Etiology of non-pain symptoms in the current era of effective antiretroviral treatment compared with earlier in the HIV epidemic, and the evolution of management strategies

Symptom	Etiologies in the early HIV treatment era	Management	Etiology in the ART treatment era	Management
Pulmonary
Dyspnea/cough	PJP, bacterial pneumonia	Antibiotics	COPD	Inhalers, steroids, oxygen
Dyspnea/cough	TB	Antimycobacterials	Pulmonary hypertension	Pulmonary vasodilators, afterload reducers, ART
Gastrointestinal
Diarrhea	Disseminated MAC	Antimycobacterials	Irritable bowel syndrome	Behavioral modification, dietary changes
	CMV	Antivirals	Chronic pancreatitis	Pancreatic enzymes, antidiarrheals
	Cryptosporidiosis	Antifungals	Irritable bowel syndrome	Behavioral modification, dietary changes, fiber intake
Constitutional
Fatigue, weight loss, anorexia, tissue wasting	AIDS	Methylphenidate, dronabinol, testosterone, oxandrolone, megestrol acetate	Malignancy	Targeted chemotherapy, psychostimulants
Fatigue, weight loss, anorexia, tissue wasting	Opportunistic infections	Treat opportunistic infections	Depression	Antidepressants, cognitive behavioral therapy

HIV: human immunodeficiency virus; ART: antiretroviral therapy; PJP: pneumocystis jiroveci pneumonia; COPD: chronic obstructive pulmonary disease; TB: tuberculosis; MAC: mycobacterium avium complex; CMV: cytomegalovirus; AIDS: acquired immunodeficiency syndrome.

Adapted from: Pahuja M, Merlin J, Selwyn PA. HIV/AIDS. In: Oxford Textbook of Palliative Medicine, 5th ed, Cherny N, Fallon M, Kaasa S, Portenoy RK, Currow DC (Eds), Oxford University Press, New York 2015.

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Etiology of non-pain symptoms in the current era of effective antiretroviral treatment compared with earlier in the HIV epidemic, and the evolution of management strategies