Group IV Symptomatic HIV infection before the development of AIDS
The progression of HIV infection is a result of a decline in immune competence that occurs due to increased replication of HIV from sites where it has been latent. The exact triggers for this reactivation are poorly understood.
As the disease progresses, infected persons may suffer from constitutional symptoms, skin and mouth problems and haematological disorders, many of which are easy to treat or alleviate. A decrease in viral load in response to the introduction of antiretroviral therapy often corresponds to a complete or partial resolution of these symptoms.Table 4.2 Differential diagnosis of glandular feverlike illness
| Condition | Test |
| Viral | |
| Infectious mononucleosis | Paul-Bunnell |
| Cytomegalovirus | Serology/culture |
| Rubella | Serology |
| Herpes simplex | HSV culture |
| Adenovirus | Serology |
| Hepatitis B/C | Serology |
| HIV | HIV, Ab, Ag, PCR |
| Protozoal | |
| Toxoplasmosis | Serology |
| Bacterial | |
| Syphilis | Serology |
| Streptococcal pharyngitis | Bacterial culture |
| Brucellosis | Serology |
| Neoplastic | |
| Lymphoma or leukaemia | Full blood count/diff |
| Lymph node biopsy | |
| Bone marrow |
| Table 4.3 Common causes of generalised lymphadenopathy | |
| Condition | Test |
| Infections | |
| Bacterial | |
| Syphilis | Serological tests (Venereal Diseases |
| Research Laboratory), Treponema | |
| pallidum haemagglutination and | |
| Fluorescent Antibody tests | |
| Brucellosis | Serological tests |
| Viral | |
| Infectious mononucleosis | Paul-Bunnell |
| (Epstein-Barr virus) | |
| Cytomegalovirus | CMV cultures or antibodies |
| Hepatitis A | Serology |
| Hepatitis B | Serology |
| Rubella | Serology |
| Parasites | |
| Toxoplasmosis | Toxoplasma serology |
| Tumours | |
| Lymphomas, leukaemia’s | Full blood count, lymph node biopsy, |
| or other tumours | CT or MRI scans etc. |
| Miscellaneous | |
| Sarcoidosis | Clinical features, Kviem test |
Box 4.3 Indications for lymph node biopsy
• Constitutional symptoms
• Painful nodes
• Asymmetrical enlargement
• Sudden increase in size
• Hilar lymphadenopathy
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