Download HIV indicator conditions

Diagnostic testing for HIV:
The symptomatic patient
HIV-associated conditions
HIV infection is associated with an increased risk of
• a range of infections
• some cancers
HIV also has some direct effects of its own
Many respiratory, oral & gut and skin conditions are HIV associated.
Some HIV symptoms and conditions are systemic.
Blood dyscrasias may give clues to HIV infection
Work in 2s or 3s (please mix GPs and PNs)
NURSES: You are not expected to know many of these things
(but some are very important for you).
Try to write down
at least EIGHT symptoms or conditions
that might be HIV-associated
HIV-associated conditions
[Still in your pairs] Review your lists:
Do you have at least
- two cancers and two infections that are HIV associated?
- Have you managed to think of at least one direct effect of
the HIV virus?
Do you have at least
- Two skin conditions on your list?
- Two oral conditions?
- One lower gut condition?
- One more systemic condition?
- Two blood dyscrasias?
HIV Tests
The UK national HIV testing guidelines recommend:
‘all patients presenting for healthcare where
HIV…. enters the differential diagnosis
should be routinely offered an HIV test’
With all HIV-associated conditions it is important to
consider if the patient could be HIV-infected –
and offer a test
So which conditions are we talking about?
First chance for diagnosis:
Primary HIV infection (PHI)
A flu-like, or glandular fever-like, infection
• Typically occurs in the first 2 or 3 weeks after
infection
• Sore throat, fever, myalgia
• Patients might also have rash, headache, perioral or peri-genital ulcers
Association between virological,
immunological, & clinical events and time
course of untreated HIV
Reproduced with permission from e-GP: e-Learning for General Practice, RCCP
Example of primary HIV infection rash
NB i) There may be NO rash
ii) This rash can vary considerably in its morphology/appearance
PHI: Why it matters so much!
• The patient is highly infectious due to a very high
viral load
• There is evidence that much transmission is at
this stage of infection
• There is a better chance of partner notification,
(as the infection is relatively recent)
• The patient’s condition can be monitored and
treatment started in a timely fashion
After primary HIV infection (PHI)
there is likely to be a period of 5 to 15 years
when the patient has no symptoms
Then other HIV-associated conditions will start to occur
Association between virological,
immunological, & clinical events and time
course of untreated HIV
Reproduced with permission from e-GP: e-Learning for General Practice, RCCP
Oral and gut conditions
Call out which ones you have on your lists!
The following conditions are commoner in HIV-infected people:
•Oral and oesophageal candida
•Oral hairy leukoplakia
•Kaposi’s sarcoma
•Aphthous ulcers
•Gingivitis
•Herpes simplex
•Chronic diarrhoea
•Weight loss of unknown cause
NB Viral hepatitis shares risks for HIV – offer an HIV test
Oral Candida
Oral candida can be either erythematous or pseudomembranous (illustrated above)
in character.
Oral Hairy Leukoplakia
Oral hairy leucoplakia is caused by EBV infection in an HIV positive
patient with immune deficiency
Dermatology
Call out which ones you have on your lists!
The following conditions are commoner in HIV-infected people:
•Severe or recalcitrant seborrhoeic dermatitis
•Severe or recalcitrant psoriasis
•Multidermatomal or recurrent herpes zoster
•Kaposi’s sarcoma
•Folliculitis – whether normal or pruritic
Cutaneous Kaposi’s sarcoma
KS is a vascular tumour and is caused by human herpes virus 8 infection.
KS may also affect the mouth, gastrointestinal tract, lungs and lymph nodes.
Respiratory
Call out which ones you have on your lists!
The following conditions are commoner in HIV-infected people:
• Bacterial pneumonia
• Tuberculosis
• Pneumocystis pneumonia (PCP)
Patients with undiagnosed HIV are at risk of PCP and this
may present with progressive dyspnoea and a dry cough
over 2-3 weeks: be sure not to confuse it with asthma
Apical Pulmonary Tb: CXR
Neurology
Call out which ones you have on your lists!
The following conditions are commoner in HIV-infected people:
• Peripheral neuropathy
• Aseptic meningitis
• Dementia
And a number of other things likely to lead to urgent referral! (eg
S.O.L due to eg lymphoma or abscess).
Systemic and other
Call out which ones you have on your lists!
The following conditions are commoner in HIV-infected people:
• Lymphadenopathy
• Sweats, PUO
• Weight loss
Blood dyscrasias: anaemia, low platelet count,
neutropaenia
Lymphoma
Asymmetrical lymphadenopathy
Generalised lymphadenopathy is common in HIV positive patients.
Asymmetrical lymphadenopathy with or without fever may be indicative of
underlying mycobacterial disease or lymphoma.
Genital conditions
Call out which ones you have on your lists!
The following conditions are commoner in HIV-infected
people:
• Atypically severe STIs (warts, herpes)
• Cervical intraepithelial neoplasia grade 2 or
above
HIV infection increases the risk of cervical cancer.
CIN disease is present in between 20-40% of women with HIV, and may be
associated with more rapid progression to higher grade disease.
Do we consider HIV in our patients referred for colposcopy?
ALL patients with STIs should be offered an HIV test
Case studies
• One GP read ‘An HIV test I wish I had offered
– the GP’s story’
• One nurse read ‘An HIV test I wish I had
offered – the nurse’s story’
Last chance to update your lists!
How many did you miss?
• Link or reference to UK 2008 testing guidelines