HIV AIDS history and symptoms: Difference between revisions

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==Overview==
==Overview==
Acute HIV should be suspected in patients with flu-like or mononucleosis-like symptoms within 2-4 weeks of exposure to HIV virus or participation in high risk behaviors. Although a significant proportion of patients are asymptomatic, those who manifest an acute illness present with fever, lymphadenopathy, rash, fatigue, and myalgia. This stage is usually followed by a clinical latency period throughout which patients may not experience any symptoms. AIDS defines the final stage of HIV infection and indicates significant immune compromise. AIDS classically presents with weight loss, night sweats, fatigue, and symptoms of opportunistic infections (or AIDS-defining illnesses) such as diarrhea, mucosal sores, cough, and cognitive and neurological deficits.
Acute HIV should be suspected in patients with flu-like or mononucleosis-like symptoms within 2-4 weeks of exposure to HIV virus or participation in high risk behaviors. Important historical questions for patients with diagnosed HIV/AIDS include: most recent CD4 count and viral load and date of testing, previous and current ART regimens and adherence to treatment, prior drug-resistance testing, current antibiotic prophylaxis, and history of AIDS-defining illnesses. Although a significant proportion of patients are asymptomatic, those who manifest an acute illness present with fever, lymphadenopathy, rash, fatigue, and myalgia. This stage is usually followed by a clinical latency period throughout which patients may not experience any symptoms. AIDS defines the final stage of HIV infection and indicates significant immune compromise. AIDS classically presents with weight loss, night sweats, fatigue, and symptoms of opportunistic infections (or AIDS-defining illnesses) such as diarrhea, mucosal sores, cough, and cognitive and neurological deficits.


==History==
==History==
{| style="float:right"
* AIDS should be suspected in patients with flu-like or mononucelosis-like symptoms within 2-4 weeks of exposure to HIV virus or participation in high risk behaviors.
|[[Image:Hiv-timecourse.png|450px|thumb|A generalized graph of the relationship between HIV copies (viral load) and CD4 counts over the average course of untreated HIV infection; any particular individual's disease course may vary considerably.
* History of exposures and possible risk factors is important in all patients presenting with such a syndrome.
{{legend-line|blue solid 2px|CD4<sup>+</sup> T Lymphocyte count (cells/mm³)}}
* For patients with diagnosed and treated HIV/AIDS, important questions include: most recent CD4 count and viral load and date of testing, previous and current ART regimens and adherence to treatment, prior drug-resistance testing, and history of AIDS-defining illnesses.
{{legend-line|red solid 2px|HIV RNA copies per mL of plasma}}
* In patients admitted for AIDS-related infections, a careful history of infectious exposures is required that includes travel history, exposure to sick individuals, exposure to pets or animals, and current antibiotic prophylaxis.
]]
* History of co-infections such as hepatitis B and C and tuberculosis are also relevant.
|}
 
*AIDS should be suspected in patients with flu like symptoms within 2-4 weeks of exposure to HIV virus or participated in a high risk behaviour like unprotected sex with patners of unknown HIV status or sharing needles or contaminated blood transfusion.
*Many people describe the flu as very severe and "worst flu ever"
*Many HIV positive people do not have any symptoms and will not complain of any symtoms untill they progress to full blown AIDS
*HIV affects nearly every [[organ system]]. 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 [[lymphoma]]s.
*After the diagnosis of AIDS is made, the current average survival time with antiretroviral therapy (as of 2005) is estimated to be more than 5&nbsp;years,<ref name=Schneider>{{
 
cite journal
| author=Schneider MF, Gange SJ, Williams CM, Anastos K, Greenblatt RM, Kingsley L, Detels R, Munoz A
| title=Patterns of the hazard of death after AIDS through the evolution of antiretroviral therapy: 1984&ndash;2004
| journal=AIDS | year=2005 | pages=2009&ndash;2018 | volume=19 | issue=17
| pmid=16260908
 
