Last reviewed:December 2019
Last updated:October  2019



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

Treatment algorithm


Associate Professor of Medicine

Infectious Diseases

Northwestern Memorial Hospital




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




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




WR declares that he has no competing interests.

Infectious Disease Physician

Oxford University Clinical Research Unit

Hospital for Tropical Diseases

Ho Chi Minh City



JD declares that he has no competing interests.

Use of this content is subject to our disclaimer