The Clinical Problem Solvers

Episode 295: Rafael Medina Subspecialty Series – fatigue in patient living with HIV

Jul 12, 2023
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INSIGHT

Think Multiple Concurrent Processes

  • Patients with very low CD4 counts can have multiple simultaneous opportunistic processes.
  • Monica Gandhi emphasizes broad differentials across bacterial, fungal, parasitic, and viral categories.
ADVICE

Prioritize Targeted Physical Exam And Eye Exam

  • Perform a focused exam including eyes, mouth, cranial nerves, heart, and skin to look for opportunistic signs.
  • Get an ophthalmology consult and assess for raised intracranial pressure before LP.
ADVICE

Rapid Comprehensive Diagnostic Workup

  • Get head imaging (CT to allow LP safety, MRI when possible) and send a broad CSF panel including fungal, AFB, viral PCRs.
  • Order serum CrAg, TB testing, chest imaging, and relevant serologies promptly.
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