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Chapter 12: HIV 503

Table 12.12 Clinical categories Oral hairy leukoplakia is due to an opportunistic in-
fection with Epstein Barr virus within the oral mu-
CD4 count Clinical State
cosa. It appears as unilateral whitish plaques on the
>500/mm 3 A1 B1 C1 ∗ side of the tongue. In the majority of cases no treat-
200–499 /mm 3 A2 B2 C2 ∗
<200/mm 3 A3 ∗ B3 ∗ C3 ∗ ment is required, any coexistent candida should be
treated, aciclovir may help although invariably it re-
∗
Patients defined as having AIDS. curs.
Toxoplasmosis causes encephalitis and abscesses in

immunodeficient patients. Infections are due to
Table 12.13 Examples of B symptoms/conditions
reactivation of previously acquired infection. Pa-
Bacillary angiomatosis tients present with headache, confusion, personal-
Cervical dysplasia / carcinoma in situ ity change, focal neurological signs, seizures and re-
Constitutional symptoms (fever >38.5 , diarrhoea)
◦
lasting >1 month duced consciousness. Fever may be absent. CT/ MRI
Herpes zoster that is recurrent or affecting more than 1 shows multiple masses, often with ring enhance-
dermatome ment and surrounding oedema. Treatment is with
Idiopathic thrombocytopenia purpura pyrimethamine and sulphadiazine.
Listerosis
Cryptosporidium parvum is transmitted by the faecal
Oral hairy leucoplakia
Pelvic inflammatory disease with tubo-ovarian abscess oral route and causes watery diarrhoea, colic, nausea,
Peripheral neuropathy vomiting and a severe fluid/electrolyte loss with se-
Persistent, recurrent or refractory vaginal candidiasis vereweightloss.Stoolmicroscopyshowscysts,stained
withZiehlNeelsenstain.Patientsrequirerehydration.
There is no satisfactory treatment.
Table 12.14 AIDS defining illnesses 1993 Cryptococcus fungal infection in HIV presents most
commonly with meningitis. Patients present with
Candidiasis of oesophagus or lower respiratory tract
Invasive cervical carcinoma headache, fever, impaired conscious level and abnor-
Extrapulmonary coccidiomycosis, crytococcosis mal affect. The classical neck stiffness and photopho-
Chronic cryptosporidiosis or isosporosis with diarrhoea bia are rarely seen. A CT scan should be performed to
Cytomegalovirus other than affecting reticuloendothelial exclude space occupying lesion prior to lumbar punc-
system
HIV associated dementia ture. CSF is stained with Indian ink, serum and CSF
HIV associated generalised wasting antigen titre can be measured, cryptococci may be
Kaposi’s sarcoma cultured from CSF and/or blood. Treatment is with iv
Lymphoma Burkitt’s, immunoblastic or brain lymphoma amphotericin B or fluconazole.
Mycobacterial infection (tuberculosis, avium, kansasii) Cytomegalovirus can cause retinitis, colitis, oe-
Pneumocystis jirovecii pneumonia sophagitis, encephalitis and pneumonitis in HIV in-
Recurrent bacterial pneumonia
Progressive multifocal lymphadenopathy fected individuals. Colitis presents as abdominal pain
Recurrent salmonella septicaemia and tenderness often in the left iliac fossa, profuse
Toxoplasmosis of internal organs bloody diarrhoea and low grade fever. Stool culture is
used to exclude other causes, endoscopy reveals an
inflamed appearance of patchy colitis and vasculi-
Infections and HIV tis. Biopsy shows non-specific inflammatory changes,
Candidiasis: The commonest appearance is of dense round (Owl’s eye) intra-nuclear inclusion bod-

pseudo-membranous creamy plaques which may be ies in swollen cells. Retinitis may cause blindness
wiped off (distinguishes from leukoplakia) to reveal and may present as loss of vision, field defect, acuity
ableeding surface. Infection of the distal oesopha- problems or pain. Eye disease is treated with ganci-
gus may cause retrosternal chest pain and dysphagia, clovir (myelosupressive) or foscarnet (nephrotoxic)
or may be asymptomatic. Diagnosis is made on bar- and must be followed by maintenance therapy.
iumswalloworendoscopy.Treatmentiswithsystemic Mycobacterium tuberculosis infections are usually due
anti-fungals such as fluconazole. to reactivation of latent infection in the context of