For Patients & General Readers
HIV (Human Immunodeficiency Virus) is a virus that attacks the body's immune system, making it harder to fight off infections. It's primarily spread through unprotected sex, sharing needles, or from mother to child. Early detection and treatment are crucial to prevent serious health problems and live a long, healthy life.
Clinical Overview
HIV infection progresses through distinct clinical stages, characterized by viral load, CD4+ T-cell counts, and the presence of opportunistic infections. Clinical presentation varies significantly, ranging from asymptomatic infection to severe immunodeficiency consistent with Acquired Immunodeficiency Syndrome (AIDS).
Clinical Presentation
- Acute Retroviral Syndrome (ARS): Occurs 2-4 weeks post-infection, characterized by flu-like symptoms.
- Clinical Latency (Asymptomatic HIV Infection): A prolonged period where the virus replicates at low levels, often without symptoms.
- Symptomatic HIV Infection: As the immune system weakens, individuals may develop persistent symptoms and minor opportunistic infections.
- Acquired Immunodeficiency Syndrome (AIDS): Defined by a CD4+ T-cell count below 200 cells/mm³ or the presence of specific AIDS-defining opportunistic illnesses.
- Opportunistic Infections (OIs): Infections that occur more frequently and are more severe in people with weakened immune systems.
Signs & Symptoms
Symptoms (Patient-Reported)
- Fever
- Fatigue
- Swollen lymph nodes (lymphadenopathy)
- Sore throat
- Rash
- Muscle and joint aches
- Headache
- Nausea and vomiting
- Diarrhea
Signs (Clinician-Observed)
- Generalized lymphadenopathy
- Maculopapular rash
- Oral candidiasis (thrush)
- Kaposi's sarcoma lesions
- Weight loss
Differential Diagnoses
| Condition | Distinguishing Feature |
|---|
| Influenza | ARS can mimic influenza, but HIV testing is definitive. Consider ARS in sexually active individuals with risk factors. |
| Infectious Mononucleosis | Both can cause fever, sore throat, and lymphadenopathy. Monospot test is negative in ARS. Consider HIV testing if risk factors are present. |
| Tuberculosis (TB) | TB can present with fever, weight loss, and cough, especially in advanced HIV. Differentiate based on sputum microscopy, culture, and HIV status. |
| Other Viral Exanthems | Many viral infections cause rashes. History of risk factors and specific HIV antibody/antigen testing are crucial. |
| Fungal Infections (e.g., Pneumocystis pneumonia) | These are typically AIDS-defining illnesses. Differentiate based on clinical presentation and diagnostic investigations for specific OIs. |
Red Flags — Seek Immediate Care
- Rapidly declining CD4+ T-cell count.
- Development of AIDS-defining opportunistic infections (e.g., Pneumocystis pneumonia, Toxoplasmosis encephalitis, Cryptococcal meningitis).
- Unexplained significant weight loss.
- Persistent fever and severe fatigue.
Key Investigations
- HIV-1/HIV-2 antibody/antigen combination immunoassay (4th generation test)
- HIV RNA (viral load) testing
- CD4+ T-cell count and percentage
- Complete blood count (CBC)
- Comprehensive metabolic panel (CMP)
- Hepatitis B and C screening
- Tuberculosis screening (e.g., PPD or IGRA)
Management Overview
Management of HIV infection involves antiretroviral therapy (ART) to suppress viral replication and preserve immune function, aiming for an undetectable viral load. Regular monitoring of viral load, CD4+ T-cell count, adherence, and potential toxicities is essential. Prophylaxis and treatment of opportunistic infections are critical components of care.
Disclaimer: This article is for educational purposes only and does not constitute medical advice.
Always consult a qualified healthcare professional for diagnosis and treatment.
TruelyserMD does not replace clinical judgement.