Fever workup in patient with HIV AIDS

• Etiologies (Infect Dis Clin North Am 2007;21:1013) infxn (82–90%): MAC, TB, CMV, early PCP, Histo, Crypto, Coccidio, Toxo, endocarditis noninfectious: lymphoma, drug reaction. Non 1° HIV itself rarely (<5%) cause of fever.
• Workup: guided by CD4 count, s/s, epi, & exposures CBC, BMP, LFTs, BCx, CXR, UA, mycobact. & fungal cx, ✓ meds, ? ✓ chest & abd CT CD4 <100–200 → serum crypto Ag, urinary Histo Ag, CMV PCR pulmonary s/s → CXR; ABG; sputum for bacterial cx, PJ stain, AFB; bronchoscopy diarrhea → stool cx, O&P, AFB; direct visualization with bx on colonoscopy cytopenias → BM bx for path & cx of aspirate including for mycobacteria & fungi headache/visual Δs→ LP; send CSF for bacterial/fungal cx, CrAg, ? MTb PCR; send CMV PCR from serum; dilated eye exam with Ophtho