Coupon Accepted Successfully!


Clinical manifestations

Acute HIV Syndrome
  1. Occurs in 50-70%
  2. Typical viral illness: fever, malaise, myalgias, arthralgias, LAP, etc.
  3. Occurs 3-6 weeks after infection
  4. Resolves spontaneously in 2-4 weeks
  5. High plasma viremia
  6. High levels of p24 antigenemia
  7. HIVRNA by PCR is used for diagnosis in this stage
  8. Seroconversion, i.e., antibody positive by 3-7 weeks after infection
  9. Dendritic lineage cells are 1st to be infected
  10. Dissemination of virus occurs to lymphoid organs where infection persists
  11. CD8+ cytotoxic T lymphocytes are responsible for containment of primary infection
  12. Initially, low CD4+ & low CD8+ counts; later in acute stage (& also in advanced HIV): low CD4+ and high CD8+ → inversion of CD4/ CD8 ratio.
  13. HIV escapes 'elimination from the body because of
    1. Deletion of CD8+ T cells due to overwhelming viremia
    2. Sequestration of virus in lymphoid organs (cf CD8+ in peripheral blood)
  14. Possible neurological complications: meningitis, encephalitis, peripheral neuropathy, myelopathy
Clinically latent phase
  1. Median time for untreated patients is 7-10 years
  2. Telescoped to 3 yrs in rapid progressors
  3. CD4+ counts decreases at the rate of 50 / mm3 per year
  4. Virus replicates in LNs (whether or not LAP+)
  5. 1 replication cycle = 1.5 days _
  6. 1010 to 1011 virions produced per day
  7. t1/2 of infected CD4+ T cells is 1 day
  8. t1/2 of circulating virion is 30 mins
  9. viral set point at 1 year has prognostic implications for the progression of disease
When CD4 count is in normal range (500-1,600 cells/cmm or 28-50%), the immune system defends itself against most antigens
Symptomatic disease
  1. 200-500 CD4+ count:
    1. Pneumococcal pneumonia
    2. Pulmonary tuberculosis
    3. Kaposi's sarcoma
    4. Herpes zoster
    5. Oral thrush
    6. Cryptosporidium
    7. Oral hairy leukoplakia
  2. <200 CD4+ count:
    1. Pneumocystis carinii pneumonia
    2. Candida esophagitis
    3. Recurrent/disseminated viral herpes simplex
    4. Toxoplasmosis
    5. Histoplasmosis
    6. Coccidioidomycosis
    7. PMLE
    8. Extrapulmonary tuberculosis
  3. <50 CCD4 count:
    1. CMV
    2. MAC
    3. Primary CNS lymphoma. (LQ 2012)
Disease of respiratory system
Upper respiratory tract Pulmonary
Acute sinusitis Acute bronchitis Infections Malignancies Idiopathic HIV related disease
H. influenza
S. pneumoniae
a. Stretococcus pneumoniae
b. Haemophilius influenzae
c. Pseudomonas aeroginosa
d. Staphylococcus aureus
e. Moraxella cattarhalis
f. Phodococcus equi
g. Nocardia asterodies
a. Mycobacterium
b. tuberculosis MAC
a. Cryptococcus neoformans
b. Histoplasma capsulatum
c. Aspergillus furnigatus
d. Coccidioides immitis
e. f. Blastomyces dermatiadis
P jiroveci
a. CMV
b. Adenovirus
c. Herpes simplex
a. Toxoplasma gondii
a. KS
b. NHL
c. Lung carcinoma
a. Lymphoid interstitial pneum
b. Nonspecific intestinal pneum
c. Primary pulmonary hypertension
d. Pneumothorax
• Emphysema
e. Bronchiectasis