}}</ref> but because new treatments continue to be developed and because HIV continues to [[Evolution|evolve]] resistance to treatments, estimates of survival time are likely to continue to change. Without antiretroviral therapy, death normally occurs within a year. Most patients die from opportunistic infections or [[malignancies]] associated with the progressive failure of the immune system.<ref name=Lawn>{{
 
cite journal
| author=Lawn SD
| title=AIDS in Africa: the impact of coinfections on the pathogenesis of HIV-1 infection
| journal=J. Infect. Dis. | year=2004 | pages=1&ndash;12 | volume=48 | issue=1
| pmid=14667787
 
}}</ref>
*The rate of clinical disease progression varies widely between individuals and has been shown to be affected by many factors such as host susceptibility and immune function health care and co-infections,<ref name=Lawn /> as well as factors relating to the viral strain.<ref name=Campbell2>{{
 
cite journal
| author=Campbell GR, Watkins JD, Esquieu D, Pasquier E, Loret EP, Spector SA
| title=The C terminus of HIV-1 Tat modulates the extent of CD178-mediated apoptosis of T cells
| journal=J. Biol. Chem. | year=2005 | pages=38376&ndash;39382 | volume=280 | issue=46
| pmid=16155003
 
}}</ref><ref name=Senkaali>{{
 
cite journal
| author=Senkaali D, Muwonge R, Morgan D, Yirrell D, Whitworth J, Kaleebu P
| title=The relationship between HIV type 1 disease progression and V3 serotype in a rural Ugandan cohort
| journal=AIDS Res. Hum. Retroviruses. | year=2005 | pages=932&ndash;937 | volume=20 | issue=9
| pmid=15585080
 
}}</ref>
*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.


==Symptoms==
==Symptoms==
Line 67: Line 26:


===Clinical Latency Stage===
===Clinical Latency Stage===
Patient may experience no symptoms or mild symptoms. Virus can be detected at this stage and patients are able to transmit the disease at this stage.
The acute or asymptomatic phase is followed by a clinical latency period throughout which patients may not experience any symptoms. The virus can be detected at this stage and patients are able to transmit the disease.


===AIDS===
===AIDS===
Symptoms can include the following.
Symptoms can include the following.
:*Rapid [[weight loss]]
:*Rapid [[weight loss]]
:*Recuring [[fever]] or profuse [[night sweats]]
:*Recurring [[fever]] or profuse [[night sweats]]
:*Extreme and unexplained tiredness
:*Extreme and unexplained fatigue
:*Prolonged swollen [[lymph nodes]]
:*Prolonged [[lymphadenopathy]]
:*[[Diarrhea]] lasting more than a week.
:*[[Memory loss]], [[depression]] and other neurological disorders
:*Sores of [[mouth]] , [[anus]] or [[genitals]]
:*Symptoms of opportunistic infections (See below)
:*[[Pneumonia]]
:*Red , brown or pink [[rashes]].
:*[[Memory loss]], [[depression]] and other neurological disorders.


==Symptoms of Opportunistic Infections==
==Symptoms of Opportunistic Infections==
Line 105: Line 61:
:* Suggestive of invasive bacterial gastroenteritis, [[cytomegalovirus]] (CMV) [[colitis]] or ''[[Clostridium difficile]]'' colitis
:* Suggestive of invasive bacterial gastroenteritis, [[cytomegalovirus]] (CMV) [[colitis]] or ''[[Clostridium difficile]]'' colitis


