Human Immunodeficiency Virus Infection



Human Immunodeficiency Virus Infection





12-A. Infection and Fever


Infections

Bacterial



  • Streptococcus pneumoniae [including penicillin-resistant S. pneumoniae (PRSP)]


  • Salmonella spp. (especially, Salmonella enteritidis and Salmonella typhimurium)


  • Haemophilus influenzae


  • Staphylococcus aureus [including methicillin-resistant S. aureus (MRSA)]


  • Pseudomonas aeruginosa


  • Moraxella catarrhalis


  • Rhodococcus equi


  • Nocardia spp.


  • Legionella spp.


  • Syphilis


  • Listeria


  • Bartonella henselae or Bartonella quintana


  • Campylobacter spp.


  • Shigella spp.


  • Clostridium difficile


  • Chlamydia spp.


  • Borrelia burgdorferi


Viral



  • Human immunodeficiency virus (HIV) (especially acute infection)


  • Cytomegalovirus (CMV)


  • Herpes simplex virus (HSV), types I and II


  • Epstein-Barr virus (EBV)


  • Varicella-zoster virus (VZV)


  • Hepatitis A, B, C


  • Human papilloma virus (HPV)


  • Measles virus


  • Papovavirus, especially JC virus


  • Human herpesvirus 6 (HHV-6)

Protozoa



  • Pneumocystis jiroveci (carinii)


  • Toxoplasma gondii


  • Cryptosporidium parvum


  • Microsporidia spp., especially Enterocytozoon bieneusi, Encephalitozoon spp.


  • Isospora belli


  • Giardia lamblia


  • Entamoeba histolytica


  • Babesia microti


  • Cyclospora cayetanensis

Nematode



  • Strongyloides stercoralis

Fungal



  • Cryptococcus neoformans


  • Candida spp.


  • Histoplasma capsulatum


  • Coccidioides immitis


  • Aspergillus spp.


  • Mucormycosis


  • Fusarium spp.


  • Blastomyces spp.

Mycobacterium



  • Mycobacterium tuberculosis


  • Mycobacterium avium complex


  • Mycobacterium chelonae


  • Mycobacterium fortuitum


  • Mycobacterium kansasii


  • Mycobacterium marinum, Mycobacterium scrofulaceum



  • Mycobacterium genavense, Mycobacterium gordonae, Mycobacterium simiae


  • Mycobacterium xenopi, Mycobacterium celatum

Malignancies

Lymphoma, especially non-Hodgkin lymphoma (NHL), central nervous system (CNS) lymphoma, Hodgkin disease

Kaposi sarcoma

Squamous cell cancer (especially of skin, anus)

Cervical and anal intraepithelial neoplasia (CIN, AIN)

Solid organ tumors (see 8-A)

Metastatic cancer

Carcinomatosis

Drugs



  • Trimethoprim and sulfamethoxazole (TMP/SMX) (Bactrim, Septra)


  • Sulfonamides


  • Dapsone


  • Phenytoin


  • Penicillins


  • Amphotericin B


  • Barbiturates


  • Clindamycin


  • Interferon


  • Pentamidine


  • Cephalosporins


  • Carbamazepine


  • Tuberculosis (TB) drugs [especially isoniazid (INH), rifampin, and streptomycin]


  • Salicylates


  • Bleomycin


  • Methotrexate


Other

Vaccinations

Adrenal insufficiency



References

1. Betts RF, Chapman SW, Penn RL. Reese and Betts’ A Practical Approach to Infectious Diseases. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2003.

2. Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2005.


3. Sande MA, Eliopoulos GM, et al. The Sanford Guide to HIV/AIDS Therapy 2006-2007. 15th ed. Sperryville, VA: Antimicrobial Therapy, Inc.; 2006.

4. Starlin R, Lin TL. The Washington Manual Subspecialty Series: Infectious Diseases Subspecialty Consult. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 2005.

