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HIV Infection & AIDS

For further information, see CMDT Part 31 HIV Infection & AIDS

Key Features

Essentials of Diagnosis

  • Modes of transmission

    • Sexual contact with an infected person

    • Parenteral exposure to infected blood by transfusion or needle sharing

    • Perinatal exposure

  • Prominent systemic complaints: sweats, diarrhea, weight loss, and wasting

  • Opportunistic infections

    • Due to diminished cellular immunity

    • Often life-threatening

  • Aggressive cancers, particularly non-Hodgkin lymphoma

  • Neurologic manifestations

    • Dementia

    • Aseptic meningitis

    • Neuropathy

General Considerations

  • Definition: Centers for Disease Control and Prevention AIDS case definition (Table 31–1)

  • Etiology: HIV-1, a retrovirus

Table 31–1.CDC AIDS case definition for surveillance of adults and adolescents.
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Table 31–1. CDC AIDS case definition for surveillance of adults and adolescents.
Definitive AIDS Diagnoses (with or without laboratory evidence of HIV infection)
1. Candidiasis of the esophagus, trachea, bronchi, or lungs.
2. Cryptococcosis, extrapulmonary.
3. Cryptosporidiosis with diarrhea persisting > 1 month.
4. Cytomegalovirus disease of an organ other than liver, spleen, or lymph nodes.
5. Herpes simplex virus infection causing a mucocutaneous ulcer that persists > 1 month; or bronchitis, pneumonitis, or esophagitis of any duration.
6. Kaposi sarcoma in a patient < 60 years of age.
7. Lymphoma of the brain (primary) in a patient < 60 years of age.
8. Mycobacterium avium complex or Mycobacterium kansasii disease, disseminated (at a site other than or in addition to lungs, skin, or cervical or hilar lymph nodes).
9. Pneumocystis jirovecii pneumonia.
10. Progressive multifocal leukoencephalopathy.
11. Toxoplasmosis of the brain.
Definitive AIDS Diagnoses (with laboratory evidence of HIV infection)
1. Coccidioidomycosis, disseminated (at a site other than or in addition to lungs or cervical or hilar lymph nodes).
2. HIV encephalopathy.
3. Histoplasmosis, disseminated (at a site other than or in addition to lungs or cervical or hilar lymph nodes).
4. Isosporiasis with diarrhea persisting > 1 month.
5. Kaposi sarcoma at any age.
6. Lymphoma of the brain (primary) at any age.
7. Other non-Hodgkin lymphoma of B cell or unknown immunologic phenotype.
8. Any mycobacterial disease caused by mycobacteria other than Mycobacterium tuberculosis, disseminated (at a site other than or in addition to lungs, skin, or cervical or hilar lymph nodes).
9. Disease caused by extrapulmonary M tuberculosis.
10. Salmonella (nontyphoid) septicemia, recurrent.
11. HIV wasting syndrome.
12. CD4 lymphocyte count < 200 cells/mcL or a CD4 lymphocyte percentage < 14%.
13. Pulmonary tuberculosis.
14. Recurrent pneumonia.
15. Invasive cervical cancer.
Presumptive AIDS Diagnoses (with laboratory evidence of HIV infection)
1. Candidiasis of esophagus: (a) recent onset of retrosternal pain on swallowing; and (b) oral candidiasis.
2. Cytomegalovirus retinitis. A characteristic appearance on serial ophthalmoscopic examinations.
3. Mycobacteriosis. Specimen from stool or normally sterile body fluids or tissue from a site other than lungs, skin, or cervical or hilar lymph nodes, showing acid-fast bacilli of a species not identified by culture.
4. Kaposi sarcoma. Erythematous or violaceous plaque-like lesion on skin or mucous membrane.
5. Pneumocystis jirovecii pneumonia: (a) a history of dyspnea on exertion or nonproductive cough of recent ...

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