Diagnostic criteria

TB [2]

People with latent TB infection are asymptomatic.

The presentation of active TB in HIV-infected people depends on the degree of immunosuppression.

Pulmonary TB presents with signs and symptoms of pulmonary disease combined with chest radiographic findings and sputum smear and culture positive for acid-fast bacilli (AFB).

Upper lobe infiltrates with or without cavitation are typical in HIV-infected patients with a CD4+ count above 200 cells/microlitre, while mediastinal adenopathy is common in patients with CD4+ count below 200 cells/microlitre. [100]

Extrapulmonary TB affecting the lymph nodes, kidneys, liver, gastrointestinal tract, or CNS can be seen in severely immunocompromised HIV-infected patients.

Mycobacterium avium complex (MAC) disease [2]

MAC is seen only in people with a CD4+ count less than 100 cells/microlitre and is associated with fever, anaemia, weight loss, diarrhoea, and elevated alk phos. It is recommended that all such HIV-infected people have mycobacterial blood cultures done. [102]

Pneumocystis jiroveci pneumonia (PCP) [1]

Diagnostic criteria

• A history of dyspnoea on exertion or non-productive cough of recent onset (within the past 3 months); AND

• Chest x-ray evidence of diffuse bi-lateral interstitial infiltrates or evidence by gallium scan of diffuse bilateral pulmonary disease; AND

• Arterial blood gas analysis showing an arterial pO2 of less than 70 mmHg or a low respiratory diffusing capacity (<80% of predicted values) or an increase in the alveolar-arterial oxygen tension gradient; AND

• No evidence of bacterial pneumonia.

Toxoplasmosis of the brain [1]

Diagnostic criteria

• Recent onset of a focal neurological abnormality consistent with intra-cranial disease or a reduced level of consciousness; AND

• Evidence by brain imaging (CT or MRI) of a lesion having a mass effect or the radiographic appearance of which is enhanced by injection of contrast medium; AND

• Serum antibody to Toxoplasma gondii or successful response to therapy for toxoplasmosis.

CMV [1]

Characteristic appearance on serial ophthalmoscopic examinations (e.g., discrete patches of retinal whitening with distinct borders, spreading in a centrifugal manner along the paths of blood vessels, progressing over several months, and frequently associated with retinal vasculitis, haemorrhage, and necrosis).

Resolution of active disease leaves retinal scarring and atrophy with retinal pigment epithelial mottling.

Cryptococcal meningitis [2]

Sub-acute meningitis or meningoencephalitis with fever, malaise, and headache.

Positive cryptococcal antigen in CSF and serum.

Oesophageal candidiasis [1]

Diagnostic criteria

• Recent onset of retrosternal pain on swallowing; AND

• Oral candidiasis diagnosed by the gross appearance of white patches or plaques on an erythematous base or by the microscopic appearance of fungal mycelial filaments from a non-cultured specimen scraped from the oral mucosa.