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Human immunodeficiency virus disease
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Human immunodeficiency virus disease

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Contributors: Neil Mendoza MD, Paritosh Prasad MD
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Synopsis

Infection with the human immunodeficiency virus (HIV) is the cause of acquired immunodeficiency syndrome (AIDS), and it is a major global problem. There are two virus types (HIV-1 and HIV-2). The virus is transmitted primarily by sexual contact. It can also be transmitted parenterally through injection drug use, blood transfusion, at the time of organ transplantation, or perinatally (in utero, intrapartum, or during breastfeeding). Men who have sex with men and patients who abuse intravenous drugs are at increased risk for this infection. The virus attacks CD4 T-lymphocytes, leading to progressive immune dysfunction.

The case definition for HIV infection for adults and adolescents includes 3 stages:
  • Stage 1 for CD4 cells greater than or equal to 500 cells per microliter.
  • Stage 2 for CD4 cells greater than or equal to 200 cells per microliter.
  • Stage 3 (AIDS) with less than 200 cells per microliter or the presence of an AIDS-defining condition.
Diagnosis of HIV infection is made when a highly sensitive screening test and a highly specific confirmatory test are both positive. There are many approved commercial assays for HIV testing, all with different testing characteristics. Commonly used fourth-generation screening tests combine testing for HIV-specific antibodies and a p24 antigen test. While the confirmatory test of choice was the Western blot, many laboratories now are using the HIV Multispot enzyme-linked immunosorbent assay (ELISA) for confirmation of infection.

The clinical manifestations of HIV infection vary widely from asymptomatic to the varied presentations of AIDS-defining conditions that are a result of profound immunosuppression.

Patients with acute infection present with signs and symptoms of the acute retroviral syndrome, a mononucleosis-like illness. They have fever, lymphadenopathy, and may have rash. Other symptoms, including mucocutaneous ulcers, sore throat, nausea, vomiting, diarrhea, and headache, may also be present.

Patients may present with a variety of other nonspecific symptoms or signs. Endocrine abnormalities may include hypogonadism, insulin resistance, and lipid abnormalities. Renal dysfunction, myocarditis, and pericarditis may be present. Oral disease may include thrush, oral hairy leukoplakia, and gingivitis. Patients may present with cutaneous infections due to herpes simplex virus, varicella-zoster virus, and molluscum contagiosum.

Patients may present with signs and symptoms of one of many AIDS-defining conditions, including multiple or recurrent bacterial infections, candidiasis, disseminated coccidioidomycosis, extrapulmonary cryptococcosis, chronic intestinal cryptosporidiosis, cytomegalovirus retinitis, chronic ulcers of herpes simplex, disseminated histoplasmosis, chronic intestinal isosporiasis, Kaposi sarcoma, Burkitt lymphoma, primary lymphoma of brain, disseminated Mycobacterium avium complex or Mycobacterium kansasii infection, Mycobacterium tuberculosis infection, Pneumocystis jirovecii pneumonia, progressive multifocal leukoencephalopathy, recurrent Salmonella septicemia, or toxoplasmosis of brain.

The most common conditions leading to evaluation and diagnosis with AIDS are P. jirovecii pneumonia, HIV wasting syndrome, and esophageal candidiasis.

Associated malignancies of HIV include lung cancer, Kaposi sarcoma, Hodgkin lymphoma, non-Hodgkin lymphoma, cervical cancer, hepatocellular cancer, anal cancer, and mouth cancer (human papillomavirus associated).

Codes

ICD10CM:
B20 – Human immunodeficiency virus [HIV] disease

SNOMEDCT:
19030005 – Human immunodeficiency virus

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The clinical manifestations of HIV infection vary widely. The differential diagnosis depends on the signs and symptoms at presentation. Patients with acute HIV may present with a mononucleosis-like illness.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 05/30/2017
Last Updated: 03/27/2018
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Human immunodeficiency virus disease
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Human immunodeficiency virus disease : Diarrhea, Fatigue, Fever, Night sweats, Lymphadenopathy, Weight loss
Copyright © 2019 VisualDx®. All rights reserved.