Signs and Symptoms of AIDS/HIV

Contrary to what many people think, being HIV positive is not the same as having AIDS (AIDS). For the diagnosis of AIDS, besides the presence of HIV, the existence of at least one frame of disease caused by the virus that causes immunosuppression is needed.

So HIV is a virus and AIDS is the disease caused by this virus. You can be HIV positive for many years before AIDS develops.

Symptoms of AIDS
Symptoms of AIDS

How does HIV cause immunosuppression?

Immunosuppression is the name given to the fall of the defenses of our immune system, which is responsible for protecting us from infections caused by germs such as viruses, bacteria and fungi.

HIV infects and destroys lymphocyte cells that are part of our immune system. This destruction process is very slow and gradual, allowing patients remain asymptomatic for many years. This means that people can be infected with HIV for a long time without necessarily develop AIDS.

A patient is only considered as having AIDS when the HIV virus has attacked and destroyed such a large amount of lymphocytes that the immune system becomes weakened. With few viable lymphocytes, the body becomes more vulnerable to infection, being susceptible to various types of viruses, bacteria, fungi and even tumors.

Indeed, the HIV virus itself causes few symptoms. Disease severity is the so-called opportunistic infections, which are those that take advantage of the weakness of the immune system to develop.

However, HIV in some cases can also cause symptoms. Shortly after the virus contamination a patient can have a picture called acute HIV infection, which has nothing to do with AIDS. It is a similar picture to any common virus, which occurs as a body's reaction to the presence of a new virus.

In this text we will talk about the two clinical pictures caused by HIV:

Primary HIV infection (acute HIV infection)

Acute HIV infection is the picture of viral infection that comes days after the patient has been infected by viruses.

A lot of signs and symptoms may be associated with acute HIV infection. Many of these symptoms are nonspecific and occur also in other infections, especially respiratory infections by other viruses, such as colds, flu, mononucleosis, etc.

Most patients that are contaminated with HIV develop symptoms of acute infection. The problem is that the picture is so nonspecific and in some cases so mild that most patients do not remember to have had it.

The most common symptom of acute HIV infection is fever (38°C to 40°C), which occurs in over 80% of cases. The following symptoms are also very common:
HIV symptoms
HIV symptoms
  • Pharyngitis without increasing the tonsils and without pus
  • Red spots on the skin (rash) occurring 48 to 72 hours after the onset of fever and usually last between 5 and 8 days. This rash is usually present as round lesions, smaller than 1 cm, reddish, with discreet signage and distributed throughout the body, especially the chest, neck and face. They can also affect the soles of the feet and palms
  • Swollen lymph nodes (lumps) mainly in the armpits and neck
  • Joint and muscle pain, headache

In 10% of cases there may also be enlarged liver and / or spleen, oral, genital or anal ulcers, vomiting and diarrhea (which may lead to weight loss of up to five pounds).

The ulcers appear to be related to the entry point of mucosal virus, similar to what occurs in syphilis. Oral ulcers indicate contamination by active oral sex and anal ulcers - by passive anal sex. Similarly, there may be vaginal and penile ulcers.

There are also reported cases of hepatitis, pneumonia and pancreatitis caused by acute HIV infection. In rare cases oral or vaginal candidiasis can occur.

Typically, symptoms of acute HIV infection begin between 2 and 4 weeks after exposure to the virus. However, cases with up to ten months have been reported.

As have been noted, the symptoms of acute HIV infection are nonspecific, common to many other diseases. It is very difficult to establish a diagnosis just by clinical picture. Therefore, the time interval between risk behavior (sex without condoms or needle sharing) and the appearance are more important than the symptoms themselves.

In any case the diagnosis is never closed with the clinical picture since various diseases can have similar symptoms, necessitating the performance of serological or virus research for confirmation.

Patients with acute HIV have very high viral load and are therefore highly contagious at this time. The picture of acute infection can last up to two weeks, then disappears silently and HIV is housed in the body for many years. After the acute stage the viral load (count of circulating virus in the blood) drops and gets stabilized at low levels.

Symptoms of AIDS

The end of the acute infection usually coincides with positivity of HIV serology, or blood tests for HIV research are to be positive.

HIV attacks and destroys the immune cells called CD4 lymphocytes. The acquired immunodeficiency syndrome (AIDS) is a framework of immunosuppression caused by low levels of CD4, which favors the emergence of opportunistic infections.

Opportunistic infections are those that take advantage of the drop in our immune system to attack us. Opportunistic infections are present not only in AIDS but also in transplant patients, chemotherapy, cancer, or any condition that leads to immunosuppression.

To establish a diagnosis of AIDS a patient must be infected with HIV and:
1) have a CD4 count less than 200 cells/mm3 or
2) provide one of the AIDS defining illnesses, which are:
  • Tracheal or pulmonary candidiasis
  • Esophageal candidiasis
  • Invasive cervical cancer
  • Disseminated coccidioidomycosis (a fungal infection)
  • Extrapulmonary cryptococcosis (also a fungal infection)
  • Intestinal cryptosporidiosis (parasitic disease)
  • Cytomegalovirus (viral illness)
  • HIV encephalopathy (HIV brain injury)
  • Herpes simplex chronic (more than one month duration) or disseminated
  • Disseminated histoplasmosis (a fungal infection)
  • Isosporiasis chronic intestinal (parasitic disease)
  • Kaposi sarcoma (cancer of the typical AIDS)
  • Burkitt's lymphoma
  • Lymphoma of the central nervous system
  • Disseminated infection with Mycobacterium avium complex (bacterial infection)
  • Disseminated tuberculosis
  • Pneumocystis carinii pneumonia fungus (also called Pneumocystis jirovecii)
  • Recurrent pneumonia
  • Recurrent multifocal leukoencephalopathy (viral disease that attacks the brain)
  • Sepsis by salmonella bacteria
  • Cerebral toxoplasmosis
  • HIV wasting syndrome (weight loss)

Any patient with one of the above diseases probably has some immune deficiency, as these are health problems that do not normally occur in individuals with perfect immune system. The diseases listed above are typical of patients with immunosuppression, not necessarily by AIDS. Their presence, however, necessarily indicates the investigation of HIV, if there is no obvious cause for immunosuppression, such as immunosuppressive drugs or chemotherapy.

There is not a single clinical AIDS. The clinical presentation depends on the type of disease to develop and the affected organs. If you ask me what are the symptoms of AIDS, I will answer: - It depends, there are many.

The diseases more typical of AIDS are esophageal candidiasis, tuberculosis (pulmonary form which can also occur in people without HIV), Kaposi's sarcoma, cerebral toxoplasmosis, the fungus P. carinii pneumonia and cytomegalovirus.

Immunosuppression besides facilitating development of infection, also increases the frequency of malignancies. Cancers such as cervical and extremely aggressive lymphomas are much more common in AIDS patients than in healthy people. Other tumors, such as Kaposi's sarcoma, are typical of immunosuppressed, particularly in homosexual population.

That image of AIDS patients, cachectic, full of skin lesions and oral candidiasis, is no longer so common. The treatment has advanced greatly in recent years and most of the HIV positive patients maintain their high levels of CD4, preventing the occurrence of opportunistic infections. Patients can be early diagnosed and treatment is usually started before advanced stages of the disease.

But beware: HIV has no cure and still kills. Actually, it is not HIV that causes death, but opportunistic infections and neoplasms secondary to immunosuppression. Therefore it is important to take the antiretroviral cocktail correctly to prevent the virus from multiplying and destroying CD4 lymphocytes.

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