HIV - AIDS (main): Difference between revisions

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==Background==
* In HIV+ patient presenting to ED, absolute lymphocyte count (ALC) can be used as surrogate for CD4 count <ref> Napoli AM, Fischer CM, Pines JM, Soe-lin H, Goyal M, Milzman D. Absolute
lymphocyte count in the emergency department predicts a low CD4 count in admitted
HIV-positive patients. Acad Emerg Med. 2011 Apr;18(4):385-9. doi:
10.1111/j.1553-2712.2011.01031.x. Erratum in: Acad Emerg Med. 2011 May;18(5):565. </ref>.
* A CD4 count of <200 is very likely if the ED ALC is <950 and less likely if the ALC is >1700.
* ALC is useful to confirm, but not exclude a low CD4
==Clinical Stages==
===Acute Infection===
*Misdiagnosed frequently as "mono" or "flu"
*Symptoms develop 2-4wks after exposure; last for <14d
**[[Fever]] (>90%)
**Fatigue (70-90%)
**[[Pharyngitis]] (>70%)
**Rash (40-80%)
**Headache (30-70%)
**[[Lymphadenopathy]] (40-70%)
===Seroconversion===
*HIV Ab detectable 3-8wk after infection
===Asymptomatic===
*Lasts for ~8yr
*Pts may have conditions that are more common in pts w/ HIV but no indicator conditions
**Thrush
**Persistent vulvovaginal candidiasis
**Peripheral neuropathy
**Cervical dysplasia
**Recurrent [[Herpes Zoster]]
**ITP
===AIDS===
*Defined as HIV + (indicator condition or CD4 < 200)
*Indicator conditions:
**Pulmonary [[TB]]
**Disseminated [[TB]]
**Invasive cervical cancer
**Esophageal candidiasis
**[[Cryptococcosis]]
**[[Cryptosporidiosis]]
**[[CMV  Retinitis]]
**HSV
**[[Kaposi sarcoma]]
**Brain lymphoma
**MAC
**PCP PNA
**PML
**Brain [[Toxoplasmosis]]
**HIV [[Encephalitis]]
**HIV wasting syndrome
**Disseminated histoplasmosis
**Isosporiasis
**Recurrent [[Salmonella]] septicemia
**Recurrent Bacterial [[Pneumonia]]
==Neurologic Complications==
*Work-Up
**CT Head w/o contrast
**LP
***Regular studies + (India ink, viral culture, fungal culture, toxo, crypto, coccidio)
*Specific Conditions:
**[[Toxoplasmosis]]
**[[Cryptococcosis]]
**[[AIDS Dementia]]
==Pulmonary Complications==
*Most common cause of PNA in HIV-infected pt is Strep pneumo, NOT PCP
*Cannot use PORT score to dispo pts
*Work-Up
**ABG
**Sputum cx, GS, AFB
**Blood cx
**CXR
*Specific Infections
**[[Pneumocystis Pneumonia (PCP)]]
**[[Tuberculosis (TB)]]
==Ophthalmologic Complications==
*[[CMV Retinitis]]
*[[Herpes Zoster Ophthalmicus]]
==See Also==
==See Also==
*[[HIV (Overview)]]
*[[HIV (CD4)]]
*[[HIV (CD4)]]
*[[HIV (Disposition)]]
*[[HIV (Disposition)]]
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*[[Immune reconstitution inflammatory syndrome]]
*[[Immune reconstitution inflammatory syndrome]]


==References==
<references/>
[[Category:ID]]
[[Category:ID]]

Revision as of 01:08, 1 August 2015

Background

  • In HIV+ patient presenting to ED, absolute lymphocyte count (ALC) can be used as surrogate for CD4 count [1].
  • A CD4 count of <200 is very likely if the ED ALC is <950 and less likely if the ALC is >1700.
  • ALC is useful to confirm, but not exclude a low CD4

Clinical Stages

Acute Infection

  • Misdiagnosed frequently as "mono" or "flu"
  • Symptoms develop 2-4wks after exposure; last for <14d

Seroconversion

  • HIV Ab detectable 3-8wk after infection

Asymptomatic

  • Lasts for ~8yr
  • Pts may have conditions that are more common in pts w/ HIV but no indicator conditions
    • Thrush
    • Persistent vulvovaginal candidiasis
    • Peripheral neuropathy
    • Cervical dysplasia
    • Recurrent Herpes Zoster
    • ITP

AIDS

Neurologic Complications

Pulmonary Complications

Ophthalmologic Complications

See Also

References

  1. ↑ Napoli AM, Fischer CM, Pines JM, Soe-lin H, Goyal M, Milzman D. Absolute lymphocyte count in the emergency department predicts a low CD4 count in admitted HIV-positive patients. Acad Emerg Med. 2011 Apr;18(4):385-9. doi: 10.1111/j.1553-2712.2011.01031.x. Erratum in: Acad Emerg Med. 2011 May;18(5):565.
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