21.5 Opportunistic infections and provider-initiated counselling and testing
You should be aware that only HIV-infected people can be categorised using the WHO clinical staging system. Occasionally, a person showing signs of opportunistic infections may not know their HIV status. If you suspect an HIV-related disease, you should offer them provider-initiated testing and counselling (Study Session 24). This is particularly recommended for individuals with PGL (persistent generalised lymphadenopathy), the most common clinical presentation that leads you to suspect HIV infection. Similarly, the presence of herpes zoster scars, or unexplained weight loss, should be indications for you to advise individuals with unknown HIV status (especially if they also show PGL) on provider-initiated HIV testing and counselling.
Makeda is a 23-year-old woman who has come to your health post for a consultation. She complains about swellings under her arms and on her neck. What would you advise Makeda?
First, you need to verify whether the swellings appear to be PGL. If so, PGL is a good reason for you to suspect HIV infection in this patient. You may need to ask Makeda if she knows her HIV status. If she is a person living with HIV, you should reassure her that PGL will not affect her health. If she does not know her HIV status, you should offer her provider-initiated counselling and testing (Study Session 24).