Human immunodeficiency virus

HIV/AIDS

Definition

• A chronic immunodeficiency resulting from infection with the human immunodeficiency virus (HIV)
• Acquired immune deficiency syndrome (AIDS) is a severe form of HIV characterized by low CD4 count resulting in characteristic infections

Presentation

Acute seroconversion

• Influenza-like illness
• Rash
• ...

Chronic HIV

• Fever
• Weight loss
• Dyspnea, cough, hemoptysis
• Dysphagia, diarrhea
• Anemia, neutropenia, thrombocytopenia
• Metabolic derangements
• [Opportunistic infections](Complications/Opportunistic infections/Opportunistic infections.md)

Investigations

• HIV serology
  • If concern for acute seroconversion syndrome, may need to repeat serology
• HIV viral load and CD4 count

Management

Initial management

• See [HIV first clinic visit](Treatment/HIV first clinic visit.md) and [single-tablet regimens](Treatment/Single-tablet regimens.md)

Follow-up

• HIV viral load
  • Every 4 to 6 weeks until undetectable
  • Then every 3 months until undetectable for 1 year
  • Then every 6 months
• CD4 count
  • Every 3 to 4 months until viral load undetectable and CD4 count >350 for 1 year
  • Then every 6 months until viral load undetectable for at least 2 years and CD4 count > 500
  • Then stop monitoring routinely unless evidence of treatment failure
  • Assess for failure if RNA level remains detectable at 24 weeks or if it increases to above 50 at any time
• Repeat RNA level within 4 weeks