Even though infection with human immunodeficiency virus (HIV) can be devastating and depressing news to a patient, the early recognition of the infection, the monitoring of immune deficiency both clinically and quantitatively, the prophylaxis and treatment of opportunistic infections and highly active antiretroviral therapy (HAART) have made HIV infection a chronic disease with an increasing survival rate. At the end of 2003, an estimated 1 039 000 to 1 185 000 persons were living with HIV/acquired immunodeficiency syndrome (AIDS) in the United States; 24% to 27% were undiagnosed and unaware of their HIV infection. It is estimated that between 35 and 42 million people are living with HIV/AIDS worldwide. Primary care physicians need to be familiar with the history, clinical presentation, and complications of HIV infection, mostly during the early stages of the infection, when they are expected to care for these patients. This chapter will help clinicians in suspecting, counseling, screening, diagnosing, and evaluating immune deficiency, as well as implementing antiretroviral therapy and other therapies as indicated.

HIV CLINICAL PRESENTATION

Patients can present with different complaints ranging from an acute nonspecific retroviral syndrome (mononucleosis type) lasting 1 to 4 weeks after HIV-1/HIV-2 viral aqcuisition with an incubation period as long as 6 weeks to an AIDS-defining illness suggesting advanced immunocompromission, most commonly Pneumocystis carinii pneumonia, esophageal candidiasis, wasting, and Kaposi's sarcoma.