A variety of incidental findings may offer subtle clues to undiagnosed HIV infection. These include:
1. Unusual Lymphadenopathy
- Suboccipital
- Posterior Cervical
- Axillary
- Epitrochlear
- NOT inguinal
2. Certain Medical Conditions
- Recurrent Staphylococcal skin infections
- Recurrent vaginal yeast infections
- Recurrent bacterial pneumonia or sinusitis
- Chronic diarrhea
- Herpes zoster (Shingles) in persons <50 years old
3. Oral Lesions
NOTE — The pictures below may appear florid, but also try to imagine a patient with just a subtle component of what you see here.
Thrush:
Hairy Leukoplakia (“corrugated” vertical streaking on sides of tongue):
Oral Kaposi’s Sarcoma:
4. Unusual Rashes
Severe Seborrheic Dermatitis:
Eosinophilic Folliculitis:
Kaposi’s Sarcoma:
Subtle Incidental Laboratory Findings That Warrant HIV Testing
1. Lymphopenia on a CBC:
- Absolute Lymphs <1000
- If differential only in percents, multiply total WBC by % Lymphs
2. Thrombocytopenia
- Platelet count <100,000
3. Elevated Serum Globulins
Chronic infections, including HIV, cause a chronic elevation in serum globulins. Calculate from a typical chemistry panel by:
- Total Protein minus Albumin = Globulins
- Globulins >4 g/dL is elevated
It doesn’t matter if the Total Protein is elevated or not; what matters is the difference by subtraction. For example
- Protein 8.5 [high] minus Albumin 5.0 [normal] = 3.5 [normal]
- Protein 7.9 [normal] minus Albumin 3.7 [normal] = 4.2 [high]
4. Very Low HDL (e.g. <25)
