Last reviewed: 3 Feb 2021
Last updated: 09 Aug 2019
Summary
Definition
History and exam
Key diagnostic factors
- no antiretroviral treatment (ART) or failure of ART
- fever
- headache and altered mental status
- dyspnea or cough
- abdominal pain, diarrhea, weight loss
- dysphagia
- lymphadenopathy
- visual floaters and blindness
- ocular hemorrhage
- mucosal changes
Other diagnostic factors
- hepatosplenomegaly
- exercise-induced oxygen desaturation
- cyanosis
- blurred vision and photophobia
- papilledema
- meningismus, focal neurologic 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/microliter
- CD4+ count below 100 cells/microliter
- CD4+ count below 50 cells/microliter
- no antiretroviral treatment (ART) or failure of ART
- men who have sex with men
- black or Hispanic race, intravenous drug use
- social factors (poverty, overcrowding, homelessness, poor nutrition)
- lack of preventive treatment for latent tuberculosis (TB) and anergy
- smoking
Diagnostic investigations
1st investigations to order
- CD4+ cell count
- sputum stain and culture
- blood cultures
- adenosine deaminase
- cytomegalovirus (CMV) cultures
- CMV serology
- peripheral blood leukocyte culture
- CMV proteins in peripheral blood leukocytes (pp65) antigenemia
- quantitative CMV polymerase chain reaction (PCR)
- Toxoplasma gondii serology
- cryptococcal polysaccharide antigen
- CBC
- LFT
- LDH
- ABG
- chest x-ray
- head CT
Investigations to consider
- tuberculosis (TB) nucleic acid amplification
- IGRA
- bronchoalveolar lavage (BAL)
- oropharyngeal scrapings (KOH prep) and culture
- cerebrospinal fluid (CSF) analysis
- PCR: respiratory specimen for TB
- PCR: CSF, BAL fluid, and vitreous and aqueous humor specimen for T gondii
- PCR: brain specimen for John Cunningham (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-diethylenetriaminepentaacetic acid (DTPA)-IgG scan
- thallium single photon emission tomography and PET
- upper gastrointestinal endoscopy and colonoscopy
Treatment algorithm
Contributors
Authors
Professor
Department of Clinical Sciences
Florida State University College of Medicine
Tallahassee
FL
Disclosures
IA declares that she has no competing interests.
Peer reviewers
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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