Click here to view next page of this article


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 non-Hodgkin's lymphoma.

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

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

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

If there are no focal neurologic, respiratory findings, the possibility of medication side effects, especially with sulfa drugs should be considered.

Drug-induced Fever

Drug-induced fever is commonly attributed to antimicrobials (TMP-SMX, clindamycin, dapsone, amphotericin B), antivirals (zidovudine, ganciclovir, interferon), isoniazid, and rifampin.

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 skin rash.

The symptomatic primary infection resolves spontaneously, usually within 2 to 3 weeks.


The patient's CD4 count is essential in assessing fever because different infections occur at different levels of immune function.