===Neurological Diseases===
===Neurological Disease===
* '''Focal neurological deficits'''
* '''Focal neurological deficits'''
:* Suggestive of cerebral [[toxoplasmosis]], [[Progressive multifocal leukoencephalopathy]] (PML), primary CNS lymphoma, or disseminated TC or MAC
:* Suggestive of cerebral [[toxoplasmosis]], [[Progressive multifocal leukoencephalopathy]] (PML), primary CNS lymphoma, or disseminated TC or MAC
Line 120: Line 76:
* '''Mucosal leasions that respond poorly to treatment'''
* '''Mucosal leasions that respond poorly to treatment'''
:* Suggestive of HPV related tumors (Oral/Anal squamous cell carcinoma, invasive cervical cancer)
:* Suggestive of HPV related tumors (Oral/Anal squamous cell carcinoma, invasive cervical cancer)
===Systemic Disease===
* '''Weight loss, night sweats, excessive fever'''
:* Suggestive of disseminated MAC, TB, or lymphoma
:* May also be related to HIV itself


===Other manifestations===
===Other manifestations===
* '''Blurry vision or vision loss'''
* '''Blurry vision or vision loss'''
:* Suggestive of CMV retinitis
:* Suggestive of CMV retinitis
==Common Symptoms==
The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy [[immune system]]s. Most of these conditions are infections caused by [[bacteria]], [[virus]]es, [[fungus|fungi]] and [[parasite]]s that are normally controlled by the elements of the immune system that HIV damages. [[Opportunistic infection]]s are common in people with AIDS.<ref name=Holmes>{{
cite journal
| author=Holmes CB, Losina E, Walensky RP, Yazdanpanah Y, Freedberg KA
| title=Review of human immunodeficiency virus type 1-related opportunistic infections in sub-Saharan Africa
| journal=Clin. Infect. Dis. | year=2003 | pages=656&ndash;662 | volume=36 | issue=5
| pmid=12594648
}}</ref>
Additionally, people with AIDS often have systemic symptoms of infection like [[fever]]s, [[sweat]]s (particularly at night), swollen glands, chills, weakness, and [[weight loss]].<ref name=Guss>{{
cite journal
| author=Guss DA
| title=The acquired immune deficiency syndrome: an overview for the emergency physician, Part 1
| journal=J. Emerg. Med. | year=1994 | pages=375&ndash;384 | volume=12 | issue=3
| pmid=8040596
}}</ref><ref name=Guss2>{{
cite journal
| author=Guss DA
| title=The acquired immune deficiency syndrome: an overview for the emergency physician, Part 2
| journal=J. Emerg. Med. | year=1994 | pages=491&ndash;497 | volume=12 | issue=4
| pmid=7963396
}}</ref>
===Tuberculosis===
Symptoms are usually constitutional and are not localized to one particular site, often affecting [[bone marrow]], [[bone]], urinary and [[gastrointestinal tract]]s, [[liver]], regional [[lymph node]]s, and the [[central nervous system]].<ref name=Decker>{{
cite journal
| author=Decker CF, Lazarus A
| title=Tuberculosis and HIV infection. How to safely treat both disorders concurrently
| journal=Postgrad Med. | year=2000 | pages=57&ndash;60, 65&ndash;68 | volume=108 | issue=2
| pmid=10951746
}}</ref>
Specific neurological impairments are manifested by cognitive, behavioral, and motor abnormalities that occur after years of HIV infection and is associated with low CD4<SUP>+</SUP> T cell levels and high plasma viral loads. Prevalence is 10&ndash;20% in Western countries<ref name=Grant>{{
cite book
| author = Grant I, Sacktor H, McArthur J
| year = 2005
| title = The Neurology of AIDS
| chapter = HIV neurocognitive disorders
| chapterurl = http://www.hnrc.ucsd.edu/publications_pdf/2005grant1.pdf
| editor = H. E. Gendelman, I. Grant, I. Everall, S. A. Lipton, and S. Swindells. (ed.)
| edition = 2nd
| pages = 357&ndash;373
| publisher = Oxford University Press
| location = London, UK
| format= PDF
| id = ISBN 0-19-852610-5
