Clinical Guide > Common Complaints > Fever


January 2011

Chapter Contents


Although fever may accompany HIV infection at various stages of disease, fever in a patient with a low CD4 count (<200 cells/µL) should prompt the clinician to rule out opportunistic infections.

S: Subjective

The patient complains of persistent fever, or new-onset fever of >101°F (38.3°C).

Assess the following during the history:

O: Objective

Document fever. Check other vital signs, including orthostatic measurements. Check weight and compare with previous values.

Search for evidence of an infectious focus. Perform a complete physical examination, including evaluation of the eyes (including fundus), sinuses, oropharynx, lymph nodes, lungs and heart, abdomen, joints, genitals, uterus, rectum, skin, and neurologic system.

Review recent CD4 measurements, if available, to determine the patient's risk of opportunistic illnesses as a cause of fever.

A: Assessment

The differential diagnosis varies depending on the CD4 count. Possibilities include the following:

Conditions More Likely with Low CD4 Count

Conditions That May Occur with Any CD4 Count

P: Plan

Diagnostic Evaluation

Perform laboratory work and other diagnostic studies as suggested by the history, physical examination, and differential diagnosis. These may include the following:


Once a diagnosis is made, appropriate treatment should be initiated. In seriously ill patients, presumptive treatment may be started while diagnostic tests are pending. In some cases, the source of fever cannot be identified. Consult with an HIV expert.

Symptomatic treatment may include NSAIDs (e.g., ibuprofen, naproxen), acetaminophen, and analgesics. Monitor for gastrointestinal adverse effects with NSAIDs. Cold compresses also can be used to relieve fever symptoms. Refer to a dietitian to avoid weight loss during the hypermetabolic state. See section Comorbidities, Coinfections, and Complications in this manual if an HIV-related cause is identified.

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