What are symptoms and signs of HIV infection and AIDS?
The time from HIV infection to the development of full blown AIDS varies. Sometimes, individuals develop complications of HIV that define AIDS within one year, while others remain completely asymptomatic after as many as 20 years from the time of infection. However, in the absence of antiretroviral therapy the time for progression from initial infection to AIDS is approximately 8 to 10 years. The reason why people experience clinical progression of HIV at different rates remains an area of active research.
Within weeks of infection, many people will develop the varied symptoms of primary or acute infection which typically have been described as “influenza” like illness but can range from minimal fever, body aches, and pains to very severe symptoms. The most common initial symptoms of primary HIV infection are fever, aching muscles and joints ,sore throat, and swollen glands (lymph nodes) in the neck.
It is not known why only some HIV-infected people develop these symptoms. It also is unknown whether or not having the symptoms is related to the future course of AIDS disease. Nevertheless, infected people will become symptom-free after this phase of primary infection. During the first weeks of infection when a patient may have symptoms of primary HIV infection, antibody testing may still be negative, this is called window period. If there is suspicion of early infection based upon the types of symptoms present and a potential recent exposure, then a test is performed that specifically looks for the virus circulating in the blood, which is called a viral load test or the use of an assay that identifies HIV p24 antigen, for example, the new fourth-generation antibody/antigen combination test. Identifying and diagnosing individuals with primary infection at an early stage is important to assure early access into care and to counsel them regarding the risk of transmitting to others. The latter is particularly important since patients with primary HIV infection have very high levels of virus throughout their body and are likely to be highly infectious. Once the patient enters the asymptomatic phase, infected individuals will know whether or not they are infected if a test for HIV antibodies is done.
Shortly after primary infection, most individuals enter a period of many years where they have no symptoms at all. During this time, CD4 cells may gradually decline, and with this decline in the immune system, patients may develop the mild symptoms of HIV such as vaginal or oral candidiasis thrush (a fungal infection), fungal infections of the nails, a white brush-like border on the sides of tongue called hairy leukoplakia, chronic rashes, diarrhea, fatigue, and weight loss. With a further decline in function of the immune system, patients are at increasing risk of developing more severe complications of HIV, including many more serious infections (opportunistic infections), malignancies, severe weight loss, and decline in mental function. From a practical perspective, most physicians think about patients with HIV diseases as having no symptoms, mild symptoms, or being severely symptomatic. In addition, many would characterize a patient’s level of immunosuppression by the degree and type of symptoms they have as well as the CD4 cell count. The Centers for Disease Control and Prevention have defined the presence of a long list of specific diseases or the presence of less than 200 CD4 cells per mm3 as meeting a somewhat arbitrary definition of AIDS. With effective antiretroviral therapy many of the signs and symptoms of HIV as well as immunosuppression can be completely reversed, restoring even the most symptomatic patients to a state of excellent health.
What are the complications of AIDS/HIV?
HIV infection weakens the body’s immune system, making the person highly susceptible to all sorts of infections and certain types of cancers.
Infections common to HIV/AIDS:
- Tuberculosis (TB). In third world nations, TB is the most common opportunistic infection associated with HIV and a leading cause of death among people living with AIDS. Millions of people are currently infected with both HIV and tuberculosis, and many experts consider the two diseases twin epidemics.
- Salmonellosis. The source of salmonella infection is contaminated food or water. Symptoms include severe diarrhea, fever, chills, abdominal pain and, sometimes, vomiting. Salmonellosis is far more common in people who are HIV-positive than other population.
- Cytomegalovirus (CMV). This virus is transmitted in body fluids such as saliva, blood, urine, semen and breast milk. A healthy immune system inactivates the virus, and it remains dormant(inactive) in the body. If your immune system weakens, the virus reactivates causing damage to your eyes, digestive tract, lungs or other organs.
- Candidiasis. Candidiasis is a common HIV-related infection. It causes inflammation and a thick white coating on the mucous membranes of your mouth, tongue, esophagus or vagina. Children may have especially severe symptoms in the mouth or esophagus, which can make eating very painful and difficult.
- Cryptococcal meningitis. Meningitis is an inflammation of the membranes and fluid surrounding your brain and spinal cord (meninges). Cryptococcal meningitis is a common central nervous system infection associated with HIV, caused by a fungus that is present in soil. It may also be associated with bird or bat droppings.
- Toxoplasmosis. This potentially deadly infection is caused by Toxoplasma gondii, a parasite spread primarily by cats. Infected cats pass the parasites in their stools, and the parasites may then spread to other animals and humans.
- Cryptosporidiosis. This infection is caused by an intestinal parasite that’s commonly found in animals. It is caused by ingesting contaminated food or water. The parasite grows in the intestines and bile ducts, leading to severe, chronic diarrhea in people with AIDS.
Cancers common to HIV/AIDS:
- Kaposi’s sarcoma. Kaposi’s sarcoma is a tumor of the blood vessel walls. It is common in HIV-positive people. Kaposi’s sarcoma usually appears as pink, red or purple lesions on the skin and mouth. In people with darker skin colour, the lesions may look dark brown or black. Kaposi’s sarcoma can also affect the internal organs, including the digestive tract and lungs.
- Lymphomas. This type of cancer originates in the white blood cells. Lymphomas usually begin in lymph nodes. The most common early sign is painless swelling of the lymph nodes in your neck, armpit or groin.
- Wasting syndrome. It is defined as a loss of at least 10 percent of body weight and is often accompanied by diarrhea, chronic weakness and fever Aggressive treatment regimens have reduced the number of cases of wasting syndrome, but it does still affect many people with AIDS.
- Neurological complications. Although AIDS doesn’t appear to infect the nerve cells, it can still cause neurological symptoms such as confusion, forgetfulness, depression, anxiety and unstable walking. One of the most common neurological complications is AIDS dementia complex, which leads to behavioral changes and diminished cognitive functioning.