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progressive quantitative and qualitative deficiency of the subset of T lymphocytes referred to as helper T cells (CD4+)
Acute HIV syndroms acute HIV syndrome (fever, skin rash, pharyngitis, and myalgia) occur less frequently in those infected by injection drug use versus those infected by sexual contact. The syndrome is typical of an acute viral syndrome and has been likened to acute infectious mononucleosis
Primary HIV Infection A maculopapular rash is seen in over half of persons with symptomatic acute HIV infection. This less typical papular/vesicular rash was present in a patient with primary HIV infection. (Courtesy of Gregory K. Robbins, MD, MPH.) Maculopapular rash
CD4 decline in CD4+ T cell count of >25% *** change the ARV CD 4 + ( cells /L ) infection management > 500 same as normal host 200 – 500 Bacterial respiratory infection <350/L ***ARV therapy < 200 P.Jirovecii Prophylaxis P. jiroveci Trimethoprim/sulfamethoxazole (TMP/SMZ), 1 DS tablet qd PO C. neoforman Fluconazole 200 mg/d PO < 100 T. gondii TMP/SMZ 1 DS tablet PO qd CMV Ganciclovir, 5–6 mg/kg 5–7 d/wk IV Valganciclovir 900 mg bid PO Foscarnet 90–120 (mg/kg)/d IV < 50 MAC CMV MAC Azithromycin 1200 mg weekly PO or Clarithromycin 500 mg bid PO
computed tomography (CT c contrast ) space-occupying lesions
lumbar puncture (LP)
CSF studies that may be of value include opening and closing pressures, cell count, glucose, protein, Gram stain, India ink stain, bacterial culture, viral culture, fungal culture, toxoplasmosis and cryptococcosis antigen, and coccidioidomycosis titer
intraocular ganciclovir implant with oral ganciclovir 1.0 to 1.5 g PO tid
alternative first-line therapy is ganciclovir 5 mg/kg IV bid for 14 to 21 days.
Visual loss and blindness occur in all cases without early detection and prompt treatment. Even with treatment, there are frequent relapses and progression of disease, with 10 percent of affected patients ultimately going blind.