HOME HELP CONTACT US SUBSCRIPTIONS CME ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Take the CME quiz: Vol. 30 No. 9, September 2009 Rapid Responses: Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Google Scholar Articles by Simpkins, E. P. Articles by Hutton, N. PubMed PubMed Citation Articles by Simpkins, E. P. Articles by Hutton, N. Related Collections Infectious Diseases Fetus and Newborn Infant Adolescent Medicine/Gynecology Ethics for the Primary Care Pediatrician Social Bookmarking                         What's this?

Thinking About HIV Infection

Evelyn P. Simpkins, MD^*
George K. Siberry, MD, MPH
Nancy Hutton, MD

^* Fellow in Adolescent Medicine, Division of General Pediatrics & Adolescent Medicine
Assistant Professor of Pediatrics, Division of General Pediatrics & Adolescent Medicine & Division of Infectious Diseases
Associate Professor of Pediatrics, Division of General Pediatrics & Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Md

Abbreviations: AIDS: acquired immunodeficiency syndrome • CCR5: chemokine coreceptor 5 • CD4: a glycoprotein on the surface of T helper cells • EIA: enzyme-linked immunoassay • HIV: human immunodeficiency virus • IDU: injection drug use • MMR: measles-mumps-rubella • mRNA: messenger RNA • MTCT: mother-to-child transmission • NNRTI: non-nucleoside reverse transcriptase inhibitor • NRTI: nucleoside reverse transcriptase inhibitor • OI: opportunistic infection • PCP: Pneumocystis jiroveci pneumonia • PCR: polymerase chain reaction • PI: protease inhibitor

The first 300 words of the full text of this article appear below.

	Objectives

 
After completing this article, readers should be able to:

1. Recognize the important role that the general pediatrician plays in the prevention, detection, and care of human immunodeficiency virus (HIV)-infected and -affected patients.
   
2. Select the proper HIV testing plan for pediatric and adolescent patients based on age, history, and physical assessment.
   
3. List the clinical conditions suggestive of HIV infection.
   
4. Provide counseling to reduce risk behaviors as part of routine adolescent health care.
   
5. Discuss comprehensive primary care for HIV-exposed infants.
   

	Case Studies

 
     Case Study 1
A 20-year-old woman, who is a recent emigrant from Ethiopia, brings in her 4-month-old infant for a health supervision visit. The baby has had no immunizations, and his mother reports having had no prenatal care. She is breastfeeding exclusively. The infant's 25-year-old father recently died after being very sick for 2 years. The mother states that he had "bad lungs." What are your next steps?

     Case Study 2
A 17-year-old honor student comes to your office with a maculopapular rash on his face, trunk, palms, and soles. He also complains of a sore throat and fever and states that he recently returned from visiting his grandmother in Georgia. During his visit, he went hunting with his uncles and his grandmother's dog. During the interview, which involves asking routine psychosocial questions in a nonthreatening manner (Table 1) to elicit sensitive information, he states that he has been sexually active with women for 2 years and with men for 6 months. He does not use condoms with either. He denies any contacts with sick persons or substance abuse, including injection drug use (IDU). What are your next steps?

Table 1. HEEADSSS^* Interview for Adolescents

Home Education and employment Eating Activities Drugs Sexuality Suicide/depression Safety

^* The mnemonic HEEADSSS reminds the clinician of important aspects of an adolescent's life that require inquiry. Sensitive information should be elicited in a nonthreatening manner.

	Introduction

 
The epidemiology, diagnosis, prevention, and treatment of HIV infection . . . [Full Text of this Article]

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?