Important manifestations of respiratory system
  1. MC manifestation is pneumonia
  2. MC 'OPPORTUNISTIC infection in HIV patients: Tuberculosis
  3. MC cause of pneumonia in HIY patient: Prieumococcal
Pneumocystis jiroved
  1. Usually occurs in patients with CD4+ < 200
  2. Transmission is airborne
  3. Transmission is airborne
  4. Pathology: binds to and damages type I pneumocytes; remains EXTRACELLULAR; hypertrophy of type II pneumocytes .
  5. Presents with fever, nonproductive cough, retrosternal burning, pleuritic pain, dyspnea
  6. Physical exam: tachypnea, tachycardia, cyanosis
  7. Chest exam: no findings / bibasilar rales
  8. CXR: normal in early disease
    Faint b/l interstitial infiltrate later
    No LNs; No Pleural effusion
    'Classic' finding of dense perihilar infiltrate is unusual
    Upper lobe cavities, pneumothorax, extrapulmonary disease (MC - LN)
  9. Hypoxemia, LDH (sensitive, not specific), DLCo
  10. Diagnosis:
    Demonstration of trophozoite / cyst is must
    Silver Methenamine stain, Wright Geimsa-stain
    1. Sputum induction
    2. Brancho-alveolar lavage
    3. Trans-bronchial lung biopsy
  11. Treatment of choice: TMP / SMZ (dose: 15-20/75-100 mg/kg/d) for 21 days
  12. S/E: rash, BM suppression, hepatitis, hyperkalemia quite common in HIV patients
  13. If pO2 <70mmHg OR (A-a)O2 > 35mmHg: ADD STEROID.(PNQ)
  14. Treatment in patient sensitive to sulfonamides: Pentamidine
  15. Prophylaxis: 1 DS tablet of Cotrimoxazole daily. .
  16. Indications are -
    1. All patients with prior PCP
    2. CD4+ count less than 200/rum3
    3. H/O PUO
    4. Oro-pharyngeal candidiasis
      (This also provides prophylaxis against Toxoplasmosis, nocardiosis & bacterial infections)
  17. In India cotrimoxazole prophylaxis is recommended for all patients who meet indications for ART.
  18. Alternative drugs for prophylaxis: Pentamidine / Dapsone / Pyrimethamine / Atovaquone
The number of HIY positives in India is estimated to be 3.97 million cases. Amongst the AIDS cases reported so far, nearly 60% had TB.
Impact of HIV on TB
  1. HIV is the most powerful risk factor for progression from TB infection to TB disease. HIV infected persons who become newly infected by M. tuberculosis rapidly progress to active TB
  2. predisposition to TB: An HIV positive person infected with M. tuberculosis has a 50% lifetime risk of developing TB whereas an HIV negative person infected with M: tuberculosis has only a 10% risk of developing TB.
  3. Unusual forms of TB common
  4. TB may accelerate the progression of HIV, as observed by a six- to seven- fold increase in HIV viral load in TB patients.
  5. TB is the cause of death for one out of every three people with AIDS worldwide.
*** Revised National Tuberculosis Control Program (RNTCP) imbibes the five components of DOTS (political commitment, diagnosis by smear microscopy, regular supply of high-quality anti-TB drugs, directly observed treatment, systematic monitoring and evaluation),

Early Disease (high CD4 count) Late Disease (low CD4 count)
1. Pulmonary disease more common Extrapulmonary disease commoner than pulmonary
2. Upper lobe Lower lobe
3. Cavitation + Cavitation -
4. Mediastinal LNs - Mediastinal LNs +
5. Sputum positivity rate-higher Sputum usually negative
6. Constitutional symptom~ common
(incl. cough and hemoptysis)


