Snapshot A 27-year-old man presents to the urgent care clinic with a 2-week history of fever, macular rash, and generalized lymphadenopathy. He denies a sore throat, genital ulcers, or urethral discharge. Sexual history is remarkable for having unprotected sex with both male and female partners while inconsistently using condoms. His last sexual encounter was a month prior to the onset of illness. His fourth-generation combination HIV-1/2 immunoassay is positive, and an HIV-1/HIV-2 antibody differentiation immunoassay confirms the diagnosis. Introduction Classification login to view 2 more bullets Epidemiology login to view 3 more bullets Transmission login to view 3 more bullets Microbiology login to view 11 more bullets Pathogenesis login to view 3 more bullets Associated conditions login to view 4 more bullets Prognosis login to view 1 more bullet Presentation Symptoms/physical exam login to view 8 more bullets Studies HIV serology login to view 15 more bullets Viral load (qRT-PCR) login to view 5 more bullets CD4+ T-cell count and percentage login to view 3 more bullets HIV genotyping login to view 1 more bullet Opportunistic Infections Opportunistic Infection Based on CD4+ T-Cell Count CD4+ Count Opportunistic Infection Findings Prophylactic Treatment < 500 mm3 Candida albicans Oral thrush that is scrapable Pseudohyphae on microscopy - < 500 mm3 Epstein-Barr virus Oral hairy leukoplakia not scrapable - < 500 mm3 HHV-8 Kaposi sarcoma a palpable, nonpruritic lesion that is brown, pink, red, or violaceous in color - < 500 mm3 HPV Squamous cell carcinoma anus (in men who have sex with men) cervix - < 200 mm3 Histoplasma capsulatum Nonspecific findings fevers, night sweats, chills, and weight loss dyspnea nausea and vomiting Macrophages contain oval yeast cells - < 200 mm3 JC virus reactivation Progressive multifocal leukoencephalopathy demyelinating disease of the central nervous system - < 200 mm3 Pneumocystis jirovecii Pneumonia ground-glass opacity on chest radiography Trimethoprim-sulfamethoxazole if contraindicated, can give dapsone, atovaquone, or pentamidine < 200 mm3 Cryptosporidium parvum Watery diarrhea Nitazoxanide < 100 mm3 Aspergillus fumigatus Hemoptysis Pleuritic chest pain - < 100 mm3 Bartonella henselae Bacillary angiomatosis angiomatous skin lesions - < 100 mm3 Candida albicans Esophagitis white plaques may appear on endoscopy - < 100 mm3 Cytomegalovirus Retinitis Esophagitis Colitis Pneumonitis Encephalitis Linear ulcers on endoscopy Fundoscopy may demonstrate cotton-wool spots Intranuclear inclusion bodies (owl eyes) - < 100 mm3 Cryptosporidium spp. Watery diarrhea Stool studies will show acid-fast oocysts - < 100 mm3 Ebstein-Barr virus B-cell lymphoma Central nervous system lymphoma - < 100 mm3 Mycobacterium avium-intracellulare Non-specific findings fevernight sweats weight loss lymphadenitis The goal is to initiate antiretroviral therapy as soon as possible Azithromycin < 100 mm3 Toxoplasma gondii Ring-enhancing brain abscesses Trimethoprim-sulfamethoxazole if contraindicated, give dapsone, pyrimethamine, and leucovorin in the presence of ring-enhancing lesions, treat with pyrimethamine Differential Influenza infection and immunosuppression caused by medications login to view 3 more bullets Treatment HIV-infected breastfeeding mothers login to view 1 more bullet HIV-infected patients and vaccinations login to view 4 more bullets Medical login to view 48 more bullets Complications Malignancy Cardiovascular and pulmonary disease AIDS