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:* Suggestive of meningitis, consider cryptococcal meningitis
:* Suggestive of meningitis, consider cryptococcal meningitis


===Tumors and Malignancies===
===Skin and Mucosal Disease===
 
* '''Purpulish rash that responds poorly to treatment'''
[[Image:Kaposi's Sarcoma.jpg|thumb|left|150px|Kaposi's sarcoma]]
:* Suggestive of [[Kaposi's sarcoma]] or [[bacillary angiomatosis]]
 
* '''Massive lymphadenopathy'''
Patients with HIV infection have substantially increased incidence of several malignant [[cancer]]s. This is primarily due to co-infection with an [[oncogene|oncogenic]] [[DNA virus]], especially [[Epstein-Barr virus]] (EBV), Kaposi's sarcoma-associated herpesvirus ([[KSHV]]), and human [[papillomavirus]] (HPV).<ref name=Boshoff>{{
:* Suggestive of malignant lymphoma
 
* '''Mucosal leasions that respond poorly to treatment'''
cite journal
:* Suggestive of HPV related tumors (Oral/Anal squamous cell carcinoma, invasive cervical cancer)
| author=Boshoff C, Weiss R
| title=AIDS-related malignancies
| journal=Nat. Rev. Cancer | year=2002 | pages=373&ndash;382 | volume=2 | issue=5
| pmid=12044013
 
}}</ref><ref name=Yarchoan>{{
 
cite journal
| author=Yarchoan R, Tosatom G, Littlem RF
| title=Therapy insight: AIDS-related malignancies &mdash; the influence of antiviral therapy on pathogenesis and management
| journal=Nat. Clin. Pract. Oncol. | year=2005 | pages=406&ndash;415 | volume=2 | issue=8
| pmid=16130937
 
}}</ref>
 
Kaposi's sarcoma (KS) is the most common tumor in HIV-infected patients. The appearance of this tumor in young homosexual men in 1981 was one of the first signals of the AIDS epidemic. Caused by a [[Gammaherpesvirinae|gammaherpes]] virus called [[Kaposi's sarcoma-associated herpes virus]] (KSHV), it often appears as purplish [[Nodule (medicine)|nodules]] on the skin, but can affect other organs, especially the [[mouth]], gastrointestinal tract, and lungs.
 
High-grade [[B cell]] [[lymphoma]]s such as [[Burkitt's lymphoma]], Burkitt's-like lymphoma, diffuse large B-cell lymphoma (DLBCL), and [[primary central nervous system lymphoma]] present more often in HIV-infected patients. These particular cancers often foreshadow a poor prognosis. In some cases these lymphomas are AIDS-defining. [[Epstein-Barr virus]] (EBV) or KSHV cause many of these lymphomas.
 
[[Cervical cancer]] in HIV-infected women is considered AIDS-defining. It is caused by [[human papillomavirus]] (HPV).<ref>{{cite journal
|author=Palefsky J
|title=Human papillomavirus infection in HIV-infected persons
|journal=Top HIV Med
|volume=15
|issue=4
|pages=130–3
|year=2007
|pmid=17720998
|doi=
}}</ref>
 
In addition to the AIDS-defining tumors listed above, HIV-infected patients are at increased risk of certain other tumors, such as [[Hodgkin's disease]] and [[Anal cancer|anal]] and [[rectal carcinoma]]s. However, the incidence of many common tumors, such as [[breast cancer]] or [[colon cancer]], does not increase in HIV-infected patients. In areas where [[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.<ref name=Bonnet>{{
 
cite journal
| author=Bonnet F, Lewden C, May T, et al | title=Malignancy-related causes of death in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy
| journal=Cancer | year=2004 | pages=317&ndash;324 | volume=101 | issue=2
| pmid=15241829
 
}}</ref>


===Other Opportunistic Infections===
===Other Opportunistic Infections===

Revision as of 20:40, 4 November 2014

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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. 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

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. Template:Legend-line Template:Legend-line
  • 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 lymphomas.
  • 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 years,[1] but because new treatments continue to be developed and because HIV continues to 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.[2]
  • 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,[2] as well as factors relating to the viral strain.[3][4]
  • 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

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

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.

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 Diseases

  • 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)

Other Opportunistic Infections

AIDS patients often develop opportunistic infections that present with non-specific symptoms, especially low-grade fevers and weight loss. These include infection with Mycobacterium avium-intracellulare and cytomegalovirus (CMV). CMV can cause colitis, as described above, and CMV retinitis can cause blindness. Penicilliosis due to Penicillium 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.[5]

Further information: [[:HIV AIDS opportunistic infections]]

Common Symptoms

The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems. Most of these conditions are infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages. Opportunistic infections are common in people with AIDS.[6]

Additionally, people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss.[7][8]

Tuberculosis

Symptoms are usually constitutional and are not localized to one particular site, often affecting bone marrow, bone, urinary and gastrointestinal tracts, liver, regional lymph nodes, and the central nervous system.[9] Specific neurological impairments are manifested by cognitive, behavioral, and motor abnormalities that occur after years of HIV infection and is associated with low CD4+ T cell levels and high plasma viral loads. Prevalence is 10–20% in Western countries[10] but only 1–2% of HIV infections in India.[11][12] This difference is possibly due to the HIV subtype in India.

Cryptococcal Meningitis

It can cause fevers, headache, fatigue, nausea, and vomiting. Patients may also develop seizures and confusion; left untreated, it can be lethal.


References

  1. ↑ Schneider MF, Gange SJ, Williams CM, Anastos K, Greenblatt RM, Kingsley L, Detels R, Munoz A (2005). "Patterns of the hazard of death after AIDS through the evolution of antiretroviral therapy: 1984–2004". AIDS. 19 (17): 2009&ndash, 2018. PMID 16260908.
  2. ↑ 2.0 2.1 Lawn SD (2004). "AIDS in Africa: the impact of coinfections on the pathogenesis of HIV-1 infection". J. Infect. Dis. 48 (1): 1&ndash, 12. PMID 14667787.
  3. ↑ Campbell GR, Watkins JD, Esquieu D, Pasquier E, Loret EP, Spector SA (2005). "The C terminus of HIV-1 Tat modulates the extent of CD178-mediated apoptosis of T cells". J. Biol. Chem. 280 (46): 38376&ndash, 39382. PMID 16155003.
  4. ↑ Senkaali D, Muwonge R, Morgan D, Yirrell D, Whitworth J, Kaleebu P (2005). "The relationship between HIV type 1 disease progression and V3 serotype in a rural Ugandan cohort". AIDS Res. Hum. Retroviruses. 20 (9): 932&ndash, 937. PMID 15585080.
  5. ↑ Skoulidis F, Morgan MS, MacLeod KM (2004). "Penicillium marneffei: a pathogen on our doorstep?". J. R. Soc. Med. 97 (2): 394&ndash, 396. PMID 15286196.
  6. ↑ Holmes CB, Losina E, Walensky RP, Yazdanpanah Y, Freedberg KA (2003). "Review of human immunodeficiency virus type 1-related opportunistic infections in sub-Saharan Africa". Clin. Infect. Dis. 36 (5): 656&ndash, 662. PMID 12594648.
  7. ↑ Guss DA (1994). "The acquired immune deficiency syndrome: an overview for the emergency physician, Part 1". J. Emerg. Med. 12 (3): 375&ndash, 384. PMID 8040596.
  8. ↑ Guss DA (1994). "The acquired immune deficiency syndrome: an overview for the emergency physician, Part 2". J. Emerg. Med. 12 (4): 491&ndash, 497. PMID 7963396.
  9. ↑ Decker CF, Lazarus A (2000). "Tuberculosis and HIV infection. How to safely treat both disorders concurrently". Postgrad Med. 108 (2): 57&ndash, 60, 65&ndash, 68. PMID 10951746.
  10. ↑ Grant I, Sacktor H, McArthur J (2005). "HIV neurocognitive disorders" (PDF). In H. E. Gendelman, I. Grant, I. Everall, S. A. Lipton, and S. Swindells. (ed.). The Neurology of AIDS (PDF)|format= requires |url= (help) (2nd ed.). London, UK: Oxford University Press. pp. 357&ndash, 373. ISBN 0-19-852610-5.
  11. ↑ Satishchandra P, Nalini A, Gourie-Devi M; et al. (2000). "Profile of neurologic disorders associated with HIV/AIDS from Bangalore, South India (1989–1996)". Indian J. Med. Res. 11: 14&ndash, 23. PMID 10793489.
  12. ↑ Wadia RS, Pujari SN, Kothari S, Udhar M, Kulkarni S, Bhagat S, Nanivadekar A (2001). "Neurological manifestations of HIV disease". J. Assoc. Physicians India. 49: 343&ndash, 348. PMID 11291974.

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