Treatment of TB in HIV positive patients
  1. In general, anti-TB treatment is the same for HIV-infected and HIV-negative TB patients, with the exception of the use of thiacetazone. Thiacetazone causes severe cutaneous reactions. Exfoliative Dermatitis or Steven Johnson syndrome may occur and can be fatal.
  2. In place of TZN, use EMB in HIV +ve persons.
  3. HIV-infected smear-negative pulmonary TB patients may have a worse prognosis than HIV - Positive patients with smear-positive pulmonary TB. Delays in the diagnosis of TB have been associated with worse outcomes
  4. NRTIs can be safely co-administered with ATT.
Recent WHO Recommendations:
  1. WHO recommends that people with TB/HIV complete their TB therapy prior to beginning ARV treatment un less there is a high risk of HIV disease progression and death during the period of TB treatment (i.e., a CD4 count <200/mm3 or the presence of disseminated TB).
  2. In cases where a person needs TB and HIV treatment concurrently, first line treatment options include ZDV/3TC (lamivudine) or d4T (Stavudine)/3TC plus either an NNRTI or ABC (Abacavir).
  3. If an NNRTI-based regimen is used, EFZ (Efavirenz) would be the preferred drug as its potential to aggravate the hepatotoxicity of TB treatment appears less than with NVP (Nevirapine). However, its dosage needs to be increased to 800mg/day.
  4. Except for Ritonavir, PIs are not recommended during TB treatment with rifampicin.
  1. Usually occurs in patients with CD4+ < 50
  2. MAC: M. avium complex (this designation is now microbiologically obsolete, but is still used clinically)
  3. M. avium commoner than M. intracellulare
  4. Prior infection with M. tuberculosis decreases risk of MAC
  5. Most commonly presents with fever, weight loss, night sweats; sometimes abdominal pain, diarrhea, LAP
  6. CXR: MC → b/l lower lobe miliary shadows
  7. Diagnosis: culture of blood / involved tissue eg sputum
  8. Treatment: Clarithromycin + Ethambutol + Rifabutin (or rifampicin) / amikacin / ciprofloxacin
  9. This treatment is continued till the time patient achieves CD4+ count more than 100/mm3 for more than 6 months.
  10. Primary Prophylaxis is given to patients with CD4 + count < 50/mm3 in the form of Tablet Azithromycin 1200 mg once a week.
Rhodococcus, Cryptococcus, Coccidioidomycosis May all cause pulmonary disease with cavitation.

Cardiovascular Disease

Cardiovascular disease as a primary Consequence of HIV

Dilated cardiomyopathy





a. Primary pulmonary hypertension

b. LV dysfunction

c. Vascular lesions


Secondary Causes of Cardiac disease

Cardiac malignancy

Opportunistic infections

Drug induced



a. Toxoplasma gondii

b. M. tuberculosis

c. Cryptococcus neoformation

d. CMV

e. Atypical mycobacteria

a. Zidovudine myopathy

b. Chemotherapeutic agents – doxorubicin vinblastine

c. i. v. recreational drugs, cocaine – LV dysfunction

d. HAART – as a part of


Neurological diseases in human immunodeficiency virus (HIV) infection


Demyelinating syndromes

HIV associated dementia

Toxoplasmosis, progressive

multifocal leukoencephalopathy

Bacterial: TB syphilitic gumma

Fungal: Aspergillus, Mucor,

Histoplasma Viral: CMV, VZV

Primary CNS lymphoma (LQ 2012)

Sensitivity to neuroleptic and

other medication side effects


Acute aseptic or chronic

meningitis; Asymptomatic

cerebrospinal fluid


Cryptococcal meningitis

Bacterial TB, syphilis,

Salmonella pneumococcus,

Listerial Fungal: Histoplasma,

Coccidioides, candida Parasitic: acanthamoeba

Lymphomatous meningitis

TMP-SMX, nonsteroidal

antiinflammatory drugs,

intravenous immunoglobulin

Spinal Cord

Vacuolar myelopathy

Herpes viruses VZV, CMV, herpes simplex virus

Other: Syphilis, TB

Metastatic lymphoma

Peripheral nerve / Root

CMV polyradiculitis, syphilis, TB


Acute & chronic inflammatory demyelinating, polyneuropathies mononeuritis multiplex

