Presentation
Lessons from practice HIV should be considered in all patients presenting with a new rash. Acute HIV infection can present as febrile illness associated with any rash, including erythema multiforme. [mja.com.au]
Heightened awareness of the cutaneous presentation of parvovirus B19 infection can help avoid unnecessary hospitalization and patient anxiety. [mdedge.com]
Meeting summary The meeting included: introductory remarks (presented by Meg Doherty); an overview plenary session on acute HIV infection (AHI) (presented by Myron Cohen); scoping review findings (presented by Sarah Rutstein and Joseph Tucker); a panel [who.int]
Case presentation A 27 year old female, presented to our hospital on 5 th July 2013 with fever, throat pain, non productive cough, anorexia and weight loss (4 kg) for one month duration. [bmcinfectdis.biomedcentral.com]
Analysis included MSM self-presenting to a community screening program in San Diego and 1) tested positive for AHI (antibody-negative, HIV NAT-positive) from 2007–2017 or 2) tested HIV NAT-negative in 2017. [insights.ovid.com]
Immune System
- Inguinal Lymphadenopathy
Inguinal lymphadenopathy was noted on examination. A skin examination revealed an extensive macular papular rash affecting his face, trunk and limbs, with an erosion noted on his soft palate. [mja.com.au]
Entire Body System
- Fever
Our patient’s fever, rash, and absolute lymphopenia focused attention on possible HIV infection, which caused the patient significant anxiety while awaiting the results of HIV testing. [mdedge.com]
Myalgia (OR 6.6 [95% CI: 2.5 to 17.5]), fever (OR 9.5 [95% CI: 3.5 to 25.7]), weight loss (OR 7.4 [95% CI: 1.9 to 29.5]), and CRAI plus ≥2 male partners (OR 7.4 [95% CI: 3.1 to 17.6]) remained significant in the multivariate model. [insights.ovid.com]
They include: Fever Fatigue Sore throat Weight loss Muscle aches Headache Nausea Night sweats Diarrhea Rash Having these symptoms does not mean that you have HIV, because these same symptoms can occur with the flu, mono, or strep throat. [depts.washington.edu]
The syndrome is characterized by fever, sore throat, headache, skin rash and swollen glands (lymphadenopathy). This syndrome precedes seroconversion -- the development of detectable antibodies to HIV in the blood as a result of the infection. [medicinenet.com]
HIV-seronegative adults presenting at the Manhiça District Hospital, Mozambique, with reported-fever were tested for VL. [nature.com]
Cardiovascular
- Heart Disease
Retroviridae Infections RNA Virus Infections Virus Diseases Sexually Transmitted Diseases, Viral Sexually Transmitted Diseases Immunologic Deficiency Syndromes Immune System Diseases Slow Virus Diseases Anti-Retroviral Agents Genvoya Emtricitabine Tenofovir [clinicaltrials.gov]
These include: Chronic renal failure Diabetes Osteoporosis Liver damage Heart disease Hyperlipidemia, an excess of fats in the blood Lipodystrophy, metabolic changes in how the body uses and stores fat Depression People who have contracted HIV become [ada.com]
Urogenital
- Scrotal Ulcer
Several small scrotal ulcers with well-defined borders were noted. Oral examination revealed white-yellow adherent plaques on the tongue and similar small ulcers on the lower lip and soft and hard palates. [mdedge.com]
Neurologic
- Guillain-Barré Syndrome
Seventy-three participants (53%) experienced one or more neurologic findings in the 12 weeks after diagnosis, with one developing a fulminant neurologic manifestation (Guillain-Barré syndrome). [n.neurology.org]
One participant had Guillain-Barré syndrome, the only severe condition in the group. All the patients were offered and began antiretroviral treatment when they were diagnosed with HIV infection. [psychiatryadvisor.com]
Less commonly, neurological complications may occur, such as aseptic meningitis, facial palsy, or Guillain-Barré syndrome. [ 39 ] Rarely, acute infection causes such a substantial drop in CD4 T-cell count that patients may initially present with oral [hiv.uw.edu]
- Insomnia
Side-effects associated with taking antiretroviral drugs include: Nausea Vomiting Tiredness Headache Insomnia Dry mouth Diarrhea Fever Dizziness Rash Muscle pain Doctors can generally tailor ART for a particular person to counter potential adverse effects [ada.com]
Patients who are taking RBV and experience insomnia may need to adjust the timing of the dose to earlier in the afternoon to avoid any sleep disruption. [hivguidelines.org]
- Motor Symptoms
However, there are some instances in acute or primary infection when treatment is strongly recommended, including: Neurological symptoms (meningitis, cognitive or motor symptoms, weakness/numbness as a result of nerve damage) Any AIDS-defining illness [aidsmap.com]
Workup
Treatment with intravenous fluids and intramuscular penicillin G was started empirically, pending a workup for infectious disease. [mdedge.com]
Microbiology
- Treponema Pallidum
Treponema pallidum particle agglutination assay, cryptococcal antigen, CMV antigen and CMV viral load in blood also negative. Chest X-Ray, abdominal ultrasound, chest and abdominal CT scan did not reveal relevant abnormality. [bmcinfectdis.biomedcentral.com]
