HIV-Related Illnesses: The Challenge Of ED Management

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HIV-Related Illnesses: The Challenge Of ED Management

January 2002


Patients infected with HIV present unique challenges for the emergency physician. Many are asymptomatic and are at no special risk for unusual diseases. However, those who progress to AIDS are susceptible to a wide range of opportunistic and traditional infections. Furthermore, even the therapies for HIV infection cause significant complications and morbidity.

Many of those infected with HIV are unaware of their serologic status. For this reason, it is important to consider the possibility of HIVrelated illness in anyone presenting with complaints suggestive of infection. If a patient has known or suspected HIV infection, determining the degree of immunosuppression helps evaluate the risk of opportunistic disease.

HIV-infected patients may complain of vague constitutional symptoms, such as fever, weight loss, and fatigue. Others have complaints localized to a specific organ system—pulmonary, neurologic, abdominal, head and neck, dermatological, or psychiatric.1 Lung and CNS infections are the most common illnesses identified in HIV-positive patients presenting to the ED.

Because AIDS-related infections frequently present atypically or with subtle findings, a high index of suspicion and an aggressive approach to diagnosis are crucial for successful management. Although AIDS-related infections often cannot be cured, many can be successfully treated in the short term and perhaps controlled in the long term using suppressive therapy.

The intimidating array of pathologies associated with HIV, as well as the dizzying pace of new developments, daunts many physicians. Fear not: This issue of Emergency Medicine Practice provides indispensable insight to the management of common HIV complications seen in the ED.

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