- Pneumocystis jirovecii pneumonia (PCP): progressive dyspnea, dry cough, ground‑glass opacities on CT
- Cryptococcal meningitis: headache, fever, neck stiffness – high mortality
- Immune reconstitution inflammatory syndrome (IRIS): paradoxical worsening of opportunistic infection after starting ART
HIV/AIDS – Newly Diagnosed
Must-Not-Miss / Red Flags
Patient Explanation
“You’ve been diagnosed with HIV, which is a virus that affects your immune system. With today’s medications, you can live a long, healthy life and not transmit the virus to others.”
Board Fact
“The goal of antiretroviral therapy (ART) is virologic suppression (HIV RNA <20 copies/mL), which restores immune function and prevents transmission (U=U).”
ICD-10
B20
Definition & Core Concept
Human immunodeficiency virus (HIV) is a retrovirus that infects CD4+ T‑cells, leading to progressive immune dysfunction. Acquired immunodeficiency syndrome (AIDS) is defined by a CD4 count <200 cells/µL or the presence of an AIDS‑defining opportunistic infection.
Epidemiology & Risk Factors
- ~38 million people globally living with HIV
- Transmission: sexual, bloodborne, vertical (mother‑to‑child)
- With ART, life expectancy approaches that of the general population
Clinical Vignette
A 30‑year‑old man presents with 2 weeks of fever, night sweats, and a 10‑lb weight loss. He has oral thrush on exam. HIV 4th gen test is positive; HIV RNA is 150,000 copies/mL; CD4 count is 120 cells/µL. He is started on Bictegravir/Emtricitabine/Tenofovir and TMP‑SMX.
Pearls & Pitfalls
- Always obtain a baseline resistance genotype before starting ART – transmitted drug resistance is present in 10‑15% of new cases.
- Immune reconstitution inflammatory syndrome (IRIS) can mimic treatment failure – it is managed with corticosteroids, not by stopping ART.
Discharge & Follow-Up
HIV viral load and CD4 every 3‑6 months. ART adherence support. Routine vaccinations (influenza, pneumococcal, hepatitis B). Cancer screening per guidelines.
Literature & Guidelines
DHHS 2024 Guidelines for the Use of Antiretroviral Agents in HIV‑1. PMID: 38599120.