Clinical Features And Treatment

The spectrum of disease caused by HIV infection varies greatly. Many patients with asymptomatic infection may come to the emergency department for complaints unrelated to HIV disease.12 Others may have involvement of virtually any organ system, commonly with multiple interrelated problems. Because of the complexity of HIV infection and related opportunistic infections or malignancies, specific diagnoses often cannot be made in the emergency department.

Evaluation of HIV-infected patients should be carried out with the same priority-based logical approach used for all emergency department patients, with attention to concerns particular to this population. Patients with unstable vital signs require attention to the "ABCs" and rapid stabilization. Universal precautions (in some hospitals termed standard precautions) must be used in all cases. The history and physical examination should focus on identifying the clinical stage of disease in order to direct attention to the most likely complications. History gathering must include a thorough review of past and current medications, previous infections, and attention to activities of daily living. Physical findings that might assist with staging ( T.a.ble..,.139-.3) include the presence of thrush, evidence of temporal wasting, or dementia. Diagnostic and therapeutic maneuvers are directed toward recognition of organ system involvement, assessment of the severity of disease, and institution of symptomatic and specific therapy. Table 139-4 lists some of the common pathogens causing organ system involvement in HIV-infected patients. While it is unlikely in most cases that specific therapy will be initiated by the emergency department physician, familiarity with therapeutic approaches and related complications is important. Table 139.-5. contains a summary of common infections and current recommendations for therapy.

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