Distal symmetrical polyneuropathy

CMV mononeuritis multiplex

Nucleosides: didanosine zalcitabine, stavudine dapsone, metronidazole, isoniazid pyridoxine, vincristine


Inflammatory myopathy

Toxoplasma gondii, pyomyositis

Zidovudine, TMP-SMX

Important manifestations of neurologic system
Aseptic meningitis
  1. CSF & clinical features same as other viral meningitides
  2. Resolves spontaneously in 2-4 "weeks
  3. Rare after development of AIDS
Cryptococcus neoformans
  1. MC cause of meningitis in AIDS patients
  2. Usually occurs in patients with CD4+ <100
  3. Subacute presentation: fever, nausea-vomiting, altered mentation, headache, meningismus
  4. The incidence of seizures and focal neurologic deficits is low.
  5. Associated pulmonary disease in 1/3rd pts.
  6. Diagnosis: CSF either India ink stain OR cryptococcal antigen (highly sensitive)
  7. Treatment: Amphotericin B 0.7mg/Kg/day + flucytosine 25mglkg qid for 2 weeks followed by fluconazole 400mg daily for 10 weeks, and then fluconazole, 200mg/day until CD4+ count has increased to >200/rnm3 for 6 months
  1. In AIDS patients,
    1. MC cause of ICSOL
    2. MC cause of encephalitis
    3. MC cause of FND
  2. Usually occurs in patients with CD4+ < 200
  3. Reactivation syndrome of poor toxoplasmosis infection. It is 10 times more common in patients with IgG antibody than in seronegative patients.
  4. Presents with fever, headache, FND, seizures
  5. MC site of lesion: brainstem
  6. DIAGNOSIS: demonstration of IgG & IgM Sabin Feldman dye test detects IgG
  7. MRI: Multiple ring-enhancing lesions
  8. TREATMENT: Sulfadiazine 500mg qid -+ Pyrimethamine 25-50 mg 00 + Leucovorin 10-25 mg OD should be given until CD4+ count has increased to >200/mm3 for 6 months
  9. Primary prophylaxis is Cotrimoxazole IDS tablet daily & is given in patients with the following
    1. IgG antibody and
    2. CDA+ count < 1004nm3
  10. PMLE (progressive multifocal leukoencephalopathy)
  11. Associations: AIDS, CLL, Hodgkin's, myeloproliferative disease, TB, sarcoidosis
  12. MC association with AIDS
  13. Causative agent: JC virus
  14. Clinical features: Multifocal neuro deficits: ataxia, aphasia, hemiparesis, visual field defects, hemiparesis (in any combination) (due to demyelination in subcortical white matter)
  15. MRI: multiple non-enhancing white matter lesions, especially in occipital & parietal lobes
There is no specific therapy for PML but HAART slows progression and may lead to remission

