Antiretroviral Therapy for HIV-Infected Adults Differential Diagnosis

Differential Diagnosis

The following should be considered in dealing with an HIV-infected adult:

• Respiratory manifestations
  • Present at any stage of CD4+ count
    • Acute bronchitis
    • Bacterial pneumonia: Present even at CD4+ count of <200 cells/µL and during immune function decline
    • Tuberculosis (TB)
  • Pneumocystis jirovecii pneumonia (PCP): Present in early HIV infection and with CD4+ count of 200-500 cells/µL
  • Human herpesvirus-8 (HHV-8) related Kaposi sarcoma: Present in early HIV infection
  • Cryptococcus neoformans pneumonia
  • Extrapulmonary or disseminated TB: Occurs more frequently during immune function decline
  • Presents as advanced HIV infection: Toxoplasma gondii pneumonia, pulmonary Kaposi sarcoma, Histoplasma capsulatum or Coccidoides immitis pneumonia, Mycobacterium avium complex
• Focal CNS manifestations
  • Toxoplasma encephalitis: Most commonly occurs in severely immunocompromised hosts (CD4+ count of <200 cells/ µL)
  • Primary CNS lymphoma: Similar presentation as toxoplasmosis but occurs during profound immunosuppression (CD4+ count of <50 cells/µL) and is associated with Epstein-Barr virus
  • PML: Characterized by demyelinating CNS lesions
  • Cryptococcus neoformans meningitis: Occurs in patients with CD4+ count of <100 cells/µL
  • CMV encephalitis: Occurs in patients with CD4+ count of <50 cells/mm³ and immune function decline
  • Tuberculoma: Common in developing countries
  • Brain abscess
• Abdominal manifestations
  • Extrapulmonary TB
  • Malignancies (eg Kaposi sarcoma): May cause massive bleeding and bowel obstruction