5. Kasper DL, Braunwald E, et al. Harrison’s Principles of Internal Medicine. 16th ed. New York: McGraw Hill; 2005.

6. Mayer KH, ed. HIV/AIDS. Infect Dis Clin North Am. 2007;21:Issue 1.

7. Powderly WG, ed. Manual of HIV Therapeutics. Philadelphia: Lippincott-Raven; 1997.

8. Wormser GP, ed. AIDS and Other Manifestations of HIV Infection. 3rd ed. Philadelphia: Lippincott-Raven; 1998.

9. Gold JWM, Telzak EE, White DA, eds. The Medical Clinics of North America: Management of the HIV-Infected Patient: Part II. Infections and Malignancies Associated with HIV Infection. Philadelphia: WB Saunders; 1997.

10. Gorbach SL, Bartlett JG, Blackow NR. Infectious Diseases. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2004.


12-B. Primary HIV Infection: Signs and Symptoms

Fever/rash (exanthem—including face, trunk, palms, soles)/fatigue

Headache/lymphadenopathy (generalized)/pharyngitis

Myalgias and arthralgias/nausea, vomiting, anorexia, diarrhea

Night sweats/oral, esophageal, and genital ulcers/weight loss

Oral, esophageal, and vaginal candidiasis

Leukopenia/thrombocytopenia

Meningitis/encephalopathy/encephalitis/radiculopathy/cranial nerve palsies (VII)—rare



References

1. Gorbach SL, Bartlett JG, Blackow NR. Infectious Diseases. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2004.

2. Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2005.

3. Sande MA, Eliopoulos GM, et al. The Sanford Guide to HIV/AIDS Therapy 2006-2007. 15th ed. Sperryville, VA: Antimicrobial Therapy, Inc.; 2006.

4. Zetola NM, Pilcher CD. Diagnosis and management of acute HIV infection. Infect Dis Clin North Am. 2007;21:19-48.



12-C. Differential Diagnosis of Primary HIV Infection

Acute viral syndrome

Infectious mononucleosis

Secondary syphilis

Acute viral hepatitis

Influenza

Acute toxoplasmosis

Acute parvovirus B19 infection

Aseptic meningitis

Acute CMV (cytomegalovirus) infection

Acute rheumatic fever

Adverse drug/medication reaction

Streptococcal pharyngitis


12-D. Ocular Complications

Retinitis



  • CMV: usually unilateral initially, painless, progressive loss of vision


  • Toxoplasmosis: chorioretinitis with or without CNS involvement


  • VZV: rapid loss of vision (can be associated with trigeminal zoster lesions)


  • HSV: can cause acute retinal necrosis syndrome or progressive outer retinal necrosis (PORN); associated with pain, keratitis, and iritis; associated with oral, mucocutaneous lesions


  • Fungal (especially C. neoformans and H. capsulatum)


  • Treponema pallidum


  • Idiopathic

Uveitis



  • T. pallidum


  • Mycobacterium spp.


  • VZV


  • Drugs, especially rifabutin, cidofovir

Optic neuritis



  • T. pallidum


  • C. neoformans

Choroiditis



  • P. jiroveci (carinii): can mimic CMV retinitis


  • Mycobacterium spp.

Other

HIV retinopathy: seen in 50-75% of patients


Fungal endophthalmitis (Candida spp.)

Herpes zoster virus (HZV) ophthalmicus

Fungal or bacterial corneal ulcers

Kaposi sarcoma (conjunctivae, lid, orbit)

NHL (lid/retina)

Molluscum contagiosum (conjunctivae, lid)

HSV keratitis

Reiter syndrome (conjunctivitis, arthritis, urethritis, or cervicitis)

VZV blepharitis, conjunctivitis, keratitis



References

1. Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2005.

