Clinical indicator conditions associated with untreated HIV infections and recommendations for HIV testing

"clinical indicator conditions " associated with untreated HIV infections and recommendations for HIV testing

A number of conditions are commoner in those who have HIV infection. They are associated with greater or lesser degrees of immunosuppression.

• many of these "indicator conditions " also arise frequently in those uninfected with HIV
• if any of these conditions are encountered or diagnosed during a consultation, a GP should in general, offer or refer for an HIV test; or at the very least think it through

Definitions of indicator conditions and recommendations for HIV testing:

• conditions which are AIDS defining among people living with HIV - HIV testing is strongly recommended
  • neoplasms
    • cervical cancer
    • non-Hodgkin lymphoma
    • Kaposi "s sarcoma
  • bacterial infections
    • Mycobacterium tuberculosis, pulmonary or extrapulmonar
    • Mycobacterium avium complex (MAC) or Mycobacterium kansasii disseminated or extrapulmonary
    • Mycobacterium, other species or unidentified species, disseminated or extrapulmonary
    • pneumonia, recurrent (2 or more episodes in 12 months
    • Salmonella septicaemia, recurrent
  • viral infections
    • Cytomegalovirus retinitis
    • Cytomegalovirus, other (except liver, spleen, glands)
    • herpes simplex, ulcer(s) > 1 month, bronchitis/pneumonitis
    • progressive multifocal leucoencephalopathy
  • parasitic infections
    • cerebral toxoplasmosis
    • Cryptosporidiosis diarrhoea, > 1 month
    • Isosporiasis, > 1 month
    • atypical disseminated leishmaniasis
    • reactivation of American trypanosomiasis (meningo encephalitis or myocarditis)
  • fungal infections
    • Pneumocystis pneumonia (PCP)
    • candidiasis, oesophageal
    • candidiasis, bronchial/tracheal/lungs
    • cryptococcosis, extrapulmonary
    • Histoplasmosis, disseminated/extrapulmonary
    • coccidioidomycosis, disseminated/extrapulmonary
    • penicilliosis, disseminate
• conditions associated with an undiagnosed HIV prevalence of >=0.1% - strongly recommended testing
  • sexually transmitted infections
  • malignant lymphoma
  • anal cancer/dysplasia
  • cervical dysplasia
  • herpes zoster
  • hepatitis B or C (acute or chronic)
  • mononucleosis-like illness
  • unexplained leucocytopenia/thrombocytopenia lasting > 4 weeks
  • seborrhoeic dermatitis/exanthema
  • invasive pneumococcal disease
  • unexplained fever
  • candidaemia
  • visceral leishmaniasis
  • preganacy - implications for the unborn child
• other conditions considered likely to have an undiagnosed HIV prevalence of >0.1% - offer testing
  • primary lung cancer
  • lymphocytic meningitis
  • oral hairy leukoplakia
  • severe or atypical psoriasis
  • Guillain-Barre syndrome
  • mononeuritis
  • subcortical dementia
  • multiple sclerosis like illness
  • peripheral neuropathy
  • unexplained weight loss
  • unexplained lymphadenopathy
  • unexplained oral candidiasis
  • unexplained chronic diarrohea
  • unexplained chronic renal impairment
  • hepatitis A
  • community acquired pneumonia
  • candidiasis
• conditions where not identifying the presence of HIV infection may have significant adverse implications for the individual "s clinical management
  • conditions requiring aggressive immunosuppressive therapy e.g. - cancer, transplantation
  • primary space occupying lesion of the brain
  • idiopathic/thrombotic thrombocytopenic purpura

Reference:

• (1) The Medical Foundation for AIDS & Sexual Health (MedFASH) 2016. HIV in primary care. A practical guide for primary healthcare professionals in Europe.