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HIV Clinical Presentation and Opportunistic Infections

Clinical categories (CD4)
1. 1. PGL
  1. > LN involving >2 noncontiguous sites other than inguinal nodes.
2. 2. B-sympt.
3. 3. C- AIDS Indicator conditions
Natural progression
WHO Clinical Staging
Clinical presentation
1. 1. Primary infection (2 w in average)
  1. • 50 - 90% get some symptoms • 1 – 6 weeks incubation • Often unrecognised • fever >95%, • lymphadenopathy 74%, • pharyngitis 70% • rash (5-10 mm maculo- papular on face, trunk, palms) • myalgia/arthralgia 54% • diarrhoea32%, • headache 32%, • nausea/vomiting 29%, • Neurological symptoms in 50%: headache, meningitis, encephalitis • Occasionally thrush
2. 2. Opportunistic infection/Malignancy (2ndary to immune suppression)
  1. Resp
    1. Sinusitis, TB, PCP, Bacterial pneumonia, Kaposi's sarcoma
  2. GIT
    1. oral thrush, Hairy leukoplakia, candida, esophageal thrush, CMV esophagitis
  3. Hepatic
    1. Hep B and C, drug induced hepatitis, acalculous cholecystitis, AIDS cholangiopathy, lactic acidosis, pancreatitis, hyperamylasaemia, pancear infection
  4. Neuro
    1. CNS diffuse
    2. CNS focal
      1. • Cerebral toxoplasmosis • Primary CNS lymphoma • Progressive multifocal leucoencephalopathy (PML) • Varicella zoster encephalitis • CMV encephalitis • Herpes simples encephalitis • Brain abscess (i.e tuberculosis, Nocardia, bacterial, aspergillus)
    3. Crytococcal Meningitis
    4. Peripheral neuropathy
    5. Demential
      1. Impaired short-term memory, Clumsiness, Slowness, apathy, irritability, Poor concentration, Personality change
      2. Pathogenesis
        - Stage correlates w CSF HIV viral RNA
        Infection of brain macrophages, neurons die
    6. Cerebral toxoplasmosis
      1. Headache 50-70%
      2. Altered mental status
      3. Focal signs 60%
      4. seizures 30%
      5. CD4 <100, Serum IgG+
    7. Primary CNS lymphoma
    8. Progressive multofocal leuconencephalopathy (PML)
    9. Viral encephalitis
  5. Skin
    1. Seborrheic dermatitis, Dermatophytosis, Dry-skin syndrome, HIV assoc. pruritis, Eosinophilic folliculitis, Fungal infections, VZV or HSV, psoriasis, scabies
    2. Kaposi Sarcoma
      1. Round or irregular, pink-red to violaceous, macules to papules, palpable, firm, not tender, later become confluent, large masses all over
    3. Molluscum contagiosum
      1. 2-5mm pink papules w central umbilication
    4. Norwegian scabies
  6. Renal
    1. CMV retinitIs, low CD4
3. 4. Complications due to HIV
  1. • Encephalitis • Peripheral Neuropathy • Pericarditis • Myocarditis • Cardiomyopathy • Pulmonaryvascular disease and pulmonary hypertension • Valvular disease • Anincreased incidence of coronary artery disease • Cardiomyopathy • Myocarditis • Cardiomyopathy • Pulmonary vascular disease and pulmonary hypertension • Valvular disease • Anaemia, bone marrow failure • Hepatitis • Pancreatitis
Differential dx
1. EBV Infection: Mononucleosis
2. CMV infection
3. Toxoplasmosis
4. Rubella
5. Syphilis
6. Primary herpes infection
7. Viral hepatitis
8. Drug reactions

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HIV Clinical Presentation and Opportunistic Infections

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	Created by Amalin Najiha Mohd Sabri almost 6 years ago