HIV Complication

Aka: HIV Complication, HIV Associated Condition, HIV Related Condition, AIDS Complication, Health Maintenance Screening in HIV

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II. Pathophysiology

  1. See HIV Pathophysiology
  2. HIV is associated with several categories of complications
    1. Direct HIV Infection related symptoms and effects
    2. Immunodefiency
      1. Significantly reduced with modern Antiretroviral therapy
      2. Malignancy
      3. Opportunistic infections
    3. Persistent immune activation and chronic inflammation
      1. Persists despite modern Antiretroviral therapy

III. Complications

  1. Cardiovascular Manifestations of HIV
    1. See Cardiovascular Manifestations of HIV
    2. HIV Cardiomyopathy
    3. HIV and specific ART agents are considered Cardiovascular Risk Factors
      1. Cardiovascular Disease
      2. Dyslipidemia
  2. Dermatologic Manifestations of HIV
    1. Pruritus in HIV
  3. Eye Manifestations
    1. CMV Chorioretinitis
  4. Endocrine Manifestations of HIV
    1. See Endocrine Manifestations of HIV
    2. See Insulin Resistance in HIV
    3. See Osteoporosis in HIV
    4. See Weight Gain in HIV
    5. AIDS Wasting Syndrome
  5. Gastrointestinal Manifestations of HIV
    1. Diarrhea in HIV
    2. Dysphagia in HIV
    3. Pancreatitis in HIV
    4. Vomiting in HIV
    5. Gastric Outlet Obstruction in HIV
    6. Gastritis in HIV
    7. Hepatitis in HIV
  6. Head and neck manifestations of HIV
  7. Hematologic Manifestations of HIV
  8. Lymphadenopathy in HIV
  9. Malignancy in HIV
    1. HIV related Lymphoma (B Cell Lymphoma)
    2. Kaposi Sarcoma
    3. HPV related coinfections (Cervical Cancer, Anal Cancer)
  10. Neurologic Manifestations of HIV
    1. HIV-Associated Neurocognitive Disorder (including Dementia in HIV)
    2. Focal Brain Lesion in HIV
    3. Headache in HIV
    4. HIV related Myelopathy
    5. HIV Related Neuropathy
  11. Renal Manifestations of HIV
  12. Opportunistic Infections in HIV
  13. Pulmonary Manifestations of HIV
  14. Rheumatologic Manifestations of HIV
  15. Sexual Health
    1. See Sexual Health in HIV
    2. See Gynecologic Manifestations of HIV
    3. See HIV in Pregnancy
    4. See Sexual History

IV. Prevention

  1. Lifestyle modification
    1. Tobacco Cessation
    2. Substance Use Disorder screening
    3. Exercise
    4. Healthy Diet
    5. Update Vaccinations
  2. Cancer Screening
    1. Follow USPTF and ACS guidelines for other cancers based on age, gender and non-HIV Risk Factors
    2. Anal Cancer
      1. Offer HPV Vaccine up to age 45 years
      2. Digital Rectal Exam AND Anal cytology or high risk HPV Testing
        1. High resolution Anoscopy if positive results
      3. Indications
        1. Age >=45 years OR
        2. Age >= 35 years
          1. Men who have Sex with Men
          2. Transgender women
    3. Cervical Cancer
      1. See Cervical Cancer Screening
      2. Offer HPV Vaccine up to age 45 years
      3. Continue Cervical Cancer Screening lifelong in HIV (do not stop in Menopause)
    4. Hepatocellular Carcinoma
      1. Screening indicated in Cirrhosis and some Hepatitis B and Hepatitis CVirus infections
  3. HIV Monitoring
    1. See Antiretroviral therapy
    2. Plasma HIV Viral Load
      1. Initially every 1-2 months after starting ART, then every 3-4 months for 1 year, then every 6 months
    3. CD4 Cell Count
      1. Obtained at baseline, every 3-6 months for 2 years, then optional if >500 cells/uL AND suppressed >2 years
    4. HIV genotypic assay
      1. Obtained baseline and then as needed (e.g. inconsistent ART, suspected ART resistance)
  4. Infection Screening
    1. Viral Hepatitis (baseline and then as indicated)
      1. Offer Hepatitis B Vaccine and Hepatitis A Vaccine
      2. Hepatitis B Surface Antigen
      3. Hepatitis B Core Antibody
      4. Hepatitis B Surface Antibody
      5. Hepatitis C Virus Antibody
    2. Sexually Transmitted Infection (baseline and then yearly as indicated)
      1. Syphilis IgG and RPR
        1. Recheck post-treatment for 2 years (month 3, 6, 9, 12 and 24 months)
      2. PCR (Nucleic Acid amplification) of all exposed sites (urine, rectal, oropharyngeal)
        1. Gonorrhea PCR
        2. Chlamydia PCR
      3. Trichomoniasis PCR
    3. Recurrent Cervicitis or Urethritis
      1. Consider testing and treating for Mycoplasma Genitalium or Ureaplasma Urealyticum
      2. Both respond to Doxycycline 100 mg orally or IV every 12 hours for 7 to 14 days
    4. Tuberculosis
      1. Tuberculin Skin Test or IFN-Gamma Release Assay (e.g. Quantiferon) baseline and then yearly as needed
  5. Metabolic Disorders
    1. Fasting Glucose
      1. Obtain baseline and then yearly as needed (most patients)
    2. Lipid profile
      1. Obtain baseline and then yearly as needed (may space to every 5 years if consistently normal)
    3. Comprehensive metabolic panel
      1. Obtain at baseline, 1-2 months after starting ART, then every 6 months
      2. Includes eGFR (based on Serum Creatinine or cystatin-C)
    4. Urinalysis
      1. Assess for Proteinuria, Hematuria and Crystalluria
    5. Complete Blood Count with differential and Platelet Count
      1. Obtain baseline and then every year
    6. Osteoporosis Screening
      1. Osteoporosis Risk Assessment
      2. Obtain baseline DEXA Scan in men age >50 years and postmenopausal women

V. References

  1. Currier (2009) Top Hiv Med 17(2): 57-67 [PubMed]
  2. Chu (2011) Am Fam Physician 83(4): 395-406 [PubMed]
  3. Jaqua (2026) Am Fam Physician 113(1): 71-9 [PubMed]

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