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Assessment of Fever in the HIV-Infected Patient

Infection is the most common cause of fever in AIDS patients. Diagnostic evaluation should first be directed at the possibility of infection or drug-induced fever.

Clinical evaluation of fever in HIV-infected patients

Protracted unexplained fever is usually caused by either Pneumocystis carinii pneumonia, Mycobacterium avium complex, tuberculosis, sinusitis, cryptococcosis, or

In patients receiving prophylactic trimethoprim-sulfamethoxazole, P carinii pneumonia, toxoplasmic encephalitis, and salmonella bacteremia are less likely to

In patients with later-stage disease who develop significant and persistent fevers, MAC infection and lymphoma are

Cryptococcal meningitis is a consideration in patients with fever accompanied by acute or chronic headache or changes in

Drug-induced fever

Drugs, such as penicillin derivatives, cephalosporins, Rifampin/Rifabutin, Dilantin, sulfa agents and drugs with sulfa side arms (eg, Lasix), INH, cimetidine, and tricyclic antidepressants.

Drug-induced fever presents as high fever (101^E) without proportionate tachycardia. The fever may be associated with rash, arthritis, or

The fever may occur even after long period of regular use of a drug and rarely may continue up to 2 weeks after offending agent is stopped.

When there is no readily identifiable explanation for fever, discontinuation of recently initiated drugs should be attempted.

Primary HIV infection

Fever is the most common manifestation of symptomatic primary HIV infection. Additional findings include malaise, sweats, weight loss, arthralgia, myalgia, headache, pharyngitis, lymphadenopathy, and