Last reviewed: November 2017
Last updated: September  2016

Summary

Definition

History and exam

Key diagnostic factors

  • no antiretroviral treatment (ART) or failure of ART
  • fever
  • headache and altered mental status
  • dyspnoea or cough
  • abdominal pain, diarrhoea, weight loss
  • dysphagia
  • lymphadenopathy
  • visual floaters and blindness
  • ocular haemorrhage
  • mucosal changes

Other diagnostic factors

  • hepatosplenomegaly
  • exercise-induced oxygen desaturation
  • cyanosis
  • blurred vision and photophobia
  • papilloedema
  • meningismus, focal neurological findings
  • pain and weakness
  • bone or joint pain
  • skin lesions

Risk factors

  • post-HIV seroconversion with any CD4+ cell count
  • CD4+ count below 200 cells/microlitre
  • CD4+ count below 100 cells/microlitre
  • CD4+ count below 50 cells/microlitre
  • no antiretroviral treatment (ART) or failure of ART
  • men who have sex with men
  • black or Hispanic race, intravenous drug use
  • social factors (poverty, over-crowding, homelessness, poor nutrition)
  • lack of preventive treatment for latent TB and anergy
  • smoking

Diagnostic investigations

1st investigations to order

  • CD4+ cell count
  • sputum stain and culture
  • blood cultures
  • adenosine deaminase
  • CMV cultures
  • CMV serology
  • peripheral blood leukocyte (PBL) culture
  • CMV proteins in peripheral blood leukocytes (pp65) antigenaemia
  • quantitative CMV PCR
  • Toxoplasma gondii serology
  • cryptococcal polysaccharide antigen
  • FBC
  • LFT
  • LDH
  • ABG
  • chest x-ray
  • head CT
Full details

Investigations to consider

  • TB nucleic acid amplification
  • IGRA
  • bronchoalveolar lavage (BAL)
  • oropharyngeal scrapings (KOH preparation) and culture
  • CSF analysis
  • PCR: respiratory specimen for TB
  • PCR: CSF, BAL fluid, and vitreous and aqueous humor specimen for T gondii
  • PCR: brain specimen for JC virus
  • bone marrow aspirate and culture
  • lymph node aspirate or biopsy
  • tissue biopsy
  • brain biopsy
  • abdomen CT
  • high-resolution CT (HRCT) of the chest
  • brain MRI
  • gallium-67 (Ga-67) lung scan
  • indium 111-DTPA-IgG scan
  • thallium single photon emission tomography (SPECT) and positron emission tomography (PET)
  • upper GI endoscopy and colonoscopy
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Associate Professor

Department of Clinical Sciences

Florida State University College of Medicine

Tallahassee

FL

Disclosures

IA declares that she has no competing interests.

Peer reviewers VIEW ALL

Consultant in Sexual Health

Department of Sexual Health

Countess of Chester Hospital NHS Foundation Trust

Chester

UK

Disclosures

CO declares that he has no competing interests.

Consultant Physician in Sexual Health and HIV

Department of Sexual Health

Countess of Chester Hospital NHS Foundation Trust

Chester

UK

Disclosures

NS declares that she has no competing interests.

Assistant Professor of Medicine

Massachusetts General Hospital

Charlestown

MA

Disclosures

WRR declares that he has no competing interests.

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