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Hiv och aids

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Definition:
Kronisk infektion förorsakad av humant immunbristvirus, som kan överföras vid sexuell kontakt, via blod, blodprodukter, vävnads- och organtransplantation och från mor till barn perinatalt. Aids är en hivinfektion som har gett allvarliga kliniska tecken på immunsvikt. 
Förekomst:
Under 2017 diagnostiserades 434 personer i Sverige med hiv (varav 63 % män). Cirka 37 miljoner människor lever med hivinfektion i världen. 
Symtom:
Akut hivinfektion ger övergående symtom hos cirka 50 %, oftast 2–4 veckor efter smitta: feber, halsfluss, cervikal lymfadenit och eventuellt makulopapulöst exantem. Vissa patienter utvecklar en persisterande lymfkörtelsvullnad. Vid hiv uppstår symtom som talar för immunbrist. 
Kliniska fynd:
Latensfasen kan sträcka sig över 10–30 år eller mer, men är oftast mellan 7–12 år. Sedan följer kliniska tecken på cellulär immunbrist.
Diagnostik:
Vanligaste metoden för diagnostik är påvisande av antikroppar mot hiv. Kan dock vara falskt positivt och måste därför bekräftas. I akutskedet kan det mycket specifika p24-antigenet ibland påvisas. 
Behandling:
Antiviral behandling, psykisk och social intervention och uppföljning samt behandling av komorbida tillstånd. PEP (postexpositionsprofylax) kan vara aktuell hos personer som varit i kontakt med hiv-smittat material och PrEP (preexpositionsprofylax) kan övervägas hos framför allt män som har sex med män med hög risk för hivsmitta. 
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  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas

Tidigare sakkunniga

  • Bertil Christensson, professor och överläkare, Infektionskliniken, Skånes universitetssjukhus