Retroviral infection with progressive CD4 depletion → AIDS-defining illnesses.
Investigations
- • 4th-gen HIV Ag/Ab test (window 4 weeks)
- • Confirmatory immunoblot
- • CD4 count, HIV viral load
- • Resistance genotype
- • Screen for HBV, HCV, syphilis, TB
Management
- • Start ART at diagnosis irrespective of CD4: integrase inhibitor + 2 NRTI (e.g. bictegravir/TAF/FTC)
- • OI prophylaxis: co-trimoxazole if CD4 <200 (PCP), azithromycin if <50 (MAC)
- • Vaccinations: pneumococcal, hepatitis B, HPV, COVID; avoid live vaccines if CD4 <200
Clinical pearls
- • U=U: undetectable viral load = untransmittable
- • PEP within 72 h, PrEP for high-risk individuals
References
- • BHIVA 2023
- • DHHS HIV 2024
Educational — verify locally.
