Physical

• Persistent generalized lymphadenopathy: During the examination, the nodes are generally discrete and freely mobile.
• Oral lesions
  • Thrush manifests as a white exudate, often with an erythematous mucosa. Thrush is observed most commonly on the soft palate. Early lesions can also be found along the gingival border. The diagnosis is made by direct examination of a scraping for pseudohyphal elements, which are characteristic of Candida species (typically Candida albicans). Severe cases can involve the esophagus, with resultant dysphagia or odynophagia.
  • Oral hairy leukoplakia manifests as filamentous white lesions, generally along the lateral borders of the tongue.
  • HSV causes lesions. Oral and genital lesions are most common, but perianal and periungual lesions are also observed. Herpetic lesions resemble a cluster of vesicles on an erythematous base.
  • Reactivation of herpes zoster (shingles) is characterized by varicella-zoster virus (VZV) lesions that may extend over several dermatomes. Widespread cutaneous dissemination may occur, but visceral involvement has not been reported.
  • Aphthous ulcers are shallow and painful and usually affect the posterior oropharynx.
• Hematologic
  • Anemia may be present, and the physical examination may reveal pallor.
  • For thrombocytopenia, as in other forms of thrombocytopenia, bleeding is rare, unless the platelet count falls to less than 10,000/µL. If this occurs, bleeding gums, extremity petechiae, and easy bruising are common presenting features.
• Neurologic
  • With aseptic meningitis, patients may experience headache, photophobia, and frank encephalitis. Cranial nerve involvement may be observed. Cranial nerve VII is affected predominantly; sometimes, nerves V and/or VIII are also affected.
  • Acute inflammatory demyelinating polyneuropathy findings include weakness, areflexia, and minimal sensory changes.
  • With mononeuritis multiplex, patients develop multifocal asymmetric cranial or peripheral nerve lesions, including facial or laryngeal palsy, wristdrop or footdrop, and other neuropathic symptoms. Early in the course of HIV infection, mononeuritis multiplex is usually limited to a single nerve or a few nerves and resolves spontaneously without treatment.