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


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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