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TM: HIV Clinical Presentations + OIs (ii) (Presentations (direct effect of…
TM: HIV Clinical Presentations + OIs (ii)
Presentations
primary infection
direct effect of virus (complications)
encephalitis
peripheral neuropathy
pericarditis
myocarditis
CM
pul vasc disease
pul HTN
valvular disease
CAD
anemia - BM failure
hep
OIs
Malignancy (secondary to immunosuppression, geographical variation)
asymptomatic screening
Resp problems
TB
most common co-infection
co-epidemics in some parts of world
often atypical
difficult to dx without culture
CXR: hilar + paratracheal lymphadenopathy, diffuse interstitial opacities
fever, cough, weightloss
PCP
dry cough, dyspnoea
variable CXR changes
subacute progression
CD4 usually < 200
preventable with co-trimoxazle, dapsone or pentamidine
bacterial pneumonia
strep pneumo
haemophilus influenza
enteric organisms
presentation more acute
Tx common pathogens
tx: vaccine, ART
sinusitis
Kaposi's sarcoma
Oral manifestations
often spotted @ dentist
oral thrush
oral hairy leukoplakia
triggered by EBV
white patches on tongue
benign outcome
used to be common @ 30% but now rarer since HAART
oral Kaposi's sarc
Oesophageal manifestations
thrush
CMV oesophagitis
Liver manifestations
Hep B+C common
drug induced hep
acalculus cholecystitis
inflamm of gallbladder
RUQ pain + fever
AIDS cholangiopathy (bile duct damage)
fever, pain, RUQ tender, elevated All Phos
cause: cryptosporidium, CMV, mircosporidia
lactic acidosis
Pancreatitis
drugs
DDI (Didanosine)
D4T (stavudine)
pentamidine
hyperamylasaemia
elevated serum amylase
can also be caused by alcohol + stones
infections (MAC, CMV)
SI manifestations
cryptosporidia parvum
non-inlamm diarrhoea
can be severe + hard to tx
isopoda belli
microsporidia
cyclospora
entamoeba histolytica
LI manifestations
CMV colitis
TB
MAC
proctitis (inflamm of rectum lining)
can also be due to STIs from anal sex (chlamydia, gonorrhoea)
eye disease
retinitis (esp when CD4 low)
Neuro manifestations
diffuse/global
delirium
HIV-associated dementia
declining mental acuity with preservation of alertness
in 1/3 of adults with AIDS
impaired short-term memory, clumsiness, slowness, apathy, irritability, poor concentration, personality change
MRI shows ventricular enlargement + large areas of hyperintense signal in the subcortical area (white matter)
stage correlates with amount of HIV viral RNA in CSF
infection of brain macrophages - neurons die - infected mulrinucleated giant cells
perivasc + parenchymal inflamm
other causes of global CNS dysfunction
drugs
opiates
benzodiazepines
alcohol
depression v common (50%)
focal
cryptococcal meningitis
dx
serum cryptococcal antigen test (also in CSF)
CSF
lymphocytic
protein elevated (normal: 15-45 mg/dl)
lumbar puncture opening pressure >20mm water (often v high, >100)
india ink stain
culture of C neoformans
tx
ampotericin B: 1 mg/kg/day IV + flucytosine 25 mg/kg/q6hrs Poor 2 wks, fluconazole 400 mg daily thereafter)
other organisms
TB
neurosyphilis
coccidioidomycosis
histoplasma
HIV aseptic meningitis
bacteria (S pneumo, haemophilus, N meningitides)
listeria
candida
stiff neck
peripheral neuropathy
acute retroviral syndrome
distal sensory loss with neuropathic pain
can be toxic neuropathy from drugs
mononeuritis (assymetric)
progressive polyradiculopathy (damage to multiple N roots)
early inflamm demyelinating polyneuropathy
meningoencephalitis