# Symptomatic HIV infection / AIDS - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: HIV and AIDS - StatPearls - NCBI Bookshelf (NBK534860) - https://www.ncbi.nlm.nih.gov/books/NBK534860/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BD04 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text SYMPTOMATIC HIV INFECTION / AIDS Sources: HIV and AIDS - StatPearls - NCBI Bookshelf (NBK534860) - https://www.ncbi.nlm.nih.gov/books/NBK534860/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BD04 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - This card is built from an HIV-2 article and several lines are true of HIV-2 only. Presentation can include an acute retroviral illness or an opportunistic infection at diagnosis - Reported opportunistic infections include oral thrush, PCP pneumonia, CMV, Kaposi sarcoma, tuberculosis, disseminated mycobacterial disease, toxoplasmosis, and progressive multifocal leukoencephalopathy - In one African cohort, generalized wasting and pulmonary tuberculosis were the leading AIDS- defining features at diagnosis [muscle wasting] - Kidney disease linked to HIV is described only rarely in HIV-2, unlike its more frequent occurrence in HIV-1 - Brain inflammation (encephalitis) may be seen more often in HIV-2 than in HIV-1, for uncertain reasons TESTS (6) - Diagnosis relies on fourth-generation antigen-antibody testing that includes a step separating HIV-1 from HIV-2 - Older antibody assays and confirmatory western blots often could not reliably tell HIV-1 from HIV-2 because of cross-reactivity - As many as 40% of untreated patients with HIV-2 have no detectable virus on blood testing - Red flag: an undetectable viral load does not rule out HIV-2, since the test is unreliable for that purpose. This does not apply to HIV-1 - Genetic and phenotypic drug-resistance testing for HIV-2 is not validated or available for clinical use in the US. It IS available for HIV-1 - Only two US laboratories routinely perform HIV-2 viral load testing, limiting its availability IF NOT THIS - what else fits (9) - Dual infection with both HIV-1 and HIV-2 is on the differential - Pneumocystis jiroveci pneumonia is on the differential - Toxoplasma gondii encephalitis is on the differential - Tuberculosis (Mycobacterium tuberculosis) is on the differential - Nontuberculous mycobacterial infection is on the differential - Mucocutaneous candidiasis is on the differential - Herpes simplex virus infection is on the differential - Kaposi sarcoma from human herpesvirus-8 is on the differential - Progressive multifocal leukoencephalopathy is on the differential Source StatPearls "HIV-2 Infection" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Advanced HIV disease needs urgent referral to a specialist HIV centre for ART and opportunistic-infection management; a GP's main contribution is recognising it, starting co-trimoxazole prophylaxis if there will be a delay reaching the centre, and referring urgently. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Advanced HIV disease needs urgent referral to a specialist HIV centre for ART and opportunistic-infection management; a GP's main contribution is recognising it, starting co-trimoxazole prophylaxis if there will be a delay reaching the centre, and referring urgently. Caution No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Advanced immunosuppression with CD4 count < 200 cells/µL places patients at high risk for opportunistic infections. RED FLAG - Primary prophylaxis is indicated for CD4 count < 200 cells/µL to prevent Pneumocystis jirovecii and Toxoplasma gondii opportunistic infections. RED FLAG - Opportunistic infection symptoms (persistent fever, chronic diarrhoea, oral thrush, weight loss, cough), neurological symptoms, severe wasting, or pregnancy. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)