HIV Indicator Conditions

For full details about HIV indicator conditions please see the RefBite video

HIV indicator conditions are conditions/symptoms which occur more frequently in people living with HIV (PLWH), either because they can be associated with immune deficiency, or because they share a common mode of transmission. In someone not known to be living with HIV, these conditions may indicate the presence of undiagnosed HIV infection. HIV testing is also recommended as a safety measure prior to the initiation of iatrogenic immunosuppressive medication, and for those with symptoms or signs that may indicate acute HIV infection.

HIV indicator conditions are classified as those:

that would be AIDS-defining in people living with HIV
in which the undiagnosed HIV seroprevalence exceeds 1 in 1000
where not identifying HIV may have an adverse impact on clinical management.

Late diagnosis of HIV (CD4 cell count < 350 cells/uL) has an adverse prognosis, and maintaining diagnostic awareness is key, for all clinicians in all settings. Late diagnosis is the leading cause of HIV related morbidity and mortality in the UK. Antiretroviral therapy is safe, highly effective and well tolerated, and if treatment is started at an early stage the prognosis is the same, if not better, than for matched HIV negative controls. Comprehensive, opportunistic testing is therefore recommended to increase the uptake of testing for those who may have undiagnosed HIV.

Non AIDS-defining conditions in which the prevalence of undiagnosed HIV is more than 0.1%:

Sexually transmitted infections
Hepatitis B or C (acute or chronic)
Malignant lymphoma
Anal cancer/dysplasia
Cervical dysplasia
Herpes zoster
Mononucleosis-like illness
Unexplained leukopenia/thrombocytopenia lasting more than 4 weeks
Seborrheic dermatitis/exanthema
Persistent unexplained fever
Candidaemia
Invasive pneumococcal disease
Visceral leishmaniasis

Non-AIDS defining conditions likely to have an undiagnosed prevalence of HIV of more than 0.1%:

Primary lung cancer
Lymphocytic meningitis
Oral hairy leukoplakia
Severe or atypical psoriasis
Guillain-Barré syndrome
Mononeuritis
Subcortical dementia
Multiple sclerosis-like disease
Peripheral neuropathy
Unexplained weight loss
Unexplained lymphadenopathy
Unexplained oral candidiasis
Unexplained chronic diarrhoea
Unexplained chronic renal impairment
Hepatitis A
Community acquired pneumonia
Unexplained oral candidiasis

Non-AIDS defining conditions likely to have an estimated prevalence of HIV < 0.1% but where not identifying HIV may have significant adverse implications:

Conditions requiring aggressive immunosuppressive therapy:
- Cancer
- Transplantation
- Autoimmune disease
Primary space-occupying lesion of the brain
Idiopathic/thrombotic thrombocytopenic purpura

Potentially AIDS-defining conditions:

Neoplasms:

Cervical cancer
Non-Hodgkin’s lymphoma
Kaposi’s sarcoma

Bacterial infections:

Mycobacterium tuberculosis, pulmonary or extrapulmonary
Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonary
Mycobacterium, other species or unidentified species, disseminated or extrapulmonary
Recurrent pneumonia (2 or more episodes in 12 months)
Recurrent salmonella septicaemia

Viral infections: