HIV AIDS history and symptoms
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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.
- Rapid weight loss
- Recurring fever or profuse night sweats
- Extreme and unexplained fatigue
- Prolonged lymphadenopathy
- Memory loss, depression and other neurological disorders
- Symptoms of opportunistic infections (See below)
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
- Suggestive of bacterial gastroenteritis, cytomegalovirus (CMV) colitis, or Clostridium difficile colitis
- Chronic diarrhea
- Suggestive of cryptosporidiosis, cytomegalovirus (CMV) colitis, or Clostridium difficile colitis
- Bloody diarrhea
- Suggestive of invasive bacterial gastroenteritis, cytomegalovirus (CMV) colitis or Clostridium difficile colitis
Neurological Disease
- Focal neurological deficits
- Suggestive of cerebral toxoplasmosis, Progressive multifocal leukoencephalopathy (PML), primary CNS lymphoma, or disseminated TC or MAC
- 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
- Suggestive of Kaposi's sarcoma or bacillary angiomatosis
- 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