Tasty Morsels of EM 034 – HIV Emergencies

2 Oct

I keep a little, ever-expanding note on my phone where I jot down little morsels of goodness that I pick up while listening to or reading one of the many excellent sites/podcasts in the useful resource section. They’re useful in a kind of “board review” way. I tend to skip the really basic stuff and try and focus on what I didn’t know.

I’ll try and transfer them here for your enlightenment.

From the AFJEM series on HIV emergencies. Well worth a read [Free Full Text]:

  • Acute HIV usually within 3 weeks. No antibodies as yet therefore antibody tests will be negative. Viral loads however will be very high for the same reason

  • Recurrent severe bacterial pneumonia (>2 in 12 mths) is a who stage four diagnosis (what you could call AIDS defining)

  • TB may present as lobar pneumonia esp in lower lobes

  • LDH greater than 500 supports diagnosis of PCP

  • Commonest HIV associated neurological conditions

    • Cryptococcal meningitis

    • Toxoplasmosis

    • TB

    • Lymphoma

  • In cryptococcal meningitis the opening pressure is usually raised. A key treatment goal is reduction of that pressure by CSF drainage

  • People with HIV have four times risk of DVT. Reason unclear.

  • The major AIDS defining malignancies are all virally mediated

  • Acute red eye means two things

    • CMV retinitis

    • Zoster Ophthalmicus

  • Diarrhoea is common and may be acute infection, HAART related or due to HIV itself

  • HIV medications are complex with a bewildering range of them with unpronounceable names and a cornucopia of side effects. The good news is they work

  • IRIS = immune reconstitution inflammatory syndrome

    • Following initiation of HAART CD4 improves and viral loads fall

    • Paradoxically there can be a worsening of condition typically manifested by an opportunistic infection

References:

Chandra, Amit, Jacqueline Firth, Abid Sheikh, and Premal Patel. “Emergencies Related to HIV Infection and Treatment (Part 1)” African Journal of Emergency Medicine 3, no. 3 (September 1, 2013): 142–149. doi:10.1016/j.afjem.2013.03.005. [Free Full Text]

Chandra, Amit, Jacqueline Firth, Abid Sheikh, and Premal Patel. “Emergencies Related to HIV Infection and Treatment (Part 2)” African Journal of Emergency Medicine (May 30, 2013): 1–6. doi:10.1016/j.afjem.2013.04.001. [Free Full Text]

 

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