AIDS Dementia Complex
  1. Also known as encephalopathy
  2. Occurs late; sub-cortical dementia
  3. Clinical features: Lack of concentration, f forgetfulness, f difficulty performing complex tasks, ataxia, tremor
  4. In contrast to Alzheimer's disease (cortical dementia) aphasia, apraxia, agnosia are rare.
  5. Bladder I bowel involvement occur in LATE stages
  6. ALERT (no deterioration in level of consciousness).
  7. Severity of cognitive dysfunction increases with declining immune function
  8. Decline in MMSE score reflects cognitive decline
  9. Me cause of seizures in HIV
Causes of seizure in HIV patient
  1. Toxoplasmosis (LQ 2012)
  2. Tuberculosis
  3. PML (LQ 2012)
  4. Cryptococcal meningitis (LQ 2012)
  5. Metabolic and electrolyte disturbances
  6. Drugs
  1. Infections
    1. Fungal
      1. Candidiasis
      2. Systemic fungal infection with oral lesion
      3. Histoplasmosis
      4. C ryptococcosis
      5. Aspergillosis
    2. Viral
      1. Oral hairy leukoplakia EB virus
      2. Herpes simplex CMV
      3. Varicella zoster
      4. Papilloma virus
    3. Bacterial
      1. Periodontal infection
  2. Neoplasm
    1. Carcinoma
      1. Squamosus cell Ca
      2. Basal Cell Ca
    2. Sarcoma
      1. Kaposi sarcoma
    3. Lymphoma
      1. NHL
    4. Idiopathic oral aphthous ulcers
    5. HIV salivary gland disease
Important oral manifestations
  1. Caused by Candida
  2. MC: soft palate
  3. Also, gingiva, posterior oropharynx
  4. Curd-white cheesy exudates on erythematous mucosa
  5. Diagnosis: demonstration of pseudohyphae by smear
    • (culture has no value)
  1. White frond – like lesion
  2. MC: lateral border of tongue
  3. Also, adjacent buccal mucosa
  4. NOT premalignant
  5. Treatment: Topical podophyllin
Aphthous ulcers
  1. Painful
  2. Posterior oropharynx
  3. MC cause: idiopathic
  4. Also, Cryptococcus, Histoplasma
  5. Treatment (if any): thalidomide
Gastrointestinal manifestations
  1. Esophageal disease
    1. Esophagitis – Candida, CMV, HSV
  2. Gastric disease
    1. Gastric lymphoma
    2. Atypical presentation of secondary infections
    3. Leutic gastritis
    4. Gastric TB
  3. Intestinal manifestations
    1. Diarrhoea
      1. Bacterial infection
        1) Salmonella
        2) Shigella
        3) Compylobacte
        4) Clostridium difficile
      2. Parasitic S.I.
        1) Cryptosporidium
        2) Isospora
        3) Microsporidia
        4) Giardia
      3. L.I.
        1) Entamoeba histolytica
        1) MAC
        2) M. Tuberculosis
      4. Viral
        1) CMV – Colitis
        2) Herpes simplex
  4. Rectal lesions
    1. Infections
      1. Perirectal ulcers
      2. HSV
      3. Cocdylomata acuminaton
    2. Neoplasm
      1. KS
Important git manifestations

