0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54
Complications of Human Immunodeficiency Virus Type 1 377Viruses
■CMV: dysphagia, odynophagia, focal chest pain, colitis and/or
enteritis, fecal leukocytes and/or blood, cramps, fever, watery diar-
rhea with/without blood, hemorrhage, toxic megacolon, fever±,
delirium, lethargy, disorientation, malaise, and headache most com-
mon, stiff neck, photophobia, cranial nerve deficits less common, no
focal neurologic deficits
■HSV: small painful ulcers or vesicles on an erythematous base, usu-
ally on gingiva and palate; local pain; dysphagia, odynophagia, focal
chest pain, vesicles on erythematous base
■VZV: vesicles on erythematous base in unilateral dermatomal distri-
bution, sever pain, trgeminal nerve involvement with possible blind-
ness, disseminated disease, VZV pneumonia
■JC (PML): afebrile, alert, no headache, progressively impaired
speech, vision, motor fxn, cranial nerve deficit, cortical blindness,
cognition affected relatively late.
■HCV: acute – malaise, nausea, RUQ pain, jaundice, dark urine;
chronic (85%) – fatigue, malaise, cirrhosis (esophageal varices,
ascites, coagulopathy, encephalopathy), hepatocellular carcinoma,
extrahepatic manifestations (cryoglobulins, glomerulonephritis,
vasculitis, porphyria, connective tissue disorders)
■HPV: cutaneous warts including deep plantar, common warts (exo-
phytic, hyperkeratotic papules with rough surface), plane or flat
warts, anogenital warts (flesh- to gray-colored, hyperkeratotic, exo-
phytic papules that are either sessile or pedunculated); rarer man-
ifestations include epidermodysplasia verruciformis and recurrent
respiratory papillomatosis
■Molluscum contagiosum: pearly white or flesh-colored papules with
central umbilication, may occur any place except palms or soles, but
most common on face±genital region
■Enteric viruses: water diarrhea, acute, 1/3 may become chronic
■HIV-associated: dementia: afebrile, triad of cognitive, motor, and
behavioral dysfunction, early concentration and memory deficits,
inattention, lack of motor coordination, ataxia, late global dementia,
paraplegic, mutism; myopathy: pain and aching in muscles, usually
in thighs and shoulders.
Tumors
■Kaposi’s Sarcoma: dyspnea, cough; red or purple nodules, usually on
palate or gingiva; most have cutaneous lesions also; usually asymp-
tomatic; may be cosmetic concern or disruption of teeth; firm, sub-
cutaneous brown-black or purple macules, papules, plaques, and