Medical history and physical exam for HIV infection

When you are first diagnosed with HIV, your health professional will check your current health status. He or she will ask questions about your current symptoms and past health to determine whether you have had any HIV-related illnesses, whether you have medication allergies, whether your immunizations are up to date, and whether you have ever been hospitalized for illness or surgery.

Many of the tests a health professional does during the initial exam will be repeated during regular checkups to monitor changes in your health.

Medical history

You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• Do you have an increased risk for developing HIV? You have an increased risk of developing HIV if you:
  • Are a man who has sex with men.
  • Have more than one sex partner, especially if one of you injects drugs.
  • Inject drugs or steroids, especially if you share needles, syringes, cookers, or other equipment used to inject drugs.
  • Have high-risk partner(s) (a man or woman who has multiple sex partners or injects drugs, or a man who has sex with men).
  • Have recently had a sexually transmitted disease.
• Have you ever had symptoms that might indicate illness, such as fever, weight loss, shortness of breath, or diarrhea?
• Have you ever had tuberculosis, fungal or yeast infections, liver infection (hepatitis), cold sores (oral herpes), or any other sexually transmitted diseases? All of these diseases can present special problems for people who are infected with HIV.
• Are you a caregiver, such as a partner or parent, of a person who is HIV-positive and has hemophilia?

Physical exam

Your health professional will do a complete physical exam to determine your present state of health. This will include the following examinations:

• Temperature. Fevers are common in people who have HIV, even when no other symptoms are present. Fever can sometimes be a sign of a certain kind of infection or cancer that is more common in people who have weakened immune systems. Your health professional will check your temperature at every visit.
• Weight. Your health professional will weigh you at every visit. A loss of 10% or more of your body weight is called the wasting syndrome, which is one of the signs of AIDS, the last and most severe stage of HIV infection. You may need help getting adequate nutrition if you have lost weight.
• Eyes.Cytomegalovirus (CMV) retinitis is a common complication of AIDS. It occurs more frequently in people who have a CD4+ cell count of less than 100 cells per microliter (µL). Symptoms include seeing floaters, blurred vision, or loss of vision. If you have symptoms of CMV retinitis, you should see an ophthalmologist as soon as possible. Some health professionals recommend ophthalmologist visits every 3 to 6 months if your CD4+ cell count is less than 100 cells/µL.
• Mouth. Oral yeast infections (thrush) and other mouth sores are very common in people who are HIV-infected. Your health professional will examine your mouth at every visit. You should have a dental exam at least twice a year. If you develop symptoms of gum disease (periodontal disease), you may need to see your dentist more often.
• Lymph nodes. Lymph node enlargement (lymphadenopathy) is not always caused by HIV alone. A biopsy may be considered if your lymph nodes are getting larger or if some are different sizes (asymmetrical). Your health professional will examine your lymph nodes at every visit.
• Abdomen. The abdominal exam may show an enlarged liver (hepatomegaly) or enlarged spleen (splenomegaly). These conditions can be caused by new infections or may indicate cancer. Your health professional will do an abdominal exam at every visit or if you develop symptoms such as pain in the upper right or upper left part of your abdomen.
• Skin. Skin problems are common for people with HIV infection. A regular exam may reveal treatable conditions ranging in severity from seborrheic dermatitis to Kaposi's sarcoma. Your health professional should do a skin exam every 6 months or whenever symptoms develop.
• Gynecologic. Women who are HIV-infected have more cervical cell abnormalities than women who do not have HIV. These cell changes can be detected with a Pap test. You should have two Pap tests during the first year after you have been diagnosed with HIV. If the first two Pap tests are normal, you should have a Pap test once a year. You may need to have a Pap test more frequently if you ever have an abnormal test result.

A thorough physical exam will provide information about your present state of health. During later visits, your health professional will use this information to see whether your health status is changing.

The medical history and physical exam are done right after a person has been diagnosed with HIV infection (2 positive ELISA tests and 1 positive Western blot assay).

These exams will be done during regular follow-up exams or if specific symptoms develop.

The medical history and physical exam may provide the following results.

Normal

No abnormalities are found. After the initial workup, talk to your health professional to decide how often to schedule follow-up exams.

• The frequency of follow-up exams depends on whether you have symptoms of illness and your initial viral load and CD4+ cell count measurements.
• Follow-up exams may be done as often as every 3 to 6 months, possibly more often, especially right after you start medication treatment.

If you do not have symptoms but you have a high CD4+ cell count and a low viral load, your health professional will probably recommend that you have follow-up exams at least every 6 months or sooner if you develop symptoms of illness.

Abnormal

Signs of illness are found. Follow-up and treatment will depend upon the specific problem.

Your family medicine physician or internist may not be able to diagnose and treat all the problems that can be caused by HIV infection. Your doctor may refer you to another health professional who specializes in conditions that affect different body systems. Before you make an appointment with a specialist, find out whether he or she has experience treating people who have HIV-related illnesses.

Complications of HIV may require treatment by the following health professionals:

• Cardiologist
• Dermatologist
• Gastroenterologist
• Infectious disease specialist
• Oncologist
• Ophthalmologist
• Orthopedist
• Pulmonologist

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