Biopsy
- Liver Biopsy
Fig. 3 Bone Marrow Biopsy: activated macrophages engulfing erythrocytes suggesting HS Liver biopsy (25 th July) revealed: portal inflammatory infiltrates, disperse necroinflammatory lesions, moderate cholestasis, hepatocyte ballooning and multifocal esteatosis [bmcinfectdis.biomedcentral.com]
Vibration-controlled transient elastography (VCTE) measures shear wave velocity (expressed in kilopascals) and assesses a larger volume of liver parenchyma than liver biopsy. [hivguidelines.org]
Treatment
Nonetheless, you could still pass on HIV if you are not taking treatment. [aidsmap.com]
It’s important to discuss all treatment options and potential side effects with your healthcare provider to determine the right time to start and continue HIV treatment. [healthline.com]
With Efavirenz, Tenofovir, and Emtricitabine Followed by Two Days Off Treatment Versus Continuous Treatment Efavirenz (DB00625) Emtricitabine (DB00879) Tenofovir (DB14126) NCT00224458 Combination of Efavirenz and Truvada - COMET Study Efavirenz (DB00625 [drugbank.ca]
These participants were treated for two to five years and maintained undetectable viral load before treatment was interrupted. [hivresearch.org]
Prognosis
[…] such as semen, containing HIV come into contact with mucosal surfaces HIV binds to and infects local CD4 positive cells, predominantly macrophages. intravenous administration during blood transfusion delivers a high dose of virus resulting in a poor prognosis [gpnotebook.co.uk]
Expectations (prognosis) There is no cure for HIV infection or AIDS. However, appropriate treatment can dramatically improve the length and quality of life for persons infected with HIV, and can delay the onset of AIDS. [ufhealth.org]
Prognosis in HIV-1 infection predicted by the quantity of virus in plasma. Science 1996; 272(5265):1167-70. [ Links ] 8. Harrigan R. Predicting response to CCR5 Antagonists. [scielo.br]
Reactive haemophagocytic syndrome in 58 HIV-1 infected patients: clinical features, underlying diseases and prognosis. AIDS. 2010;24:1299–306. 8. Adachi E, Koibuchi T, Imai K, et al. [bmcinfectdis.biomedcentral.com]
Prognosis in HIV-1 infection predicted by the quantity of virus in plasma. Science. 1996;272(5265):1167-1170. Quinn T.C. Acute primary HIV infection. JAMA. 1997;278(1):58-62. Daar E.S., Little S., Pitt J., et al. [thebodypro.com]
Etiology
Current concepts in the etiology and treatment of Behçet disease. Surv Ophthalmol 2005 ; 50: 297 – 350. Google Scholar | Crossref | Medline | ISI 8. Patel, N, Patel, N, Espinoza, LR. [journals.sagepub.com]
Etiological aspects of reactive hemophagocytoses: retrospective study in 99 patients. Rev Med Interne. 1997;18:855–64. 7. Fardet L, Lambotte O, Meynard JL, et al. [bmcinfectdis.biomedcentral.com]
"Diarrhea in developed and developing countries: magnitude, special settings, and etiologies". Reviews of Infectious Diseases. 12 (Suppl 1): S41–50. doi : 10.1093/clinids/12.Supplement_1.S41. PMID 2406855. ^ Gazzard, B; Balkin, A; Hill, A (2010). [en.wikipedia.org]
Additional studies are needed to define the exact timing, duration, and etiology of this observation. [jem.rupress.org]
They are useful for patients with highly discordant results on noninvasive testing and in patients suspected of having a second etiology for liver disease in addition to HCV infection. [hivguidelines.org]
Epidemiology
This quantity changes with epidemic stage, epidemiological context, and the stage of the HIV treatment scale-up. [pnas.org]
The Women's Interagency HIV Study, Epidemiology, 1998, vol. 9 2 (pg. 117 - 125 ) 37. [academic.oup.com]
Clinical and epidemiologic features of primary HIV infection. Ann Intern Med. 1996;125(4):257-264. Daar E.S. Virology and immunology of acute HIV type 1 infection. AIDS Res Hum Retroviruses. 1998;14(Suppl 3):S229-234. [thebodypro.com]
Modern epidemiologic techniques can supplement the information provided by STD contact tracing. [jci.org]
Google Scholar 17. 2000 HIV Prevention and Community Planning Epidemiologic Profile for North Carolina. Raleigh: North Carolina Department of Health and Human Services; 2000. 18. Ly T, Edlinger C, Vabret A. et al. [jamanetwork.com]
Prevention
At this level, it is no longer transmissible, according to the Center for Disease Control and Prevention (CDC). [medicalnewstoday.com]
Starting treatment soon after diagnosis prevents infecting others and protects the immune system. [aidsmap.com]
Centers for Disease Control and Prevention. HIV Testing Implementation Guidance for Correctional Settings. 2008. 1-38: Cooper CJ, Metch B, Dragavon J, Coombs RW, Baden LR,. [medscape.com]
A variety of prevention methods are available including condoms (male or female), pre-exposure prophylaxis (PrEP), treatment as prevention, and post-exposure prophylaxis (PEP). Avoid sharing needles. [healthline.com]
Pre-exposure prophylaxis (PrEP) for HIV prevention: promoting safe and effective use in the United States. Atlanta: Centers for Disease Control and Prevention; http://www.cdc.gov/hiv/prep. [ Google Scholar ] 90. [ncbi.nlm.nih.gov]