Signs and symptoms of HIV/AIDS

Source: Wikipedia, the free encyclopedia.

Figure 1. Early Symptoms of HIV

The stages of HIV infection are acute infection (also known as primary infection), latency, and AIDS. Acute infection lasts for several weeks and may include symptoms such as fever, swollen lymph nodes, inflammation of the throat, rash, muscle pain, malaise, and mouth and esophageal sores. The latency stage involves few or no symptoms and can last anywhere from two weeks to twenty years or more, depending on the individual. AIDS, the final stage of HIV infection, is defined by low CD4+ T cell counts (fewer than 200 per μL), various opportunistic infections, cancers, and other conditions.

Acute infection

Main symptoms of acute HIV infection

Acute HIV infection, primary HIV infection or acute

AIDS
succeeding the latency stage.

During this period (usually days to weeks post-exposure) fifty to ninety percent of infected individuals develop an influenza or

mononucleosis-like illness called acute HIV infection (or HIV prodrome),[2][3] the most common symptoms of which may include fever, lymphadenopathy, pharyngitis, rash, myalgia, malaise, mouth and esophageal sores, and may also include, but less commonly, headache, nausea and vomiting, fatigue, ulcers in the mouth or on the genitals, enlarged liver/spleen, weight loss, thrush, night sweats and diarrhea and neurological symptoms. Infected individuals may experience all, some, or none of these symptoms.[4] The duration of symptoms varies, averaging 28 days and usually lasts at least a week.[5]

Because of the nonspecific nature of these symptoms, they are often not recognized as signs of HIV infection. Even if patients go to their doctors or a hospital, they will often be misdiagnosed as having one of the more common

infectious diseases with the same symptoms. As a consequence, these primary symptoms are not used to diagnose HIV infection, as they do not develop in all cases and because many are caused by other more common diseases. However, recognizing the syndrome can be important because the patient is much more infectious during this period.[6]

Symptoms and signs of primary HIV infections[6]
sensitivity[a]
specificity[b]
Fever 88% 50%
Malaise 73% 42%
Muscle pain 60% 74%
Rash 58% 79%
Headache 55% 56%
Night sweats 50% 68%
Sore throat 43% 51%
Lymphadenopathy 38% 71%
Joint pain 28% 87%
Nasal congestion 18% 62%

Latency

A strong immune defense reduces the number of viral particles in the bloodstream, marking the start of secondary or chronic HIV infection. The secondary stage of HIV infection can vary between two weeks and 10 years. During the secondary phase of infection, HIV is active within

CD4+ CD45RO+ T cells carry most of the proviral load.[8]
A small percentage of HIV-1 infected individuals retain high levels of CD4+ T-cells without antiretroviral therapy. However, most have detectable viral loads and will eventually progress to AIDS without treatment. These individuals are classified as HIV controllers or
long-term nonprogressors (LTNP). People who maintain CD4+ T cell counts and also have low or clinically undetectable viral load without anti-retroviral treatment are known as elite controllers or elite suppressors (ES).[9][10]

AIDS

Main symptoms of AIDS
pneumocystis pneumonia (PCP)
. There is increased white (opacity) in the lower lungs on both sides, characteristic of PCP.

The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy

opportunistic infections caused by bacteria, viruses, fungi, and parasites that are normally controlled by the elements of the immune system that HIV damages.[11] These infections affect nearly every organ system.[citation needed
]

A declining CD4+/CD8+ ratio is predictive of the progression of HIV to AIDS.[12]

People with AIDS also have an increased risk of developing various cancers such as Kaposi's sarcoma, cervical cancer, and cancers of the immune system known as lymphomas. Additionally, people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss.[13][14] The specific opportunistic infections that AIDS patients develop depend in part on the prevalence of these infections in the geographic area in which the patient lives.[citation needed]

Pulmonary

Pneumocystis pneumonia (PCP) (originally known as Pneumocystis carinii pneumonia) is relatively rare in healthy, immunocompetent people, but common among HIV-infected individuals.[15] It is caused by Pneumocystis jirovecii.

Before the advent of effective diagnosis, treatment, and routine

prophylaxis in Western countries, it was a common immediate cause of death. In developing countries, it is still one of the first indications of AIDS in untested individuals, although it does not generally occur unless the CD4 count is less than 200 cells per µL of blood.[16]

gastrointestinal tracts, liver, regional lymph nodes, and the central nervous system.[19]

Gastrointestinal

Esophagitis is an inflammation of the lining of the lower end of the esophagus (gullet or swallowing tube leading to the stomach). In HIV-infected individuals, this is normally due to fungal (candidiasis) or viral (herpes simplex-1 or cytomegalovirus) infections. In rare cases, it could be due to mycobacteria.[20]

Unexplained chronic diarrhea in HIV infection is due to many possible causes, including common bacterial (Salmonella, Shigella, Listeria or Campylobacter) and parasitic infections; and uncommon opportunistic infections such as cryptosporidiosis, microsporidiosis, Mycobacterium avium complex (MAC) and viruses,[21] astrovirus, adenovirus, rotavirus and cytomegalovirus, (the latter as a course of colitis).