}}</ref> but only 1&ndash;2% of HIV infections in India.<ref name=Satischandra>{{
cite journal
| author=Satishchandra P, Nalini A, Gourie-Devi M, et al | title=Profile of neurologic disorders associated with HIV/AIDS from Bangalore, South India (1989&ndash;1996)
| journal=Indian J. Med. Res. | year=2000 | pages=14&ndash;23 | volume=11 | issue=
| pmid=10793489
}}</ref><ref name=Wadia>{{
cite journal
| author=Wadia RS, Pujari SN, Kothari S, Udhar M, Kulkarni S, Bhagat S, Nanivadekar A
| title=Neurological manifestations of HIV disease
| journal=J. Assoc. Physicians India | year=2001 | pages=343&ndash;348 | volume=49 | issue=
| pmid=11291974
}}</ref> This difference is possibly due to the HIV subtype in India.
===Cryptococcal Meningitis===
It can cause fevers, [[headache]], [[Fatigue (medical)|fatigue]], [[nausea]], and [[vomiting]]. Patients may also develop [[seizure]]s and confusion; left untreated, it can be lethal.
<!---
Infection with HIV-1 is associated with a progressive decrease of the CD4+ T cell count and an increase in viral load, the level of HIV in the blood. The stage of infection can be determined by measuring the patient's CD4+ T cell count and viral load and the sign and symptom depends upon the stage of the viral infection.
==Signs and symptoms==
The stages of HIV infection are:
# [[HIV signs and symptoms#Acute infection|Acute infections]] (also known as primary infection).
# [[HIV signs and symptoms#Latent stage|Latency]]
# AIDS. 
===Acute infection===
'''Duration:''' Last for several weeks.
'''Symptoms:''' fever, lymphadenopathy (swollen lymph nodes), pharyngitis (sore throat), rash, myalgia (muscle pain), malaise, and mouth and esophageal sores.
To read more about acute HIV infection, click [[HIV acute infection|'''here''']]
===Latent stage===
'''Duration:''' Last for two weeks to twenty years or more.
'''Symptoms:''' None
=== AIDS===
The final stage of HIV infection, is defined by low CD4+ T cell counts (fewer than 200 per microliter), various opportunistic infections, cancers and other conditions.
==WHO classification based on HIV infection symptoms==
{|border="1" cellpadding="2" cellspacing="0"
|-
!colspan=4|'''Classification of HIV Stages in Adults and Adolescents'''
|-
| style="text-align:center"|'''Quantity (%) of CD4 lymphocites per ml blood'''
| colspan=3 align="center"|    '''Clinical Stage'''
|-
|
| style="text-align:center"|A
| style="text-align:center"|B
| style="text-align:center"|C
|-
|
|Asymptomatic, acute (primary) or primary generalized lymphadenopaphy
|style="text-align:center"|Symptomatic non '''А''' non '''С'''
|style="text-align:center"|AIDS related diseases
|-
|style="text-align:center"| ≥500 (≥29%)
|style="text-align:center"|'''A1'''
|style="text-align:center"|'''B1'''
|style="text-align:center"|'''C1'''
|-
|style="text-align:center"| 200–499 (14–28%)
|style="text-align:center"|'''A2'''
|style="text-align:center"|'''B2'''
|style="text-align:center"|'''C2'''
|-
|style="text-align:center"| <200 (<14%) = AIDS indicator
|style="text-align:center"|'''A3'''
|style="text-align:center"|'''B3'''
|style="text-align:center"|'''C3'''
|}
--->


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}


[[Category:HIV/AIDS]]
[[Category:HIV/AIDS]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Immune system disorders]]
[[Category:Immune system disorders]]
[[Category:Infectious disease]]
[[Category:Viral diseases]]
[[category:viral diseases]]
[[Category:Pandemics]]
[[Category:Pandemics]]
[[Category:Sexually transmitted infections]]
[[Category:Sexually transmitted infections]]
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[[Category:Immunodeficiency]]
[[Category:Immunodeficiency]]
[[Category:Microbiology]]
[[Category:Microbiology]]
 
