportunistic infections (OIs).
Option D: These are symptoms of HIV, but these do not determine a positive diagnosis. A large number of patients may only have an asymptomatic infection after the exposure. The usual time from exposure to onset of symptoms is 2 to 4 weeks, although, in some cases, it can be as long as 10 months. A constellation of symptoms, known as an acute retroviral syndrome, may appear acutely. Although none of these symptoms are specific to HIV, their presence of increased severity and duration is an indication of poor prognosis.