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

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"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.

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

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