HIV

Screening:
- CDC's recommendations urge providers to include HIV testing as a routine part of their patients’ healthcare.
- CDC recommends *at least* annual screening for high risk patients
- VA recommends screening all patients for HIV

Diagnosis of HIV:
- detection of AB usually takes 2-12 weeks to appear in circulation, but the test is ELISA/EIA (>99.5% sensitive)
- ELISA reads positive (highly reactive), negative (non-reactive) OR indeterminate (partially reactive)
- False positive: autoantibodies, hepatic dz, recent flu vaccine, acute viral infections, AB to class I Ag.
- Confirm with western blot (more specific): detects multiple HIV Ag of different, well characterized molecular weights.
- Western blot reads negative (no bands), positive (AB to products of 2-3 of 3 major genes: gag, pol, env).

Acute HIV syndrome:
- Occurs in 50-70% of individuals with HIV, and in this patient could have been his initial presentation (not GAS).
- anywhere from 6 days to 6 weeks after primary infection
- DDx includes EBV, CMV, viral hepaitis, enteroviral infection, secondary syphilis, toxo, HSV, drug reaction etc
- Findings: Fever (97%), erythematous maculo-papular rash (77%), pharyngitis (73%), myalgias/arthralgias (58%), LAN, H/A, retroorbital pain, lethargy/malaise, anorexia/weight loss, N, V, D, meningitis, encephalitis, peripheral neuropathy.
- Lab findings: lymphopenia then lymphocytosis, thrombocytopenia, elevated transaminase, depressed CD4 count, HIV AB usually negative-- so check Viral load.

Eosinophilia in HIV can be from direct HIV effect especially if advanced, drug allergy (think bactrim or other sulfas), or less commonly parasitic infection. This is less common bc most HIV associated parasites (toxo, crypto) DON'T cause eosinophilia. If in an endemic area you might think of isospora or strongyloides.

Common oral lesions in HIV can generally be groups into papules/nodules/plaque, ulcers or pigmented.
Papules/nodules/plaques:
- candidiasis
- condyloma
- squamous cell
- NHL
- oral hairy leukoplakia (lateral tongue usually, rarely causes discomfort)

Ulcers:
- recurrent aphthous ulcers
- angular chelitis
- acute necrotizing ulcerative gingivitis/periodonitis
- squamous cell
- viral (HSV, zoster, CMV)
- MTB, MAI
- bacterial
- drug reactions

Pigmented:
- KS (most common on palate)
- zidovudine pigmentation

Disease of hepatobiliary system in HIV patients:
- drug reaction: hypersensitivity or hepatic steatosis from ARV
- hep B, hep C
- granulomatous hepatitis 2/2 mycobacterium or fungal
- hepatic masses from TB, fungal (histo, cocci)
- biliary tract disease from papillary stenosis or sclerosing cholangitis (crypto, CMV and KS)

(Katharine Cheung MD, 11/14/10)