Infectious DiseasesTier 2Disease (DEADMAN)

HIV

Description

  • Retroviral infection causing progressive CD4+ T cell depletion -> opportunistic infection and malignancy
  • With treatment it is a chronic manageable condition with near-normal life expectancy; the modern problems are late diagnosis, comorbidity and stigma
Stages
  • Acute (seroconversion) illness - 2-4 weeks after exposure, in ~50-90%
    • Fever, pharyngitis, generalised lymphadenopathy, maculopapular rash, myalgia, mouth/genital ulcers, headache; a "glandular fever-like illness with a rash and mucosal ulcers"
    • Very high viral load and high transmissibility; CD4 dips transiently
    • *Antibody tests may still be negative - this is the moment HIV is most often missed*
  • Clinical latency - median ~8-10 yr untreated; persistent generalised lymphadenopathy
  • Symptomatic / AIDS - CD4 <200 or an AIDS-defining illness
AIDS-defining illnesses
  • **Pneumocystis jirovecii pneumonia, oesophageal candidiasis, cerebral toxoplasmosis, cryptococcal meningitis, CMV retinitis/colitis, disseminated MAC, TB, cryptosporidiosis, PML**
  • Kaposi sarcoma, non-Hodgkin lymphoma (incl. primary CNS lymphoma), invasive cervical cancer
  • HIV-associated dementia (AIDS dementia complex), HIV wasting syndrome
Opportunistic infection by CD4 count - the examinable table
CD4 (cells/microL)At risk of
Any countTB, Kaposi sarcoma, bacterial pneumonia, shingles, candidiasis (oral)
<200**Pneumocystis pneumonia**, oesophageal candidiasis
<100Cerebral toxoplasmosis, cryptococcal meningitis, cryptosporidiosis
<50CMV retinitis, disseminated MAC, primary CNS lymphoma, PML

6 more sections, plus exam facts

Premium unlocks every note across every specialty, and the full exam fact library behind it.

Get premium access