HIV Infection in Adults and Adolescents (10-19 years old)
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Click here to access the Primary Health Care - PHC Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS) - 26 February 2026
Description
Diagnosis
Prognosis
General Measures
Comprehensive guidelines are available for ART and the care of adults and children with HIV infection in the 2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates.1
DESCRIPTION
HIV replicates in CD4 lymphocytes and monocytes, leading to progressive destruction of CD4 lymphocytes and impaired immunity.
Primary infection is characterised by:
- glandular fever-type illness
- maculopapular rash
- small orogenital ulcers
After primary infection, patients may have generalised lymphadenopathy and are usually asymptomatic for several years. Subsequently, if untreated, inflammatory skin conditions and an increased frequency of minor infections occur, followed by more severe infections (especially tuberculosis), weight loss and/or chronic diarrhoea. Eventually severe opportunistic infections, HIV-associated cancers, or other severe HIV manifestations develop, known as the Acquired Immune Deficiency Syndrome (AIDS).
DIAGNOSIS
- Provide adequate pre- and post-test counselling.
- Ensure patient confidentiality.
- A positive rapid HIV test in adults must be confirmed with a 2nd rapid test from a different manufacturer. If the screening and confirmation rapid test result differ, repeat the tests. If the repeated test series differ, do a laboratory test (usually ELISA).
- HIV antibodies are not detected during the 1st few weeks after infection. This is known as the window period.
PROGNOSIS
- HIV disease progression is variable. The CD4 lymphocyte count and clinical features of immune suppression (see WHO staging below) both provide independent information on prognosis. Patients may be asymptomatic with very low CD4 counts or have severe clinical features with well-preserved CD4 counts. CD4 counts < 200 cells/mm3 indicate severe immune suppression. All HIV-infected patients must have a CD4 count and WHO clinical staging done at diagnosis.
- All PLHIV are eligible for ART, irrespective of CD4 count or WHO stage. Patients should be counselled about the benefits and risks of early ART initiation, and encouraged to initiate ART as soon as feasible. However, should a patient elect to defer ART, the CD4 count should be repeated every 6 months until ART can be initiated.
South African modified WHO staging of HIV/AIDS for adults and adolescents
Clinical stage 1
- Asymptomatic.
- Persistent generalised lymphadenopathy.
Clinical stage 2
- Unexplained moderate weight loss (< 10% of presumed or measured body weight).
- Recurrent respiratory tract infections (sinusitis, otitis media and pharyngitis).
- Herpes zoster (shingles).
- Angular stomatitis.
- Recurrent oral ulceration.
- Papular pruritic eruption.
- Seborrhoeic dermatitis.
- Fungal nail infections.
Clinical stage 3
- Unexplained severe weight loss (> 10% of presumed or measured body weight).
- Unexplained chronic diarrhoea for > 1 month.
- Unexplained persistent fever (> 37.5ºC intermittent or constant for > 1 month).
- Persistent oral candidiasis (thrush).
- Oral hairy leukoplakia.
- Pulmonary TB.
- Severe bacterial infections (such as pneumonia, empyema, pyomyositis, bone or joint infection, meningitis, or bacteraemia).
- Acute necrotizing ulcerative stomatitis, gingivitis, or periodontitis.
- Unexplained anaemia (< 8 g/dL), neutropaenia (< 0.5 × 109/L) and/or chronic thrombocytopaenia (< 50 × 109/L).
Clinical stage 4
- HIV wasting syndrome.
- Extrapulmonary tuberculosis.
- Pneumocystis pneumonia.
- Recurrent severe bacterial pneumonia.
- Chronic herpes simplex infection (orolabial, genital or anorectal of > 1 month duration or visceral at any site).
- Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs).
- Kaposi’s sarcoma.
- Cytomegalovirus infection (retinitis or infection of other organs).
- Central nervous system toxoplasmosis.
- HIV encephalopathy.
- Extrapulmonary cryptococcosis including meningitis.
- Disseminated non-tuberculous mycobacterial infection.
- Progressive multifocal leukoencephalopathy.
- Chronic cryptosporidiosis.
- Chronic isosporiasis.
- Disseminated mycosis (extrapulmonary histoplasmosis or coccidiomycosis).
- Recurrent septicaemia (including non-typhoidal Salmonella).
- Lymphoma (cerebral or B cell non-Hodgkin).
- Invasive cervical carcinoma.
- Atypical disseminated leishmaniasis.
- Symptomatic HIV-associated nephropathy or symptomatic HIV-associated cardiomyopathy.
GENERAL MEASURES
- Encourage patients and their families to join support or peer groups.
- Counsel patients on methods to reduce the spread of HIV:
- Use condoms during sexual intercourse.
- ART in HIV-infected. See Antiretroviral therapy.
- PrEP where indicated. See Pre-exposure prophylaxis (PrEP).
- Seek early treatment for sexually transmitted infections. See Sexually transmitted infections.
- Safe handling of blood spills.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 2.1_09 December 2024
Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV AND AIDS)_HIV Infection in Adults and Adolescents (10-19 years old)