Last reviewed:September 2019
Last updated:October  2019

Summary

Definition

History and exam

Key diagnostic factors

  • fevers and night sweats
  • weight loss
  • skin rashes and post-inflammatory scars
  • oral ulcers, angular cheilitis, oral thrush, or oral hairy leukoplakia
  • diarrhea
  • wasting syndrome
  • changes in mental status or neuropsychiatric function
  • recent hospital admissions
  • tuberculosis (TB)
  • medical comorbidities
  • sexual activity
  • generalized lymphadenopathy
  • Kaposi sarcoma
  • genital STIs
  • chronic vaginal candidiasis
  • shingles
  • headaches
  • periodontal disease
  • retinal lesions on fundoscopy
  • shortness of breath on exertion, cyanosis on exertion, dry cough, silent chest on auscultation

Other diagnostic factors

  • current and prior use of other substances
  • peripheral neuropathy
  • recurrent herpes simplex
  • hepatomegaly or splenomegaly
  • meningeal signs (bacterial or viral meningitis)

Risk factors

  • needle sharing with intravenous drug use
  • unprotected receptive anal intercourse
  • unprotected receptive penile-vaginal sexual intercourse
  • percutaneous needle stick injury
  • high maternal viral load (mother-to-child transmission)
  • use of progestin-only injectable contraceptives
  • herpes simplex virus type 2 (HSV-2) infection

Diagnostic investigations

1st investigations to order

  • serum HIV enzyme-linked immunosorbent assay (ELISA)
  • serum HIV rapid test
  • HIV noninvasive tests
  • serum Western blot
  • serum p24 antigen
  • serum HIV DNA polymerase chain reaction (PCR)
  • CD4 count
  • serum viral load (HIV RNA)
  • drug resistance testing
  • pregnancy test
  • serum hepatitis B serology
  • serum hepatitis C serology
  • serum venereal disease research laboratory test
  • Treponema pallidum hemagglutination test
  • rapid plasma reagin
  • tuberculin skin test
  • CBC with differential
  • serum electrolytes
  • serum creatinine
  • urinalysis
Full details

Investigations to consider

  • chest x-ray
  • liver function tests (LFTs)
  • lipid profile
  • plasma glucose
  • hepatitis A serology (IgG)
  • toxoplasma serology (IgG)
  • gonorrhea and chlamydia testing
  • human leukocyte antigen-B*5701 testing
Full details

Treatment algorithm

Contributors

Associate Professor of Medicine

Infectious Diseases

Northwestern Memorial Hospital

Chicago

IL

Disclosures

CJA has been a member of an advisory board on HIV, aging and telomeres for ViiV, and has done consultant work as a member of DSMBs for ABIVAX, Atea, and Biotron. He has also received a grant for Investigator Sponsored Research from Gilead.

Dr Chad J. Achenbach would like to gratefully acknowledge Dr Richard Rothman, Dr Michael Ehmann, Dr Linda-Gail Bekker, Dr Catherine Orrell, and Dr Lisa Capaldini, the previous contributors to this topic.

Peer reviewersVIEW ALL

Clinical Assistant Professor

University of British Columbia

Vancouver

Canada

Disclosures

MH is a member of an advisory board and/or speakers' bureau for Gilead Sciences Canada Inc, Merck Canada Inc, and ViiV Healthcare.

Assistant Professor of Medicine

Harvard Medical School

Director of Research

Global Health Delivery Project

Harvard School of Public Health

Boston

MA

Disclosures

WR declares that he has no competing interests.

Infectious Disease Physician

Oxford University Clinical Research Unit

Hospital for Tropical Diseases

Ho Chi Minh City

Vietnam

Disclosures

JD declares that he has no competing interests.

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