Clinical Clues to Undiagnosed HIV Infection

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)