Diagnosis Of Hiv Infection In Adults With Tuberculosis

CLINICAL RECOGNITION OF HIV INFECTION IN TB PATIENTS

In many TB/HIV patients in sub-Saharan Africa, the only HIV-related illness present is TB. However, certain clinical features are more common in HIV-positive TB patients than in HIV-negative TB patients. The table below shows the clinical features that suggest possible HIV infection.

Clinical features suggestive of HIV confection in TB patients

Past history

° sexually transmitted infection (STI) ° herpes zoster (shingles), which often leaves a scar ° recent or recurrent pneumonia ° severe bacterial infections

(sinusitis, bacteraemia, pyomyositis) ° recent treated TB

Symptoms

° weight loss (> 10 kg or > 20% of original weight) ° diarrhoea (> 1 month) ° retrosternal pain on swallowing

(suggests oesophageal candidiasis) ° burning sensation of feet

(peripheral sensory neuropathy)

Signs

° scar of herpes zoster ° pruritic (itchy) papular skin rash ° Kaposi sarcoma

° symmetrical generalized lymphadenopathy ° oral candidiasis ° angular cheilitis ° oral hairy leukoplakia ° necrotizing gingivitis ° giant aphthous ulceration ° persistent painful genital ulceration

IMPRACTICAL POINT

Always look in the mouth of any patient. Many mouth lesions are highly suggestive of HIV infection, and others are pathognomonic.

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