HIV (Human Immunodeficiency Virus) — Complete Clinical Guide (हिंदी)
यह विस्तृत गाइड HIV के विज्ञान (pathogenesis), लक्षण, डायग्नोसिस, इलाज (ART, PrEP, PEP), निगरानी, सपोर्टिव केयर, रोकथाम और संबंधित इंटरनल लिंक पर आधारित है। स्रोतों में WHO, CDC, UNAIDS और NIH शामिल हैं।
सामग्री-सूची (Jump to)
1) Definition & Burden 2) Pathogenesis & HIV Life Cycle 3) Clinical Course & Stages 4) Symptoms & Red Flags 5) Diagnosis & Tests 6) Treatment — ART (Initiation, Regimens, Monitoring) 7) PrEP & PEP 8) Supportive Medicine & Opportunistic Infection Management 9) Monitoring, Resistance & Adherence 10) Special Populations (Pregnancy, Children, TB/HBV coinfection) 11) Nutrition & Lifestyle 12) Prevention, Vaccination & Harm Reduction 13) Internal Links & Resources 14) FAQ 15) Conclusion & Key Takeaways1) Definition & Global Burden
HIV (Human Immunodeficiency Virus) एक RNA retrovirus है जो मुख्य रूप से CD4+ helper T-cells, macrophages और dendritic cells को Infest कर प्रतिरक्षा प्रणाली को धीमे-धीमे नष्ट करता है। untreated HIV समय के साथ AIDS (Acquired Immunodeficiency Syndrome) में प्रगट हो सकता है।
Global burden (latest estimates): end-2024 तक लगभग 40.8 million लोग HIV के साथ जीवित थे; 31.6 million ART पर थे। (UNAIDS data)। 0
2) Pathogenesis & HIV Life Cycle
HIV का life-cycle और प्रतिरक्षा क्षति समझना जरूरी है—यह़ाँ संक्षेप में:
- Attachment & Entry: HIV की envelope glycoprotein (gp120/gp41) CD4 और co-receptors (CCR5 या CXCR4) से जुड़ती है और कोशिका में प्रवेश करती है।
- Reverse Transcription: Viral RNA को reverse transcriptase से DNA में बदला जाता है।
- Integration: Integrase enzyme viral DNA को host genome में integrate कर देता है—यह persistency/latency की वजह बनता है।
- Transcription & Translation: Integrated provirus host machinery से नए virions बनाता है।
- Assembly & Budding: नया virus सेल से निकलता है और अन्य CD4 cells को infect करता है।
विस्तृत life-cycle और molecular targets के बारे में NIH/HIVinfo का सार उपयोगी है। 1
3) Clinical Course & Stages
अ) Acute (primary) HIV infection
इन्फेक्शन के 2–4 सप्ताह के भीतर फ्लू-जैसे लक्षण (fever, sore throat, rash, lymphadenopathy, myalgia) हो सकते हैं; high viremia और transmissibility इस चरण में अधिक।
ब) Clinical latency (chronic HIV)
इस चरण में untreated में धीरे-धीरे CD4 घटता है; कुछ समय asymptomatic रह सकता है पर virus replication जारी रहता है।
स) AIDS / Advanced disease
CD4 count सामान्यतः <200 cells/mm³ होने पर या AIDS-defining illnesses (Pneumocystis jirovecii pneumonia, CMV, Kaposi sarcoma, TB आदि) के साथ AIDS घोषित होता है।
4) Symptoms & Red Flags
Common features
- अक्यूट phase: fever, sore throat, rash, lymphadenopathy, malaise
- Progressive stage: weight loss, chronic diarrhea, recurrent infections, night sweats
Red flags
- तुरंत डॉक्टर: सांस की गंभीर तकलीफ, तेज़ वजन घटाव, neurological deficits, severe opportunistic infection के संकेत
5) Diagnosis & Tests
HIV की पहचान पर परखा-खत्म करना और स्थिति का staging करना ज़रूरी है—यहाँ सामान्य परीक्षण रणनीति दी जा रही है:
- Screening tests: 4th generation HIV antigen/antibody ELISA (detects p24 antigen + HIV antibodies) — early infection में बेहतर sensitivity।
- Confirmatory testing: Positive screening → confirmatory immunoassay/Western blot or nucleic acid test (NAT) as per national algorithm.
- Baseline labs: CD4 count, HIV viral load (RNA), CBC, LFT, RFT, Hepatitis B & C serology, pregnancy test (if applicable), TB screening.
- Resistance testing: Genotypic resistance testing (before or at ART initiation when feasible) in many settings per guidelines.
HIV testing recommendations and algorithms are provided by CDC/WHO—screening improves case detection and linkage to care. 2
6) Treatment — ART (Antiretroviral Therapy)
Principle: Combination ART suppresses HIV replication (viral load → undetectable), allows CD4 recovery and prevents progression to AIDS. Early diagnosis + prompt ART initiation improves outcomes.
WHO and national guidelines recommend that all people with HIV start ART as soon as possible after diagnosis (test and treat approach). 3
Initial regimen (typical modern regimens)
Regimens change with guidelines and availability—commonly used backbone and anchor drugs include:
- Backbone: Tenofovir (TDF or TAF) + Emtricitabine (FTC) or Lamivudine (3TC)
- Anchor/third agent: Integrase strand transfer inhibitor (INSTI) e.g., dolutegravir (DTG), bictegravir (BIC)
उदाहरण: TDF + FTC + DTG (एक पॉपुलर first-line triple)।
Monitoring
- Viral load at baseline and 3 months after ART start, then every 6–12 months once virologic suppression achieved.
