216.2 📚 國考版

216.2.0.1 必背 — HIV Types

  • HIV-1: worldwide main, multiple subtypes (M most common; subtypes A-K, recombinants)
  • HIV-2: W Africa, slower progression, NNRTI-resistant

216.2.0.2 必背 — Receptor

  • CD4 + CCR5 or CXCR4 co-receptor
  • Macrophage-tropic (CCR5) early; T-cell-tropic (CXCR4) late

216.2.0.3 必背 — Acute Retroviral Syndrome

  • Mononucleosis-like: fever, LAP, rash, pharyngitis, myalgia 2-4 wk post-exposure
  • ~ 50% symptomatic
  • Many missed

216.2.0.4 必背 — Global Stats (2023 UNAIDS)

  • 39M living with HIV
  • 1.3M new infections/yr
  • 630K deaths/yr
  • 95-95-95 target by 2030

216.2.0.5 必背 — Transmission Risk

  • Receptive anal: 1.4% per act
  • Receptive vaginal: 0.08% per act
  • Vertical without prevention: 25-30%; with prevention < 2%

216.2.0.6 必背 — U=U (Undetectable = Untransmittable)

  • Sustained VL < 200 copies/mL on ART = no sexual transmission
  • PARTNER trials documented
  • Major messaging

216.2.0.7 必背 — Diagnosis

  • 4th-gen combo test (Ab + p24 antigen) = primary screening (window 2-3 wk)
  • HIV-1/HIV-2 differentiation = confirmatory
  • HIV RNA PCR = acute infection or pediatric

216.2.0.8 必背 — Universal Screening

  • All 13-64 yr at least once (CDC, USPSTF)
  • High-risk: annual
  • Pregnancy: each pregnancy

216.2.0.9 必背 — Stages

  • Acute (weeks 1-4)
  • Clinical latency (years)
  • AIDS (CD4 < 200 or AIDS-defining illness)

216.2.0.10 必背 — Reservoirs

  • Resting memory CD4+ T cells
  • Macrophages, microglia
  • Major obstacle to cure