Pharyngitis in Well-Controlled HIV — SCE Infectious Diseases MCQ

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EasyHIV MedicinePharyngitis in Well-Controlled HIVSCE Infectious Diseases

A 28-year-old man with HIV (CD4 620, VL <50 on ART for 6 years) presents to his GP with a sore throat and tonsillitis. He is otherwise well. Should his HIV status alter the management of simple pharyngitis?

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Correct answer: C — No — simple pharyngitis in well-controlled HIV with normal CD4 should be managed identically to an HIV-negative patient per NICE sore throat guidelines (FeverPAIN/Centor scores)

In well-controlled HIV with immune reconstitution (CD4 >200, suppressed VL), the approach to common infections (pharyngitis, sinusitis, bronchitis) follows standard guidelines. FeverPAIN or Centor scores guide the need for antibiotics in pharyngitis. Most are viral and do not require antibiotics. This principle of normalised management in well-controlled HIV applies broadly — unnecessary medicalisation of common infections in PLWH should be avoided. The exception is patients with advanced immunosuppression (CD4 <200), where atypical/opportunistic causes should be considered.

Reference: NICE NG84 2018 – Sore throat; BHIVA 2025 – Primary care management of PLWH