  1. MC cause: Candida-AIDS defining illness suspected when oral candidiasis is associated with dysphagia.
  2. Definite diagnosis is possible on endoscopic biopsy.
  3. CMV can also cause esophagitis.
  1. MC cause: protozoa
  2. MC protozoan causing diarrhea: Cryptosporidiym .
HIV enteropathy / AIDS enteropathy
  1. Diarrhea for >1 month
  2. No cause of diarrhea identified despite extensive evaluation (incl. Upper & lower gi endoscopies)
  3. Mucosal hypo proliferation mucosal atrophy lactase deficiency malabsorption & weight loss'
  1. Once infected with CMV, individuals carry CMV for life: Reactivation occurs with immunosuppression e.g. organ transplant / HIV
  2. In HIV:
    1. CMV disease other than that of liver / spleen / lymph nodes is AIDS-defining
    2. CD4 < 50
    3. Respiratory involvement: Bilateral interstitial infiltrates which begin in lower lobes peripherally spread centrally & superiorly
    4. GI involvement.
      1. Esophagitis; Ulcers (anywhere from esophagus to colon)
      2. Hepatitis
    5. Encephalitis
      1. Progressive dementia
      2. Focal Neurologic Deficits o Myeloradiculopathy
    6. Retinitis: Tomato Ketchup appearance (perivascular hemorrhage & exudates). All patients with CD4+ count less than 100/ mm3 should be screened by ophthalmoscopic examination every 3 months.
    7. Wasting syndrome: Fever / Diarrhea > 1 month + weight loss > 10% of body weight
    8. Diagnosis:
      1. Characteristic funduscopic appearance
      2. CMV DNA PCR
    9. Treatment
      Ganciclovir 5mg/kg body weight i.v. twice daily for 21 days followed by Maintenance therapy with Valganciclovir 900 mg OD.
      Discontinue therapy if the patient maintains CD4'+ count more than 100/mm) for more than 6 months.
Important Hepatobiliary diseases
High incidence of HBV & HCV in HIV because of similar routes of transmission 95% of HIV-infected patients have evidence of prior / active HBV infection, of which 10% are HBsAg +ve 5-40% have HCV co-infection
HBV Co-infections
  1. in chronic HBV infection (HBsAg positivity after acute infection)
  2. inflammatory liver disease (lower ALT, milder histology)
  3. BUT higher viral replication of HBV. There is 10 folds increase in liver related mortality in patients with active HBY infection.
  4. Instituting ART severe hepatitis (±)
  5. TOC: Lamivudine + (other ART)
  6. (IFN less successful)
HCV Co-infection
  1. More severe hepatitis & worse prognosis than with HCV alone
  2. aed incidence of liver failure
  3. Lack of sensitivity of serological tests (anti-HCV) in diagnosing HCV infection
  4. HCV replication
  5. risk of heterosexual & perinatal transmission of HCV
  6. Treatment is Pegylated Interferon α with Ribavirin
Patients co-infected with hepatitis B or C
  1. Because of the possibility of additive hepatotoxicity regimens with dd1/d4T and/or NVP should be avoided in patients known to have active hepatitis.
  2. 3TC and TDF are both active against hepatitis B and may even protect against new infections.
Disease of hematopoietic System
Disorders of RBC’s Lymphadenopathy Disorder of WBC Disorder of platelets Disorders of Coagulation Hematologic toxicity
PGL Lymphopenia HIV related thrombocytopenia Venous thrombotic events Drug induced bone marrow suppression
Dideoxy nucleoside agents
Antimicrobral agents
KS Neutropenia Thrombotic thrombocytopenia purpura Protein S deficiency  
TB     Lupus anticoagulants and anticardiolipin antibodies  
Lymphoma     HIV related thrombocytopenia is an additional hemostatic challenge to hemophiliacs Drug induced oxidative hemolysis
Low levels of Vitamin B 12 Atypical mycobacterium     Elevations in D-dimer Megaloblastic anemia
  Toxoplasmosis       TTP – due to Valciclovir
  Systemic fungal infection       PIs, NNRTIs and azole antifungals potentiate the effect of warfarin
Important Hematological manifestations
CD4+ percentage 28-50%: Normal : 500 – 1600 cells/mm3
CD4+ count of 200: 15%
Persistent Generalized Lymphadenopathy
Early manifestation / any time during course
Definition (“1-2-3”): enlarged LNs (>1cm) in 2 / more extra inguinal sites for > 3 months without an identifiable cause.
D/ D of LAP according to degree of immunocompromise:
CD4+ > 200 KS, TB
CD4+ < 200 lymphoma, MAC, toxoplasmosis, bacillary angiomatosis, systemic fungal infections
MC hematological abnormality in HIV
Erythropoietin levels in patients with HIV infection and anemia are generally less than expected given the degree of anemia.
Treatment with Epo at doses of 100 μg/Kg thrice a week may result in an increase in hemoglobin levels.
Zidovudine associated anemia:
Erythroid series affected first( block in maturation)
MCV (>100)
The incidence increases as the disease progresses.
Clinically it resembles the thrombocytopenia seen in patients with Idiopathic Thrombocytopenic Purpura.
The most effective therapy is HAART.

