HIV Disease Clinical Presentation
- Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Michael Stuart Bronze, MD more...
The history should be carefully taken to elicit possible exposures to human immunodeficiency virus (HIV). Risk factors include the following:
Unprotected sexual intercourse, especially receptive anal intercourse (8-fold higher risk of transmission)
A large number of sexual partners
Prior or current sexually transmitted diseases (STDs): Gonorrhea and chlamydia infections increase the HIV transmission risk 3-fold, syphilis raises the transmission risk 7-fold, and herpes genitalis raises the transmission risk up to 25-fold during an outbreak
Sharing of intravenous drug paraphernalia
Receipt of blood products (before 1985 in the United States)
Mucosal contact with infected blood or needle-stick injuries
Maternal HIV infection (for newborns, infants, and children): Steps taken to reduce the risk of transmission at birth include cesarean delivery and prenatal antiretroviral therapy in the mother and antiretroviral therapy in the newborn immediately after birth.
The patient may present with signs and symptoms of any of the stages of HIV infection. Acute seroconversion manifests as a flulike illness, consisting of fever, malaise, and a generalized rash. The asymptomatic phase is generally benign. Generalized lymphadenopathy is common and may be a presenting symptom.
AIDS manifests as recurrent, severe, and occasionally life-threatening infections and/or opportunistic malignancies. The signs and symptoms are those of the presenting illness, meaning that HIV infection should be suspected as an underlying illness when unusual infections present in apparently healthy individuals.
HIV infection itself does cause some sequelae, including AIDS-associated dementia/encephalopathy and HIV wasting syndrome (chronic diarrhea and weight loss with no identifiable cause).
No physical findings are specific to HIV infection. The physical findings are those of the presenting infection or illness. Generalized lymphadenopathy is common. Weight loss may be apparent.
Evidence for risk factors or minor concurrent opportunistic infections (eg, herpetic lesions on the groin, widespread oral candidiasis) may be clues to HIV infection.
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|Nucleoside reverse transcriptase inhibitors (NRTIs)||Abacavir (Ziagen, ABC)
Didanosine (Videx, Videx EC, ddI)
Emtricitabine (Emtriva, FTC)
Lamivudine (Epivir, 3TC)
Stavudine (Zerit, Zerit XR, d4T)
Tenofovir DF (Viread, TDF)
Tenofovir AF (TAF)
Zalcitabine (Hivid, ddC)*
Zidovudine (Retrovir, ZDV, AZT)
|Protease inhibitors (PIs)||Amprenavir (Agenerase, AVP)*
Atazanavir (Reyataz , ATV)
Darunavir (Prezista, DRV)
Fosamprenavir (Lexiva, f-APV)
Indinavir (Crixivan, IDV)
Lopinavir and ritonavir (Kaletra, LPV/r)
Nelfinavir (Viracept, NFV)
Ritonavir (Norvir, RTV)
Saquinavir (Invirase [hard gel] capsule, SQV)
Tipranavir (Aptivus, TPV)
|Non-nucleoside reverse transcriptase inhibitors (NNRTIs)||Delavirdine (Rescriptor, DLV)
Efavirenz (Sustiva, EFV)
Etravirine (Intelence, ETR)
Nevirapine (Viramune, NVP)
|Fusion inhibitors||Enfuvirtide (Fuzeon, T-20)|
|Cellular chemokine receptor (CCR5) antagonists||Maraviroc (Selzentry, MVC)|
|Integrase inhibitors||Raltegravir (Isentress, RAL)
Dolutegravir (Tivicay, DTG)
Elvitegravir (Vitekta, EVG)
|*No longer available on market|
|Drug Content per Tablet/Capsule*||Brand Name||Adult Dose (≥40 kg)|
|Elvitegravir 150 mg
Cobicistat 150 mg
Emtricitabine 200 mg
Tenofovir AF 10 mg
|Genvoya||1 tab PO qd|
|Elvitegravir 150 mg
Cobicistat 150 mg
Emtricitabine 200 mg
Tenofovir DF 300 mg
|Stribild||1 tab PO qd|
|Abacavir 600 mg
Lamivudine 300 mg
|Epzicom||1 tab PO qd|
|Abacavir 600 mg
Dolutegravir 50 mg
Lamivudine 300 mg
|Triumeq||1 tab PO qd|
|Abacavir 300 mg
Lamivudine 150 mg
Zidovudine 300 mg
|Trizivir||1 tab PO bid|
|Efavirenz 600 mg
Emtricitabine 200 mg
Tenofovir DF 300 mg
|Atripla||1 tab PO qd on empty stomach|
|Emtricitabine 200 mg
Rilpivirine 25 mg
Tenofovir DF 300 mg
|Complera||1 tab PO qd with a meal|
|Emtricitabine 200 mg
Rilpivirine 25 mg
Tenofovir AF 25 mg
|Odefsey||1 tab PO qd with a meal|
|Emtricitabine 200 mg
Tenofovir DF 300 mg
|Truvada||1 tab PO qd
CrCl 30-49 mL/min: 1 tab PO q48h
CrCl <30 mL/min: Do not administer
|Emtricitabine 200 mg
Tenofovir AF 300 mg
|Descovy||1 tab PO qd
CrCl <30 mL/min: Do not administer
|Lamivudine 150 mg
Zidovudine 300 mg
|Combivir||1 tab PO bid|
|*Not indicated for patients requiring dosage adjustments (eg, weight < 40 kg, renal impairment, hepatic impairment, dose-limiting adverse effects) unless otherwise stated.|