[[Category:Emergency mdicine]]
{{WH}}
[[Category:Up-To-Date]]
{{WS}}
[[Category:Infectious disease]]

Latest revision as of 22:12, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Acute HIV should be suspected in patients with flu-like or mononucleosis-like symptoms within 2-4 weeks of exposure to HIV virus or participation in high risk behaviors. Important historical questions for patients with diagnosed HIV/AIDS include: most recent CD4 count and viral load and date of testing, previous and current ART regimens and adherence to treatment, prior drug-resistance testing, current antibiotic prophylaxis, and history of AIDS-defining illnesses. Although a significant proportion of patients are asymptomatic, those who manifest an acute illness present with fever, lymphadenopathy, rash, fatigue, and myalgia. This stage is usually followed by a clinical latency period throughout which patients may not experience any symptoms. AIDS defines the final stage of HIV infection and indicates significant immune compromise. AIDS classically presents with weight loss, night sweats, fatigue, and symptoms of opportunistic infections (or AIDS-defining illnesses) such as diarrhea, mucosal sores, cough, and cognitive and neurological deficits.

History

  • AIDS should be suspected in patients with flu-like or mononucelosis-like symptoms within 2-4 weeks of exposure to HIV virus or participation in high risk behaviors.
  • History of exposures and possible risk factors is important in all patients presenting with such a syndrome.
  • For patients with diagnosed and treated HIV/AIDS, important questions include: most recent CD4 count and viral load and date of testing, previous and current ART regimens and adherence to treatment, prior drug-resistance testing, and history of AIDS-defining illnesses.
  • In patients admitted for AIDS-related infections, a careful history of infectious exposures is required that includes travel history, exposure to sick individuals, exposure to pets or animals, and current antibiotic prophylaxis.
  • History of co-infections such as hepatitis B and C and tuberculosis are also relevant.

Symptoms

Acute Retroviral Syndrome

  • Within 2-4 weeks after HIV infection, patients may complain of flu-like or mononucleosis-like symptoms. This phase is known as the acute retroviral syndrome. The common symptoms include:

Clinical Latency Stage

The acute or asymptomatic phase is followed by a clinical latency period throughout which patients may not experience any symptoms. The virus can be detected at this stage and patients are able to transmit the disease.

AIDS

Symptoms can include the following.

Symptoms of Opportunistic Infections

Opportunistic infections can produce a wide variety of symptoms that can often unmask AIDS in patients without previously documented HIV infection. These infections are known as AIDS-defining illnesses.

Pulmonary Infections

  • Cough
  • Dry: Suggestive of Pneumocystis jirovecii pneumonia
  • Productive: Suggestive of bacterial or fungal pneumonia
  • Hemoptysis
  • Suggestive of tuberculosis or fungal pneumonia
  • Dyspnea
  • Chest pain

Gastrointestinal Infections

  • Chest pain
  • Suggestive of esophageal candidiasis
  • Abdominal pain
  • Chronic diarrhea
  • Bloody diarrhea

Neurological Disease

  • Focal neurological deficits
  • Memory loss and cognitive decline
  • Suggestive of AIDS-Dementia complex or primary CNS lymphoma
  • Fever, headache, meningeal signs and symptoms
  • Suggestive of meningitis, consider cryptococcal meningitis

Skin and Mucosal Disease

  • Purpulish rash that responds poorly to treatment
  • Massive lymphadenopathy
  • Suggestive of malignant lymphoma
  • Mucosal leasions that respond poorly to treatment
  • Suggestive of HPV related tumors (Oral/Anal squamous cell carcinoma, invasive cervical cancer)

Systemic Disease

  • Weight loss, night sweats, excessive fever
  • Suggestive of disseminated MAC, TB, or lymphoma
  • May also be related to HIV itself

Other manifestations

  • Blurry vision or vision loss
  • Suggestive of CMV retinitis

References

Template:WH Template:WS

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