This week in morning report this week we talked about an approach to opportunistic infections in patients with HIV, as we reviewed a case of a patient with HIV and a recent CD4 count of 50 and elevated viral load who presented with acute diarrhea.

If you are seeing a patient with HIV who is presenting with signs and symptoms of infection, you can organize your thinking by asking yourself the following questions:

• What is their CD4 counts?
• What prophylaxis are they taking against opportunistic infections?
• What vaccinations have they had?
• What exposures have they had?

This will help to direct with pathogens you are concerned about. You can also organize your thinking by thinking about typical pathogens that might cause infection in immunocompetent patients as well as atypical pathogens that might cause infection in immunocompromised patients. Then consider non-infectious causes as well in your differential.

Below is a table about antimicrobial prophylaxis for opportunistic infections in patients with HIV. For more information read

In the case of diarrhea in a patient with HIV, the differential includes infectious and non infectious causes. In our patient, we suspected infectious causes due to associated fevers, chills and the acute onset of symptoms.

For more information about diarrhea in patients with HIV, there is an excellent article on UpToDate. Please also see the tables below:

Further Reading:

https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf