HIV Clinical Presentation and Opportunistic Infections

HIV Clinical Presentation and Opportunistic Infections

1. Clinical categories (CD4)

   • 1. PGL
     • > LN involving >2 noncontiguous sites other than inguinal nodes.
   • 2. B-sympt.
   • 3. C- AIDS Indicator conditions

2. Natural progression

3. WHO Clinical Staging

4. Clinical presentation

   • 1. Primary infection (2 w in average)
     • • 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. Opportunistic infection/Malignancy (2ndary to immune suppression)
     • Resp
       • Sinusitis, TB, PCP, Bacterial pneumonia, Kaposi's sarcoma
     • GIT
       • oral thrush, Hairy leukoplakia, candida, esophageal thrush, CMV esophagitis
     • Hepatic
       • Hep B and C, drug induced hepatitis, acalculous cholecystitis, AIDS cholangiopathy, lactic acidosis, pancreatitis, hyperamylasaemia, pancear infection
     • Neuro
       • CNS diffuse
       • CNS focal
         • • 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)
       • Crytococcal Meningitis
       • Peripheral neuropathy
       • Demential
         • Impaired short-term memory, Clumsiness, Slowness, apathy, irritability, Poor concentration, Personality change
         • Pathogenesis
           • - Stage correlates w CSF HIV viral RNA
           • Infection of brain macrophages, neurons die
       • Cerebral toxoplasmosis
         • Headache 50-70%
         • Altered mental status
         • Focal signs 60%
         • seizures 30%
         • CD4 <100, Serum IgG+
       • Primary CNS lymphoma
       • Progressive multofocal leuconencephalopathy (PML)
       • Viral encephalitis
     • Skin
       • Seborrheic dermatitis, Dermatophytosis, Dry-skin syndrome, HIV assoc. pruritis, Eosinophilic folliculitis, Fungal infections, VZV or HSV, psoriasis, scabies
       • Kaposi Sarcoma
         • Round or irregular, pink-red to violaceous, macules to papules, palpable, firm, not tender, later become confluent, large masses all over
       • Molluscum contagiosum
         • 2-5mm pink papules w central umbilication
       • Norwegian scabies
     • Renal
       • CMV retinitIs, low CD4
   • 4. Complications due to HIV
     • • 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

5. Differential dx

   • EBV Infection: Mononucleosis
   • CMV infection
   • Toxoplasmosis
   • Rubella
   • Syphilis
   • Primary herpes infection
   • Viral hepatitis
   • Drug reactions

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