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Fever in HIV Patients

Neda Frayha, MD and Matthieu DeClerck, MD
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Fever in HIV-AIDS patients remains a challenge. HAART has contributed to a decrease in its incidence but has not altered the spectrum of causes. It is a common cause of admission to hospitals and is associated with substantial cost and significant mortality. In most cases fever of unknown origin in the context of HIV is a result of occult opportunistic infection and physicians should take into consideration differing geographic prevalences of infectious pathogens. If no infectious cause can be demonstrated, AIDS-related lymphoproliferative diseases and drug fever should be considered along with an number of less common etiologies. The diagnostic work-up is initially directed toward infection, which remains the single leading etiology. The single most important early investigation is blood culture. Bone marrow examination, liver biopsy, and newer nuclear imaging techniques are useful further diagnostic modalities. An algorithm for the diagnostic approach and management of patients with HIV-associated fever of unknown origin is presented.

Opportunistic infections are much more common in the advanced stages of HIV/AIDS and when CD4+ is less than 200 cells/ml. This is true for both pts on HAART and those not on HAART. In the end it appears that the CD4+ is one of the most relevant predictor of opportunistic vs typical infectious etiologies as well as the viral load.

Pt with CD4+ > 500 cells/mm3 generally have causes of fever similar to those in immunocompromised patients.

Pts with CD4+ 200 - 500 cells/mm3 most likely have early bacterial respiratory infections or sinusitis.

Pts with CD4+ < 200 cells/mm3 most common causes of fever without localizing finds are opportunistic infections (Pneumocystis jirovecii pneumonia, Mycobacterium avium complex, Mycobacterium tuberculosis, cytomegalovirus, Histoplasma capsulatum, Cryptococcus neoformans); central line infections; drug fever; lymphoma; endocarditis; and sinusitis.

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Better Put A Ring On It Full episode audio for MD edition 196:02 min - 92 MB - M4AHippo UC RAP May 2018 Written Summary 367 KB - PDF

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