Dermatologic Manifestation of HIV



Non infectious, non malignant findings

Superficial Cutaneous


Systemic infections

with cutaneous






Well defined cutaneous lesion

Poorly classified skin eruptions


Human papilloma virus

Molluscum contagiosum

Herpes simplex

Varicella - Zoster virus

Seborrheic dermatitis

Eosinophilic folliculitis

Reiter’s disease

Invasive squamous cell Ca

B cell lymphomas


Drug reactions






Bacillary angiomatosis

T cell lymphomas




Atopic dermatitis














Porphyria cutanea tarda









Mixed floral infection

Oral hairy leukoplakia






Seborrheic Dermatitis
  1. Affects 3% of general population & 50% of HIV -infected patients
  2. ing prevalence with ing CD4+ count
  3. Aggravated by concomitant infection with Pityrosporum
Eosinophilic Pustular Folliculitis
  1. Eosinophilic infiltration of hair follicle → multiple perifollicular follicles / plaques
  2. Raised IgE in serum
Norwegian scabies
  1. Severe form of scabies seen in HIV (& other immunocompromised states)
  2. Hyperkeratotic, psoriasiform lesions
Reactivation herpes zoster
  1. Multiple dermatomes
  2. Recurrence in 20%
  3. TOC: acyclovir; if resistant → foscarnet
Reactivation herpes simplex
  1. Orolabial / genital/perianal
  2. âing prevalence with âing CD4+ count
**chronic ulcers / bronchitis / pneumonia / esophagitis due to HSV are all AIDS defining conditions according to CDC
Molluscum contagiosum
  1. Flesh-colored, umbilicated
  2. Regress with ART
Steven johnson syndrome
NNRTls, Abacavir, amprenavir, sulfa drugs
Endocrine and metabolic disorders



Body composition anthropomorphic


Pituitary & Hypothalamus



(Symptomatic rare)

Parathyroid (rare)

Adrenal (Clinical dysfla uncommon)

Gondal (most common)


Pancreatic endocrine dysfunction

Hyper triglyceridemia





Gonadotropin deficiency



Adrenal insufficiency

Testicular failure

Bone demineralization


Hyper cholesterolemia






Menstrual disorders

Avascular necrosis



Diabetes insipidus

HIV associated wasting

Calcium disorder

GH deficiency

Magnesium disorders


Lactic acidosis

  1. Due to HAART (incidence is 33-75%)
  2. Consists of in total cholesterol, ApoB, triglycerides and hyperinsulinemia. HDL is decreased.
  3. Fat redistribution: truncal obesity & peripheral wasting (similar to Cushing's)
  4. Rare complications: IDDM, AVN of femoral head
  5. May develop anywhere from 6 weeks to many years after starting HAART
  6. MC used drugs for HIV-Associated dyslipidemia: gemfibrozil & atorvastatin
Immunologic and Rheumatologic diseases

Allergic disorders

Arthritis / Arthralgia


Autoimmune & connective tissue disease

Drug allergies

Directly related to HIV



Diffuse infiltrative

lymphocytosis syndrome (DILS)

Immediate – Type hypersensitivity reaction – Occurrence increased

HIV or AIDS – associated Arthropathy

Arthralgia 1/3rd of HIV pts



Inflammatory myopathy polymyositis

Drug induced myopathy

Non inflammatory myopathy

Painful articular syndrome

Reactive arthritis and retires syndrome



CNS angitis

Psoriatic arthritis

Septic aureus

Staph aureus


Fungal – C. Neoformans,

Sporothrix schenckii

H. capsulatum



M. tuberculosis

M. haemophilum

M. avium

M. kansasii



Important Rheumatological disorders
  1. HIV / AIDS associated arthropathy: subacute, oligo-articular, affects large joints (esp. knee, ankle)
  2. Painful articular syndrome: due to direct effect of HIV on joint
  3. Fibromyalgia: ed incidence
HIV + Sicca syndrome = DILS (Diffuse infiltrative lymphocytosis syndrome) (PNQ)
  1. It is the only auto-immune disease which occurs with increased frequency in HIV infected patients
  2. CD8+ infiltration of salivary glands (c.f. CD4+ in primary Sjögren’s or other causes of secondary Sjögren’s)

Test Your Skills Now!
Take a Quiz now
Reviewer Name