0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13
732 Human Immunodeficiency Virus Type 1 (HIV-1)differential diagnosis
■HIV-specific lab tests will confirm HIV infection
■Differential diagnosis (DDx) of acute retroviral syndrome (fatigue,
malaise, other subjective symptoms) include EBV, CMV, HSV, viral
hepatitis, rubella, toxoplasmosis, drug reaction, secondary syphilis,
measles, disseminated gonococcemia, pityriasis rosea, and acute
rheumatologic syndrome
■DDx of persistent CD4 decline includes idiopathic CD4 lymphopenia
management
What to Do First
■Thorough history and physical (including pap smear if needed)
with emphasis on conditions and behaviors relevant to HIV; lab-
oratory tests should include confirmatory HIV serology, CBC with
CD4 count, viral load (VL), renal function tests, liver function tests
(LFTs), toxoplasma serology, RPR/VDRL, hepatitis serologies (HAV,
HBV, HCV), baseline lipids and glucose if to start antiretrovirals, PPD
±CXR, G6PD (optional)
■Assess severity of injury to immune system (CD4 and VL)
■Assess need for antiretroviral therapy (acute infection or severe
immunosuppression)
■Provide secondary prevention counseling to decrease risk of acquir-
ing opportunistic infection and decrease risk of further HIV trans-
mission.General Measures
■Use history, physical exam, CD4, VL, LFT’s, renal function tests
to assess changes in immune status and possible need to initiate
antiretroviral treatment (Rx) or in preparation to start Rx; CD4 count
and HIV viral load independently predict prognosis and indicate
response to Rx; rate of CD4 decline also correlates with disease pro-
gression
■Check HIV genotype or phenotype when changing Rx b/c drug fail-
ure. Guidelines suggest resistance testing may be helpful during
acute HIV infection or during pregnancy and also in chronically
infected prior to starting HAART.
■Vaccinate as needed with: Pneumovax, influenza vaccine, HBV vac-
cine, HAV vaccine, tetanus booster
specific therapy
■Indications for highly active antiretroviral treatment (HAART): preg-
nancy, symptomatic HIV infection (AIDS, thrush, fever of unknown