Acute infection

Early HIV symptoms, (one to four weeks) can mimic that of mononucleosis-like symptoms. Symptoms include, swelling of the lymph nodes, headache, fever, loss of appetite, sweating, and sore throat. Often times this can be mistaken as having the flu or another viral-type infection. Some people may develop skin rashes on the chest, abdomen and/or back.

Seroconversion

HIV Symptoms in this second stage of infection usually occur anytime after four weeks. Seroconversion is the point at which antibodies to HIV can be detected. Eventually the body will produce enough antibodies specific for the HIV virus; white blood cells called B lymphocytes, in which a blood test will reveal that a person has been infected by the HIV virus. Often times, people will lead a fairly healthy period where no symptoms are present. However, if the person is aware of a positive blood test, they may have psychological symptoms of depression and anxiety about the future. It can be up to five years before a person develops any physical signs. This time period is dependent on many factors. Chiefly, it is the person's large amount of CD4 cells (helper cells to the immune system, helping to fight viruses). In addition, age and the general health condition of the person can also play a role. An immune system that has been trying to battle the HIV infection eventually weakens and will make the person more susceptible to opportunistic infections.

Early Symptoms of HIV infection

As the immune system becomes increasingly compromised, the body is not able to fight off infections that a normal intact immune system could suppress. Early HIV symptoms occur usually when a person has a CD4 count of 300 or below, but can happen at even higher CD4 counts. The most common are thrush, Herpes Zoster (shingles), Herpes Simplex, Oral Hairy Leukoplakia, Idiopathic Thrombocytopenic Purpura and Pneumococcal Pneumonia.

Thrush

This is the most common infection among hiv positive people. Thrush is a condition that is located in the mouth and is caused by a fungus called Candida Albicans. White patches on the walls of the mouth, gums, and on the tongue is a good indication of this fungal infection. In addition, people may have a burning sensation and an altered sense of taste. Thrush is irritating more than anything and can be easily treated with drugs such as Clotrimazole Troches and Nystatin.

Herpes Zoster (Shingles)

Herpes Zoster is the virus that causes chicken pox in children. Anyone who had chicken pox as a child has the virus for Herpes Zoster in the nerves of their body. Immune deficiencies and stress tend to be the two main factors that cause the reactivation of the virus leading to shingles.

Symptoms: Shingles looks like a red rash that normally appears in a specific area and may look like a band around the body. In addition, headaches, fatigue and fever may accompany the rash.

Treatment: Generally analgesics are used to control the pain. The correct one is based on the severity of the pain. Oral Acyclovir, best when started as early as possible, is also used to decrease the severity of the symptoms.

Herpes Simplex

Herpes Simplex is a common sexually transmitted disease. In HIV - AIDS patients, it may become a chronic condition. With further deterioration of the immune system, the frequency of Herpes Simplex along with the severity may increase.

Symptoms: Most often Herpes Simplex affects the rectal, genital, and esophageal regions of the body. Painful lesions are observed that can erupt into ulcerations of the area.

Treatment: The main drug to treat Herpes Simplex infections is Oral Acyclovir 200mg, four times a day for two weeks or longer until the lesions disappear. New forms of Acyclovir-like drugs are being produced that have an increased effect on the disease.

Oral hairy leukoplakia

This is an infection of the mouth that resembles thrush and its cause is unknown. Unless the person is in pain from the infection, generally treatment is not given, as it eventually disappears on its own.

Idiopathic Thrombocytopenic Purpora

This condition is when a person develops antibodies, which attack cells called platelets, which are responsible for allowing the blood to clot. This condition can go unnoticed and is not detected until a routine blood test is performed.

Symptoms: Excessive bruising and bleeding.

Treatment: There are several approaches to treating this disorder. The use of Zidovudine (AZT), Prednisone, IV Gamma Globulin, Splenectomy, Danazol, or no treatment at all.

Pneumococcal Pneumonia

This is an infection of the lung and is one of the most common causes in people with AIDS. This infection can sometimes be prevented by the use of Pneumococcal vaccine. Ask your doctor about this possibility.

Diarrhea

Diarrhea is found in both early and late stages of hiv. There are many different microbes that can be responsible for diarrhea. It is often hard to define the cause of diarrhea, but by analyzing stool samples, the organism responsible can sometimes be uncovered. However, often times it is unknown what the cause is, since either the HIV virus or some other opportunistic infection may be the cause. It can also be intermittent. One day a person may have a regular bowel movement and the next day they may have severe diarrhea. It can be treated by antidiarrheals.

Weight Loss

Weight loss is caused by an increase in the metabolic rate of the body or how fast the body burns calories for fuel, which results in a decrease of weight. This can happen due to many factors such as opportunistic infections, fever, or the HIV virus itself.

Fever

Fever is very common among HIV infected individuals. It has many different origins including the HIV virus itself and other opportunistic infections. Fever can occur in both in the early and late stages. In later stages, it is often accompanied by night sweats and chills, which indicate that the body may be trying to fend off some type of opportunistic infection.

Fatigue

Fatigue is a very common complaint amongst hiv infected individuals. The sources, like that listed with fever are also numerous. Other causes can be from depression, anemia, and side effects of some of the drugs used to treat hiv.

