Signs and symptoms

The oropharynx is usually affected, with taste disturbances and sometimes, a burning sensation on the tongue. White, non-adherent plaques on the buccal mucosa, tonsillar ring and tongue confirm the diagnosis. Involvement of the tongue alone is rare. Occasionally, there may be atrophic candidiasis, which presents only with an erythematous mucosa. Candida esophagitis usually occurs with oropharyngeal involvement, but in about one third of cases there is no oral thrush. It often presents with...

Other routine checks what else should be monitored

Besides the CD4-cell count and viral load, several other parameters should be monitored in the HIV patient. The following recommendations apply to clinically asymptomatic patients with normal results on routine laboratory evaluation, who have been on stable treatment for several months, or who are not taking antiretroviral therapy. Of course, if treatment is started or changed, or if the patient develops complaints, more frequent and, depending on the problem, further investigations are...

Asymptomatic patients 200350 CD4 cellspl

Even in these patients, most guidelines recommend starting treatment, although the risk of developing AIDS is rather low. In the MACS Cohort, frozen blood samples obtained in the years 1985-1988 were analyzed and correlated with the clinical course of disease in these patients (Phair 2002). Not a single patient with more than 200 CD4 cells tl and a viral load below 20,000 copies ml became ill with AIDS within the following year. On the other hand, a long-term risk of AIDS, especially with a...

Candidiasis

Candidiasis is an infection with yeast-forming fungi. Of the 150 Candida species known to date, only approximately 20 cause disease. By far the most frequent species is C. albicans. Other species such as C. tropicalis, C. glabrata and C. krusei are rare, but may respond less readily to treatment with azoles. Although it is commonly assumed that azole resistance is a problem particularly with albicans strains, this has not been the case to date (Sanglard 2002). Candidiasis is an important...

References

Acquired immunodeficiency in an infant possible transmission by means of blood products. Lancet 1983, 1 956-8. 2. Andreani T, Modigliani R, le Charpentier Y, et al. Acquired immunodeficiency with intestinal crypto-sporidiosis possible transmission by Haitian whole blood. Lancet 1983, 1 1187-91. 3. Armbruster C, Kriwanek S, Vorbach H. Gender-specific differences in the natural history, clinical features, and socioeconomic status of HIV-infected patients...

Preconceptual counseling

The initial counseling of the couple should not only consider extensive information on all reproductive options available, diagnostics and prerequisites for reproductive treatment, but also the psychosocial situation of the couple. Important issues to discuss are the financial situation, current psychosocial problems, the importance of a network of social support from family or friends, and planning and perspectives about the future as a family, including possible disability or death of one of...

CDC classification system

The most widely accepted classification system of HIV infection, initially published by the U.S. Centers for Disease Control and Prevention (CDC) in 1986, is based on certain conditions associated with HIV infection (see Table 1). This classification system was intended for use in conducting public health surveillance and it has been a useful epidemiological tool for many years. In 1993, the CDC classification was revised (CDC 1993b). Since then, the clinical definition of AIDS has been...

Assessing the risk of a vaccination

Following a vaccination, a rise in viral load is often observed (e.g for tetanus, pneumococcus, influenza, HBV). This effect reflects the stimulation of cellular immunity viral replication peaks one to three weeks later. Thus, a routine viral load should not be performed within four weeks of vaccination. Numerous studies demonstrated that these viral load elevations are immunologically and clinically irrelevant. However, one study of influenza vaccinees showed 2 out of 34 patients whose HIV...

W4w12 W24w48 W72

< 2 log drop in HCV-RN Stop * In patients with low viral load at baseline and minimal fibrosis Figure 1 Hepatitis C treatment algorithm modified after Soriano 2007 The management of possible side effects is often the decisive factor for the success of treatment (s. table 2). A high discontinuation rate of up to 30 in numerous (older) clinical studies is likely also to have been due to a lack of experience with combination therapy. Proper management of side effects probably results in...

Female HIV infection

HIV-positive women with unimpaired fertility can conceive by self-insemination. Similar to cases in which the male partner is infected, a fertility screen and further investigations are recommended (see Table 1 for the revised German guidelines , . (Tandler-Schneider 2007)) In some cases, ovarian stimulation may be advisable. Ovarian stimulation, however, requires highly qualified supervision to avoid multiple gestations. It is important to time ovulation accurately (i.e., by use of...

Risk factors diseases and comorbidities

Important ED risk factors coexist frequently in HIV patients, including excessive alcohol consumption, smoking and other recreational drug use metabolic disorders (hyperlipidemia, diabetes mellitus) and cardiovascular disease, with hypertension being of particular importance. Pathophysiologically, most cases of ED are caused by neuronal (polyneuropathy) and vascular (micro- and macroangiopathy) changes however, ED can also be an early sign of a metabolic syndrome. Other possible risk factors...

HIVassociated nephropathy HIVAN

HIV-AN is characterized by rapid loss of renal function, which is especially observed in Afro-Americans. At the end of 2005, 56 HIV-positive dialysis patients were registered in Germany (new in 2005 9 dialysis patients with HIV and 3 HIV patients with a kidney transplant, Quasi Kidney Report 2006). The risk factors are genetic predisposition (97 Afro-Americans), male gender and drug abuse. Most patients have a poor immune status with < 100 CD4+ T-cells l (only 20 have normal ranges)....

Diagnosis

The diagnostic tests used in coinfected patients are the same used in patients with HCV monoinfection (table 1). Detection of HCV antibodies (anti-HCV) proves exposure to HCV, but does not distinguish between resolved and chronic hepatitis C. Chronic hepatitis C is diagnosed by the detection of HCV viremia (i.e. HCV RNA). It should be noted that HCV antibodies might be lost during the course of HIV infection as a result of the underlying immunosuppression, although nowadays this phenomenon has...