Which physical findings are characteristic of acute HIV infection?

Updated: Jan 02, 2020
  • Author: Robert J Carpenter, DO, FACP; Chief Editor: John Bartlett, MD  more...
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Physical examination findings of acute HIV infection are nonspecific and may mimic those of other viral infections, such as influenza. In addition, many of these findings resolve without medical intervention. The most common findings include fever and chills, lymphadenopathy, pharyngitis, anemic pallor, and rash. Involved lymph nodes are generally discrete and freely mobile and may be tender. Rash is usually maculopapular and primarily on the trunk and/or proximal extremities.

A variety of oral lesions may be found. Thrush manifests as a white exudate, often with an erythematous mucosa. Thrush develops most commonly on the soft palate. Early lesions can also be found along the gingival border. The diagnosis is made based on clinical appearance or direct examination of a scraping for pseudohyphal elements, which are characteristic of candidiasis (typically with Candida albicans). Severe cases of thrush can involve the esophagus, with resultant dysphagia or odynophagia.

Oral hairy leukoplakia manifests as filamentous white lesions, generally along the lateral borders of the tongue. Aphthous ulcers are shallow and painful and usually affect the posterior oropharynx.

Lesions from herpes simplex virus (HSV) may be present; oral and genital lesions are most common, but perianal and periungual lesions are also observed. Herpetic lesions resemble a cluster of vesicles on an erythematous base.

Reactivation of herpes zoster (shingles) is characterized by lesions due to varicella-zoster virus (VZV) that may extend over several dermatomes. Widespread cutaneous dissemination may occur, but visceral involvement has not been reported.

Thrombocytopenia may occur acute HIV infection. As in other forms of thrombocytopenia, bleeding is rare unless the platelet count falls to below 10,000 cells/µL. In those cases, bleeding gums, extremity petechiae, and easy bruising are common presentations.

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