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Key Clinical Updates in HIV Infection & AIDS: Complications
Tenofovir-based regimens for HIV may be protective against SARS-CoV-2, as seen in large observational studies.
Li G et al. AIDS. [PMID: 35848570]
In settings of meningococcal outbreaks, the meningococcal B vaccine may be administered to adolescents and young adults with HIV for short-term protection against most strains of serogroup B meningococcal disease. Routine administration of meningococcal B vaccine to patients with HIV, however, is not indicated.
National Institutes of Health (NIH). https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/immunizations
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A. Systemic Complaints
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Fever, night sweats, and weight loss are common symptoms in people with HIV and may occur without a complicating opportunistic infection. Patients with persistent fever and no localizing symptoms should nonetheless be carefully examined and evaluated with a CXR (Pneumocystis pneumonia can present with subtle respiratory symptoms), bacterial blood cultures if the fever is greater than 38.0°C, as well as serum cryptococcal antigen and mycobacterial cultures of the blood in those with low CD4 cell counts. Abdominal CT scans can be considered to evaluate occult intrabdominal infections or cancers. If these studies are normal, patients should be observed closely. Antipyretics are useful to prevent dehydration.
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Centers for Disease Control and Prevention (CDC). 2018 quick reference guide: recommended laboratory HIV testing algorithm for serum or plasma specimens.
https://stacks.cdc.gov/view/cdc/50872 +
Erlandson
KM
et al. HIV and aging: reconsidering the approach to management of comorbidities. Infect Dis Clin North Am. 2019;33:769.
[PubMed: 31395144]
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Pahwa
S
et al. NIH Workshop on HIV-associated comorbidities, coinfections, and complications: summary and recommendation for future research. J Acquir Immune Defic Syndr. 2021;86:11.
[PubMed: 33306561]
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Weight loss is a particularly distressing complication of long-standing HIV infection. Patients typically have disproportionate loss of muscle mass, with maintenance or less substantial loss of fat stores. The mechanism of HIV-related weight loss is not completely understood but appears to be multifactorial, with some of the older thymidine analog medications implicated. In the setting of the newer medications, weight gain has been seen with some ART regimens, with the mechanisms and interactions currently being examined.
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Patients with AIDS frequently suffer from anorexia, nausea, and vomiting, all of which contribute to weight loss by decreasing caloric intake. In some cases, these symptoms are secondary to a specific infection, such as viral hepatitis. In other cases, however, evaluation of the symptoms yields no specific pathogen, and it is assumed to be due to a primary effect of HIV. Malabsorption also plays a role in decreased caloric intake. Patients may suffer diarrhea from infections with bacterial, viral, or parasitic agents.
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Exacerbating the decrease in caloric intake, many patients with uncontrolled HIV have an increased metabolic rate. This increased rate has been shown to exist even among asymptomatic people ...