In some cases, diarrhea may be a side effect of several drugs used to treat HIV, or it may simply accompany HIV infection, particularly during primary HIV infection. It may also be a side effect of

intestinal tract absorbs nutrients and may be an important component of HIV-related wasting.[22]

Neurological and psychiatric

HIV infection may lead to a variety of neuropsychiatric sequelae, either by infection of the now susceptible nervous system by organisms, or as a direct consequence of the illness itself.[23]

seizures and confusion; left untreated, it can be lethal.[citation needed
]

JC virus which occurs in 70% of the population in latent form, causing disease only when the immune system has been severely weakened, as is the case for AIDS patients. It progresses rapidly, usually causing death within months of diagnosis.[25]

HIV-associated dementia (HAD) is a metabolic encephalopathy induced by HIV infection and fueled by immune activation of HIV-infected brain macrophages and microglia. These cells are productively infected by HIV and secrete neurotoxins of both host and viral origin.[26] Specific neurological impairments are manifested by cognitive, behavioral, and motor abnormalities that occur after years of HIV infection and are associated with low CD4+ T cell levels and high plasma viral loads.[citation needed
]

Prevalence is 10–20% in Western countries[27] but only 1–2% of HIV infections in India.[28][29] This difference is possibly due to the HIV subtype in India. AIDS-related mania is sometimes seen in patients with advanced HIV illness; it presents with more irritability and cognitive impairment and less euphoria than a manic episode associated with true bipolar disorder. Unlike the latter condition, it may have a more chronic course. This syndrome is less frequently seen with the advent of multi-drug therapy.[citation needed]

Tumors

Kaposi's sarcoma

People with HIV infections have substantially increased incidence of several cancers. This is primarily due to co-infection with an

Epstein-Barr virus (EBV), Kaposi's sarcoma-associated herpesvirus (KSHV) (also known as human herpesvirus-8 [HHV-8]), and human papillomavirus (HPV).[30][31]

Kaposi's sarcoma (KS) is the most common tumor in HIV-infected patients. The appearance of this tumor in young

Epstein-Barr virus (EBV) or KSHV cause many of these lymphomas. In HIV-infected patients, lymphoma often arises in extranodal sites such as the gastrointestinal tract.[32] When they occur in an HIV-infected patient, KS and aggressive B cell lymphomas confer a diagnosis of AIDS.[citation needed
]

Invasive

human papillomavirus (HPV).[33]

In addition to the AIDS-defining tumors listed above, HIV-infected patients are at increased risk of certain other tumors, notably

Hodgkin's disease, anal and rectal carcinomas, hepatocellular carcinomas, head and neck cancers, and lung cancer. Some of these are caused by viruses, such as Hodgkin's disease (EBV), anal/rectal cancers (HPV), head and neck cancers (HPV), and hepatocellular carcinoma (hepatitis B or C). Other contributing factors include exposure to carcinogens (cigarette smoke for lung cancer), or living for years with subtle immune defects.[citation needed
]

The incidence of many common tumors, such as breast cancer or

HAART is extensively used to treat AIDS, the incidence of many AIDS-related malignancies has decreased, but at the same time malignant cancers overall have become the most common cause of death of HIV-infected patients.[34] In recent years, an increasing proportion of these deaths have been from non-AIDS-defining cancers.[citation needed
]

In line with the treatment of cancer, chemotherapy has shown promise in increasing the number of uninfected T-cells and diminishing the viral load.[35]

Other infections

People with AIDS often develop opportunistic infections that present with

non-specific symptoms, especially low-grade fevers and weight loss. These include opportunistic infection with Mycobacterium avium-intracellulare and cytomegalovirus (CMV). CMV can cause colitis, as described above, and CMV retinitis can cause blindness.[citation needed
]

Talaromycosis due to Talaromyces marneffei is now the third most common opportunistic infection (after extrapulmonary tuberculosis and cryptococcosis) in HIV-positive individuals within the endemic area of Southeast Asia.[36]

An infection that often goes unrecognized in people with AIDS is Parvovirus B19. Its main consequence is anemia, which is difficult to distinguish from the effects of antiretroviral drugs used to treat AIDS itself.[37]

References

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  3. PMID 19127422
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  35. ^ Karrakchou, J., Rachik, M., & Gourari, S. (2006). Optimal control and infectiology: Application to an HIV/AIDS model. Applied Mathematics and Computation, 177(2), 807–818. doi: 10.1016/j.amc.2005.11.092
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  37. ^ Silvero AM; Acevedo-Gadea CR; Pantanowitz L "" (June 4, 2009). "Unsuspected Parvovirus B19 Infection in a Person With AIDS". The AIDS Reader. 19 (6).

Notes

  1. ^ Presence of symptoms as a predictor of acute HIV infection.
  2. ^ Absence of symptom as a predictor of no acute HIV infection.
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