HIV is a virus that slowly destroys CD4 immune cells, and AIDS is its advanced stage, defined by a CD4 count under 200 or an opportunistic infection. With daily antiretroviral therapy people live a near-normal lifespan, and an undetectable viral load means no sexual transmission.
Key symptoms
- Fever, sore throat, rash and swollen glands 2 to 4 weeks after exposure
- Often no symptoms for years
- Weight loss, night sweats and chronic diarrhea
- White patches in the mouth
- Repeated or unusual infections
What you find on exam
- Swollen lymph nodes in several areas
- Oral thrush or hairy leukoplakia on the tongue
- Purple skin or mouth lesions of Kaposi sarcoma
- Weight and muscle wasting
- Breath sounds, oxygen saturation and a neurological exam
Tests
- HIV-1/2 antigen/antibody test, then a confirming differentiation test
- HIV RNA if acute infection is suspected
- CD4 count, viral load and resistance genotype
- Screen for hepatitis B and C, syphilis and tuberculosis
Treatment basics
- Start antiretroviral therapy as soon as possible, ideally the same week
- Common regimen: bictegravir, emtricitabine and tenofovir alafenamide in one pill
- Trimethoprim-sulfamethoxazole to prevent Pneumocystis if CD4 is under 200
- Viral load checks to confirm it becomes undetectable
- Prevention: PrEP, and PEP within 72 hours of an exposure
Red flags
- Cough, breathlessness and low oxygen with low CD4
- Headache, confusion or seizure
- Persistent fever and weight loss
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.