Later Stage AIDS and Opportunistic Infections

As the immune system becomes increasingly compromised, the body is not able to fight off more serious infections that a normal intact immune system could suppress. Some of these infections can be life threatening in a person with AIDS and are usually the cause of death in the AIDS patients. The current definition of someone in late stage AIDS is when their CD4 count dips below 200. Opportunistic infections are infections that a normal intact immune system can fight off, but could prove to be life threatening to a immunocompromised person. The two most common opportunistic infections are Pneumocystic Pneumonia and Kaposi's Sarcoma. Others include: Tuberculosis, Mycobacterium Avium Complex, HIV-Related Lymphoma, Toxoplasmosis Encephalitis, Cytomegalovirus Infection, Cryptocococcosis, and Cryptosporidiosis.

Pneumocystic Pneumonia (PCP)

A parasite called Pneumocystis Carinii is responsible for this condition. Since PCP is the most common opportunistic infection, prophylaxis (the use of drugs to prevent the infection) is important. It is usually started in patients with CD4 counts under 200. Early medical intervention and prophylaxis against PCP can improve the chances of keeping the infection at bay.

Symptoms: The symptoms of PCP are very similar to that of Pneumococcal Pneumonia; fever, respiratory problems, etc.

Treatment: Trimethoprim/Sulfmethoxazole (Bactrim, Septra), Dapsone, Pentamadine.

Kaposi's Sarcoma

This is a condition in which tumors of the blood vessels develop. The cause is unknown although it is known that it is a malignancy originating in the endothelial or lymphatic cells. Tumors can arise anywhere on the skin, in the gastrointestinal tract, mouth, lungs, groin, brain, liver and lymph glands. The tumor takes on the appearance of a purple or black spots.

Symptoms: Small non-painful lesions are present. (red, brown, or purple in color)

Treatment: Local lesions are treated only if they are painful or interfering with cosmetic problems. The common treatment is radiotherapy, cryotherapy, or intralesional injections with Vinblastine. These therapies can help reduce the condition but reoccurrence is common. Systemic lesions are treated with chemotherapy. Other therapies are under current investigation.

Tuberculosis (Mycobacterium Tuberculosis “MTB”)

MTB can occur in both early and late stages of the hiv disease. It is not as necessary to have a weakened immune system to contract MTB. One of the major problems with this disease is the development of multiple-drug resistant strains being produced, thus making it a great challenge to treat. Another problem with reoccurrence of MTB is non-compliance to treatment of patients with MTB.

Symptoms: Night sweats, fever, cough, and weight loss.

Treatment: Isoniazid (INH) along with Pyridoxine (Vitamin B6). Other combinations with INH include Ethambutol, Rifampin or Streptomycin.

Mycobacterium Avium Complex (MAC)

MAC generally occurs in the later stages of the disease, in patients with CD4 counts below 100. It is very common to find MAC in up to 50% of patients at autopsy.

Symptoms: Fatigue, chills, night sweats, fever, weight loss, diarrhea, and abdominal pain. With such non-specific symptoms, it makes it difficult to diagnose MAC accurately.

Treatment: A combination of drugs is used to treat MAC infection. These include using Clarithomycin and one or two other drugs such as Ethambutol and/or Clofazamine. Other drugs may include Amikacin, Azithromycin, Ciprofloxin and Rifampin. Once a person has started treatment for MAC, they are treated for life.

HIV-Related Lymphoma (Tumors of the lymph glands)

Symptoms: Very large lymph glands in the neck, around the groin region or under the arms.

Treatment: Radiation and chemotherapy are the main treatments to irradiate the tumors.

Toxoplasmosis Encephalitis

Toxoplasmosis is caused by the parasite,Toxoplasmosis Gondii, which is commonly found in the stools of cats and in uncooked meats. This parasite causes an infection in the brain leading to neurological impairment and seizures.

Symptoms: Headaches, fevers, lethargy, confusion and seizures. Uncoordinated walking and loss of balance may also occur. The latter two symptoms are the most common.

Treatment: Sulfadiazine and/or Pyrimethamine. If the person is allergic to sulfa (Sulfadiazine), the drug Clindamycin may be substituted. In addition, folinic acid is administered. Recent evidence has shown that AZT may also help in the treatment of toxoplasmosis. Treatment continues for life once toxoplasmosis has been diagnosed.

Cytomegalovirus Infection (CMV)

About 90% of AIDS patients eventually develop Cytomegalovirus. CMV may appear as a mono-like illness. This virus is very similar to that of Toxoplasmosis Gondii and Pneumocystis Carinii.

Symptoms: Since CMV is located in the blood, it is distributed to all parts of the body, causing infections in many different organs. Most common are infections in the eye (retinitis; inflammation of the eye) and lung infections, which lead to pneumonia.

Treatments: Gangciclovir and Foscarnet.

Cryptococcus

A fungus found in the soil, Cryptococcus Neoformas, can develop in many different areas of the body. The most serious site of infection is in the brain.

Symptoms: Fatigue, fever, nausea and vomiting. Accompanying headaches are not always specific to one region of the head. Encephalitis, which is the inflammation of the brain, may be present, as well as altered mental states, memory loss, confusion, and behavioral changes.

Treatment: Amphotericin B with or without flucystine (5FU). Once stabilized, the patient is treated with Fluconazole for life.

Cryptosporidium

The most common route of infection is through drinking water that contains Cryptosporidium

Symptoms: Diarrhea and weight loss.

Treatment: This is a difficult disease to treat and there are no current effective treatments although active research and clinical trials are closing in on the treatment of this disease.