小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 发热和盗汗
- 体重减轻
- 皮疹和炎症后瘢痕
- 口腔溃疡、口角炎、鹅口疮或口腔毛状白斑
- 腹泻
- 消耗综合征
- 精神状态或神经精神功能改变
- 最近住院
- 结核病 (TB)
- 医学共病
- 性活动
- 全身性淋巴结肿大
- 卡波西肉瘤
- 生殖道 STI
- 慢性阴道念珠菌病
- 带状疱疹
- 各类头痛
- 牙周病
- 视网膜病变（眼底镜）
- 活动时气短、活动时发绀、干咳、肺部听诊为寂静胸
其他诊断因素
- 当前和既往使用其他药物
- 周围神经病
- 复发性单纯疱疹
- 肝或脾大
- 脑膜炎体征（细菌或病毒性脑膜炎）
危险因素
- 静脉注射毒品时共用针头
- 无保护肛交接受方
- 无保护阴茎-阴道性交接受方
- 经皮针刺伤
- 母体病毒载量高（母婴传播）
- 使用仅含孕激素的注射型避孕药
- 2 型单纯疱疹病毒 (herpes simplex virus type 2, HSV-2) 感染
诊断性检查
首要检查
- 血清 HIV 酶联免疫吸附测定 (ELISA)
- 血清 HIV 快速检测
- 无创 HIV 检测
- 血清蛋白免疫印迹法
- 血清 p24 抗原
- 血清 HIV DNA 聚合酶链反应 (PCR)
- CD4 细胞计数
- 血清病毒载量 (HIV RNA)
- 耐药检测
- 妊娠试验
- 乙型肝炎病毒血清学检测
- 丙型肝炎病毒血清学检查
- 血清性病研究实验室试验
- 梅毒螺旋体血凝试验
- 快速血浆反应素试验
- 结核菌素皮肤试验
- FBC 和分类计数
- 血清电解质
- 血清肌酐
- 尿液分析
需考虑的检查
- 胸部 X 线检查
- 肝功能检查 (LFTs)
- 随机或空腹血脂
- 随机或空腹血糖
- 甲型肝炎血清检测 (IgG)
- 弓形虫血清学检查 (IgG)
- 淋病和衣原体检测
- 人类白细胞抗原-B*5701 检测
治疗流程
新确诊的感染
病毒学或免疫学治疗失败
撰稿人
作者
Chad J. Achenbach, MD, MPH
Assistant Professor of Medicine
Infectious Diseases
Northwestern Medicine
Feinberg School of Medicine, Northwestern University
Chicago
IL
利益声明
CJA has received funds for lecturing at educational events and reimbursement for travel to these lectures by ViiV pharmaceuticals. CJA has been paid for service on a Data Safety Monitoring Board by ABIVAX.
鸣谢
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.
利益声明
ME, LGB, and CO declare that they have no competing interests. RR attended a symposium/conference hosted by a funding agency, Gilead HIV FOCUS programme, from which he receives research funds. RR pays staff for an implementation/research programme grant from Gilead HIV FOCUS for development of HIV testing programmes in Emergency Departments. LC is on the speakers' bureau for the following pharmaceutical companies: GlaxoSmithKline, BMS, Merck, Gilead, Roche, Pfizer, Solvay, Lilly, Serrano, and Tibotec.
同行评议者
Marianne Harris, MD
Clinical Assistant Professor
University of British Columbia
Vancouver
Canada
利益声明
MH is a member of an advisory board and/or speakers' bureau for Gilead Sciences Canada Inc, Merck Canada Inc, and ViiV Healthcare.
William Rodriguez, MD
Assistant Professor of Medicine
Harvard Medical School
Director of Research
Global Health Delivery Project
Harvard School of Public Health
Boston
MA
利益声明
WR declares that he has no competing interests.
Jeremy Day, BChir, MB
Infectious Disease Physician
Oxford University Clinical Research Unit
Hospital for Tropical Diseases
Ho Chi Minh City
Vietnam
利益声明
JD declares that he has no competing interests.
鉴别诊断
- 传染性单核细胞增多症
- 巨细胞病毒感染 (CMV)
- 流感病毒感染
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