HIV - AIDS (main): Difference between revisions

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lymphocyte count in the emergency department predicts a low CD4 count in admitted
lymphocyte count in the emergency department predicts a low CD4 count in admitted
HIV-positive patients. Acad Emerg Med. 2011 Apr;18(4):385-9. doi:
HIV-positive patients. Acad Emerg Med. 2011 Apr;18(4):385-9. doi:
10.1111/j.1553-2712.2011.01031.x. Erratum in: Acad Emerg Med. 2011 May;18(5):565. </ref>.
10.1111/j.1553-2712.2011.01031.x. Erratum in: Acad Emerg Med. 2011 May;18(5):565. </ref>
* A CD4 count of <200 is very likely if the ED ALC is <950 and less likely if the ALC is >1700.
* A CD4 count of <200 is very likely if the ED ALC is <950 and less likely if the ALC is >1700
* ALC is useful to confirm, but not exclude a low CD4
* ALC is useful to confirm, but not exclude a low CD4



Revision as of 00:17, 23 February 2016

Background

  • In HIV+ patient presenting to ED, absolute lymphocyte count (ALC) can be used as surrogate for CD4 count [1]
  • A CD4 count of <200 is very likely if the ED ALC is <950 and less likely if the ALC is >1700
  • ALC is useful to confirm, but not exclude a low CD4

HIV Associated Diseases by CD4 Level

CD4 Count Stage Diseases
>500 Early disease Similar to non-immunocompromised patients (Consider HAART medication side-effects)
200-500 Intermediate disease Kaposi's sarcoma, Candida, bacterial respiratory infections
<200 Late disease PCP, central line infection, MAC, TB, CMV, drug fever, sinusitis, endocarditis, lymphoma, histoplasmosis, cryptococcus, PML
<100 Very late disease Cryptococcus, Cryptosporidium, Toxoplasmosis
<50 Final Stage CMV retinitis, MAC

Clinical Features

Acute Infection

  • Misdiagnosed frequently as "mono" or "flu"
  • Largest viral load, widespread dissemination of virus, and most infectious stage[2]
  • Symptoms develop 2-4wks after exposure; last for <14d

Seroconversion

  • HIV Ab detectable 3-8wk after infection

Asymptomatic

  • Lasts for ~8yr
  • Pts may have conditions that are more common in pts w/ HIV but no indicator conditions
    • Thrush
    • Persistent vulvovaginal candidiasis
    • Peripheral neuropathy
    • Cervical dysplasia
    • Recurrent Herpes Zoster
    • ITP

AIDS

Differential Diagnosis

HIV associated conditions

Management

Disposition

Suggested Admission

  • New presentation of fever of unknown origin
  • Hypoxemia worse than baseline or PaO2 <60
  • Suspected PCP
  • Suspected TB
  • New CNS symptoms
  • Intractable diarrhea
  • Suicidal
  • Suspected CMV retinitis
  • Ophthalmicus zoster
  • Cachexia or weakness
  • Unable to care for self/receive care
  • Unable to assure F/U

Suggested Discharge

  • Normal or baseline vitals
  • Stable medical condition
  • Able to tol POs/not orthostatic
  • F/U arranged
  • Able to comply with D/C instructions

See Also

References

  1. Napoli AM, Fischer CM, Pines JM, Soe-lin H, Goyal M, Milzman D. Absolute lymphocyte count in the emergency department predicts a low CD4 count in admitted HIV-positive patients. Acad Emerg Med. 2011 Apr;18(4):385-9. doi: 10.1111/j.1553-2712.2011.01031.x. Erratum in: Acad Emerg Med. 2011 May;18(5):565.
  2. Serrano KD, Westergaard RP. Diagnosis and management of acute HIV in the emergency department. EM Reports, 2012:33;16.
  3. Gutteridge, David L MD, MPH, Egan, Daniel J. MD. The HIV-Infected Adult Patient in The Emergency Department: The Changing Landscape of the Disease. Emergency Medicine Practice: An Evidence-Based Approach to Emergency Medicine. Vol 18, Num 2. Feb 2016.