2. Gorbach SL, Bartlett JG, Blackow NR. Infectious Diseases. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2004.

3. Wormser GP, ed. AIDS and Other Manifestations of HIV Infection. 3rd ed. Philadelphia: Lippincott-Raven; 1998.

4. Cohen J, Powderly WG. Infectious Diseases. 2nd ed. New York: Mosby; 2004.

5. Jabs DA, Van Natter ML, et al. Longitudinal study of the ocular complications of AIDS: ocular diagnoses at enrollment. Ophthalmology. 2007;114:780-786.


12-E. Hematologic Complications


Red Blood Cell Disorders

Etiologies of anemia



  • HIV infection


  • M. avium complex infection


  • Parvovirus B19 infection


  • Drugs, especially:



    • TMP/SMX


    • Sulfonamides


    • Interferon or ribavirin


    • Azidothymidine (AZT)


    • Ganciclovir


    • Pentamidine


    • Dideoxycytidine (ddC, zalcitabine)


    • Lamivudine (3TC, Epivir)


    • Dapsone (especially in patients with glucose-6-phosphate dehydrogenase deficiency)


  • Iron deficiency anemia



  • Autoimmune hemolytic anemia (AIHA)


  • Vitamin B12 deficiency


  • Blood loss


  • Bone marrow infiltration with infection (especially CMV, M. avium complex)


  • Bone marrow infiltration with malignancy (especially lymphoma)


  • Hypersplenism


  • Thrombotic thrombocytopenic purpura (TTP)


White Blood Cell Disorders

Etiologies of neutropenia or leukopenia



  • HIV infection


  • Drugs, especially:



    • ddC (zalcitabine)


    • 3TC (Epivir)


    • TMP/SMX


    • Ganciclovir


    • AZT (Retrovir)


  • Bone marrow infiltration with infection (especially CMV, M. avium complex)


  • Bone marrow infiltration with malignancy (especially lymphoma)


  • Hypersplenism


Platelet Disorders

Etiologies of thrombocytopenia



  • HIV infection


  • CMV


  • Parvovirus B19


  • Fungal infections (especially Cryptococcus and Histoplasma)


  • M. tuberculosis and M. avium complex disseminated infections


  • Lymphoma


  • Hepatitis B and C


  • HHV-6


  • TTP


Drugs Causing Multiple Hematologic Abnormalities in HIV Infection

Zidovudine (Retrovir or AZT)

Ganciclovir

TMP/SMX


Sulfonamides

Interferon-α or ribavirin, or both

Pyrimethamine

3TC (Epivir)

Antineoplastic chemotherapy

Dapsone

Didanosine (ddI)

ddC (zalcitabine)

Amphotericin B

Pentamidine

Fluconazole

Rifabutin

Clarithromycin



References

1. Kasper DL, Braunwald E, et al. Harrison’s Principles of Internal Medicine. 16th ed. New York: McGraw Hill; 2005.

2. Sande MA, Eliopoulos GM, et al. The Sanford Guide to HIV/AIDS Therapy 2006-2007. 15th ed. Sperryville, VA: Antimicrobial Therapy, Inc.; 2006.

3. Gorbach SL, Bartlett JG, Blackow NR. Infectious Diseases. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2004.

4. Dolin R, Massur H, Saag MS. AIDS Therapy. Philadelphia: Churchill Livingstone; 1999.

5. Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2005.

6. O’Connor PG, Scadden DT. AIDS oncology. Infect Dis Clin North Am. 2000;14:945-965.

7. Barnes PF, Lakey DL. TB in patients with HIV infection. Infect Dis Clin North Am. 2002;16:107-126.

8. Stenzel MS, Carpenter CCJ. The management of the clinical complications of antiretroviral therapy. Infect Dis Clin North Am. 2000;14:851-878.

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Related posts:

  1. Gastrointestinal and Hepatic System
  2. Genitourinary System
  3. Hematologic System
  4. Respiratory System

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Jun 19, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Human Immunodeficiency Virus Infection

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