- CD4 count at baseline; thereafter frequency depends on stability and local protocol.
- Routine labs: LFT/RFT, lipid profile, pregnancy test, HBV/HCV monitoring where relevant.
When to change regimen
- Virologic failure (persistent detectable viral load despite adherence) with resistance testing guide regimen switch.
- Drug toxicity/intolerance or significant drug–drug interactions.
7) PrEP & PEP (Pre- and Post-Exposure Prophylaxis)
PrEP (Pre-Exposure Prophylaxis)
PrEP is for HIV-negative people at substantial ongoing risk. Daily oral PrEP (TDF/FTC or TAF/FTC where approved) reduces HIV acquisition when taken as prescribed. Long-acting injectable PrEP options exist in some settings. 5
PEP (Post-Exposure Prophylaxis)
PEP is an emergency 28-day ARV course started ASAP (ideally within 72 hours) after a significant exposure (occupational or sexual). CDC recommends a 3-drug regimen for PEP in most adults/adolescents. Clinical evaluation, baseline HIV test and follow-up testing are required. 6
8) Supportive Medicine & Opportunistic Infection (OI) Management
Supportive care
- Symptomatic medicines: antipyretics, antiemetics, analgesics as needed.
- Nutritive support: calories/protein, micronutrients (treat documented deficiencies — e.g., iron, folate, vitamin D when indicated).
- Management of comorbidities: TB, hepatitis, non-communicable diseases.
Prevention & treatment of Opportunistic Infections
- PCP prophylaxis: Trimethoprim-sulfamethoxazole (TMP-SMX) at CD4 thresholds (guideline dependent).
- Tuberculosis: active TB screening & treatment; TB preventive therapy (e.g., isoniazid or shorter regimens) for eligible people with HIV.
- Cryptococcal disease: screening in high-burden settings for people with low CD4 and preemptive therapy where appropriate.
- Vaccinations: Influenza, pneumococcal, hepatitis B, HPV (age-appropriate) — live vaccines use guideline caution.
9) Monitoring, Resistance & Adherence
- Adherence counseling: Sustained adherence ≥95% historically linked to viral suppression—tools: pillboxes, SMS reminders, counseling.
- Viral load monitoring: primary tool to assess ART efficacy; detect virologic failure early.
- Resistance testing: Genotypic testing to guide second/third line regimens when failure suspected.
10) Special Populations
Pregnancy & breastfeeding
Pregnant people with HIV should start/continue ART to maintain viral suppression—this dramatically reduces vertical transmission. Infant prophylaxis and maternal monitoring per PMTCT guidelines are essential.
Children
Pediatric ART dosing, formulations and monitoring differ—early infant diagnosis and prompt ART improve survival.
Tuberculosis & Hepatitis coinfection
Co-management requires drug interaction awareness (e.g., rifampicin reduces levels of some ARVs) and coordinated therapy planning.
11) Nutrition & Lifestyle
- Balanced diet with adequate protein to maintain weight and immunity.
- Treat micronutrient deficiencies based on tests (iron, folate, vitamin D).
- Avoid alcohol/tobacco; maintain exercise, sleep and mental health support.
Nutrition guide and organ-wise roles: refer to Complete Medical Nutrition Guide for detailed meal plans and nutrient timing. 7
12) Prevention, Public Health & Harm Reduction
- Safer sex: condoms, regular testing for sexually active people.
- Sterile injecting equipment for people who inject drugs; syringe programs.
- Screening of blood products and safe healthcare practices.
- Scale-up of PrEP for high-risk groups and PEP for exposures.
- Population-level approaches guided by UNAIDS/WHO targets (testing, ART coverage). 8
13) Internal Links & Resources
- Complete Medical Nutrition Guide
- Fever — Complete Medical Guide
- Digoxin — Guide
- Heart Failure Diet
- Biotin Deficiency
14) FAQs (Short)
HIV से कैसे बचें?
Safe sex (condoms), PrEP for high-risk people, sterile injecting, screening of blood and timely ART for people with HIV to reduce transmission.
क्या HIV का इलाज है?
वर्तमान में HIV को cure करने वाली सामान्य चिकित्सा उपलब्ध नहीं है; पर ART viral suppression देता है, जीवन प्रत्याशा सामान्य स्तर तक ला सकता है और AIDS को रोकता है। 9
ART कब शुरू करें?
जैसे ही HIV निदान होता है—'test and treat'—WHO की सलाह अनुसार तुरंत ART शुरू करने का लाभ होता है। 10
15) Conclusion & Key Takeaways
- HIV एक lifelong infection है पर आधुनिक ART के साथ viral suppression achievable है और AIDS से बचना संभव है।
- Diagnosis → prompt ART initiation → monitoring (viral load/CD4) → adherence & OI prophylaxis constitute the care backbone.
- PrEP/PEP, safe practices और public health interventions महत्वपूर्ण हैं ताकि नए संक्रमण रोके जा सकें।
स्रोत: WHO consolidated HIV guidelines, CDC clinical guidance (PrEP/PEP/testing), UNAIDS global data और NIH/HIVinfo life-cycle resources। 11