Common clinical presentations of HIV infection

Fever

This is of unknown origin. Weight loss

This is usually severe and muscle wasting. Respiratory

• non-productive cough, increasing dyspnoea and fever: due to opportunistic pneumonias More than 50% of patients present with pneumocystitis pneumonia which may have an abrupt or insidious onset. 6 With the insidious type of onset, examination and chest X-ray are often normal early. Many other agents, e.g. CMV, cryptococcosis and TB, can be responsible. Exclusion of pneumocystitis pneumonia is important as this condition carries a high mortality if untreated.

Gastrointestinal

• chronic diarrhoea (many causes) with weight loss or dehydration

Neurological

• progressive dementia (HIV encephalopathy)

• ataxia due to myelopathy

• mononeuritis

• Guillain-Barre type mononeuropathy

• toxoplasma encephalitis

• cryptococcal meningitis

• peripheral neuropathy

• progressive visual loss (CMV retinitis)

Oral cavity

• aphthous ulcers

• angular chelitis

• periodontal/gingival disease tonsillitis

• oral candidiasis

• oral hairy cell leukaemia (frequently mistaken for candidiasis but affects lateral border of tongue)

Genitourinary

• cervical dysplasia

• vaginal candidiasis

Skin impetigo

• herpes simplex

• shingles, especially multidermatomal

• seborrhoeic dermatitis

• cutaneous mycoses

• Kaposi's sarcoma (painless red-purple lesions on any part of the body including palms, soles, oral cavity and other parts of the GIT)

Figure 24.2 presents the chronology of HIVinduced disease correlated with time since infection and CD4 cell levels.

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