H.I.V. — Case Finding & Diagnosis

PRIMARY HIV (ACUTE HIV)

Onset 9-30 days from time of transmission; Duration 1-3 wks
  • Dx important because highly infectious
Signs & Symptoms
  • Mono-like Syndrome: Fever, malaise, adenopathy, sore throat, rash, myalgias/arthralgias, headache
  • Aseptic Meningitis:  Headache, Fever, Facial Palsy
Diagnosis:     HIV RNA (Viral Load) extremely high (>100,000 copies/mL)
  • HIV-antibody (EIA) usually negative (“Window Period”)
  • EIA Seroconverts:
    • 50% by 1 mo., 95% by 3 mos, >99% by 6 mos
    • 4th Generation EIA + p24 Antigen can convert by 18 days (viral load still best test)

See also Primary HIV and HIV Rashes.

SCREENING

Screen all persons 13-64 y.o.  at least once
  • Opt-out; no counseling or consent forms
Repeat Annually (at least):
•   New partner          •    IDU & partner           •  Exchange sex for $$$/drugs
•  Partners of HIV+        •  Pregnancy: Repeat in 3rd Trimester if hi-risk
 

ASYMPTOMATIC PERIOD — CLINICAL CLUES

1. Unusual Lymphadenopathy
•   Posterior Cervical                •   Posterior Auricular          •   Epitrochlear
•  Sub-occipital                           •   Axillary                                  •   NOT inguinal
 
2.  Certain Symptoms
•  Recurrent Fevers/Sweats          •  Weight Loss          •  Chronic Diarrhea
 
3.  Certain Medical Conditions
•  Recurrent Staph infections, Vaginal Yeast, bacterial sinusitis/pneumonia
•  Active TB          •  Non-Hodgkin Lymphoma          •  Invasive Cervical CA
•  Herpes Zoster (shingles) if <50 y.o.
 
4.  Oral Lesions
•  Thrush          •  Hairy Leukoplakia          •  Kaposi’s          •  Severe Gingivitis
Pictures: HIV — Oral Lesions
 
5.  Unusual Rashes
•  Seborrheic Derm (severe)          •  Eosinophilic Folliculitis (very itchy)
•  Kaposi’s Sarcoma               •  Other unusual rashes
Pictures:  HIV — Rashes
 
6.  Subtle Incidental Laboratory Findings That Warrant HIV Testing
  • Lymphopenia on CBC:   Abs Lymphys <1,000 (ballpark guide)
  • Thrombocytopenia:  Platelet count <100,000
  • Elevated Globulins (>4.0)     see Calculating Serum Globulins
  • HDL Cholesterol <25  [ballpark guide]

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