Typical exam stem
A patient with newly diagnosed HIV presents with weight loss, fever and CD4 count below 200 cells/µL. How would you assess and manage the patient?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
What defines advanced HIV disease?
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Define the syndrome and immediately look for active disease
Advanced HIV disease is associated with a high risk of opportunistic infection and death. In an exam, do not jump directly to antiretroviral therapy without first assessing for active tuberculosis, cryptococcal disease, severe bacterial infection and other opportunistic conditions suggested by symptoms and immune status.
The history should cover cough, fever, headache, neurological symptoms, diarrhoea, odynophagia, visual symptoms, weight loss, prior ART, adherence and exposure to tuberculosis.
Core assessment
- Confirm HIV status and obtain CD4 count and viral load where available, without delaying treatment of acute illness.
- Screen actively for tuberculosis using symptoms and appropriate molecular or imaging tests according to local algorithms.
- In patients with advanced immunosuppression, assess for cryptococcal antigenaemia and meningitis where recommended.
- Evaluate for bacterial infection, anaemia, renal or hepatic dysfunction and medication toxicity.
- Look for oral candidiasis, Kaposi sarcoma, chronic diarrhoea, focal neurological deficits and severe wasting.
ART timing requires context
ART should generally be initiated rapidly, but important opportunistic infections alter timing because immune reconstitution can worsen clinical outcomes if treatment is started at the wrong point. Cryptococcal meningitis and selected forms of tuberculosis involving the central nervous system are classic exam examples where immediate ART is not automatically correct.
Preventive therapies, vaccination, adherence support and linkage to longitudinal HIV care should be incorporated once the acute problem is stabilised.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.