Written by : Dr.M.D.Mazumdar, MD

Acquired Immune Deficiency Syndrome (AIDS) is a deadly disease caused by infection with a retrovirus, the Human Immunovirus (HIV).

A person who carries the virus is said to be HIV positive. AIDS is the end-stage of HIV infection.

Spread of the HIV Virus

The HIV is a highly infectious virus that spreads quickly from person to person through exchange of body fluids, specially during sexual intercourse.

But it can also spread by anything that causes direct entry of blood into the body such as by infected syringes and blood transfusion. HIV infection or AIDS is not caused by kissing, touching, sharing of towels and utensils, swimming pools or even using the same toilet seats.

The HIV virus gradually destroys cells in the human immunity system. It specifically infects the T-cells (which is a type of lymphocyte) that stimulates the cells of the immune system to fight against other virus, bacteria and infecting organisms.

Signs and Symptoms of HIV Infection

HIV infection and AIDS occurs in four stages and the signs and symptoms depends on the stage of the disease. The first symptoms of HIV infection occurs within 2 - 4 weeks from the time of exposure to the virus.

Stage 1 of HIV Infection

This stage is also called the Primary HIV Infection Stage. It starts from the time of infection (exposure to the virus by sex or otherwise) and lasts for 1 -2 weeks only. It is frequently ignored as a upper respiratory tract infection since the symptoms of both primary HIV infection and flu are similar. The common symptoms at this stage are:

• Sudden onset of a high fever between 100.4 F (38 C) to 104 F (40 C).
• Sore throat
• Cough which is usually dry
• Muscle and joint aches and pains
• Painless swelling of lymph nodes, especially of the neck and armpits
• Rash, about 2-3 days after the onset of fever. The rash can affect the whole body but is usually seen mainly in the face, neck and upper chest. The rash consists of dark pink to reddish spots or slightly raised areas of skin. There is usually no itching. If there is any, it tends to be very mild.

Stage 2 of HIV infection

This stage is also called the Clinically Asymptomatic Stage. This stage can last from a few years to upto 10 years in some individuals. As the name suggests , there is no specific symptom pointing to HIV infection. But the patient may have symptoms produced by infections of different body systems due to a failing immune system. The severity of the symptoms tends to increase with the duration of the infection. The symptoms are described according to the body system involved:

• General symptoms

  • Tiredness and sometimes extreme fatigue.
  • Weight loss of less than 10% of the body weight.
  • Diarrhea that lasts for more than 1 week and does not respond or responds poorly to standard anti-diarrheal drugs.
  • Frequent fevers and sweats, especially night sweats.
  • Severe headaches

• Digestive system

  The common symptoms that can occur in the digestive system in the second stage of HIV infection are:
  • Abdominal cramps with severe diarrhea
  • Loss of appetite
  • Angular stomatitis - ulcers in the angles of the mouth
  • Thrush in the mouth and in other sites in the digestive tract. Thrush is an opportunistic infection caused by the fungus candida, and is usually an indication of a deficient immune system.
  • Sores or white spots in the mouth. If the person is also infected by the herpes simplex virus, there can be a flare up of the cold sores caused by the herpes virus.
  • Difficulty in swallowing due to thrush and cold sores.

• Respiratory system

  • Recurrent infections like tonsilitis, pharyngitis, sinusitis.
  • Cough that is due to a constant dry and scratchy feeling in the throat.
  • Tightness in the chest with difficulty in respiration.
  • Coughing or spitting up blood
  • Pneumonia
  • Tuberculosis of the lungs.

• Skin

  • Unusual spots or blemishes under the skin, inside the mouth, throat, nose, around the eyes and eyelids.
  • Skin eruptions which are remarkably similar to acne
  • Seborrheic Dermatitis
  • Open sores or ulcers in different parts of the body. The ulcers are usually shallow, with sharply defined margins and tend to be very painful.
  • Fungal nail infections.

  Neurological system

  • Severe headache, usually just behind the eyes. The headache increases with the movement of the eyes.
  • Abnormal sensitivity to light
  • Confusion, loss of memory, changes in the personality
  • Seizures
  • Paralysis of nerves in the body can lead to sudden and severe muscle wasting and difficulty or inability to move that part of the body.

Stage 3 of HIV infection

Also called the Symptomatic HIV Infection Stage, this is the stage in which the HIV infection produces symptoms which are more acute and persistent and cannot be cured by any standard medicines. Some of the symptoms are:

• Unexplained Weight loss of more than 10% of the body weight.
• Unexplained Persistant diarrhea of more than 1 month duration.
• Unexplained fever lasting for more than 1 month.
• Unexplained oral sores and fungal infection that cannot be cured by standard medicines.
• Severe bacterial infections like pneumonia, meningitis, muscle, bone or joint infections.
• Severe anemia, decreased WBC and platelet count.

Stage 4 of HIV infection or AIDS

This is the stage when the disease becomes a full-blown AIDS disease. The symptoms are severe and the patient is usually in a terminal stage. Some of the symptoms are:

• Severe wasting, also called the HIV wasting syndrome.
• Severe pneumonia, which may be bacterial or due to an organism called pneumocystitis carinii.
• Chronic herpes infections with wide-spread sores all over the mouth, throat, lips and esophagus.
• Fungal infections of the mouth, lungs, entire respiratory system.
• Wide spread enlargement of the lymph glands.
• Cancers like Kaposis sarcoma, cervical cancer, non-Hodgkins lymphoma
• Infections like tuberculosis, cytomegalovirus infection, leishmaniasis, cryptosporiodosis etc.
• Severe personality abnormalities.

Diagnosis of HIV infection and AIDS

Diagnosis of HIV infection in the primary acute stage can be done by screening for the HIV genetic material in the blood. But these are screening tests, not diagnostic tests.

The diagnostic tests are mainly for the HIV antibodies (antibodies to the virus) in the blood. These can take about 1-3 months and sometimes as late as 6 months to show up in the blood.

Two different types of HIV antibody tests are done - the ELISA test and the Western Blot test. If the tests are negative and there is a likelihood of an infection, the tests are again repeated after 6 months for a more accurate diagnosis.

If the tests for HIV infection and AIDS are negative after one year of exposure to unprotected sex, then the chances of infection with the HIV virus are minimal.

Treatment

Treatment is with a group of drugs known as the anti-retroviral drugs. Each drug blocks the virus in a different way. They act mainly by preventing the virus from making copies of itself or by preventing it from producing infectious viral particles. Some of these drugs also work to damage the outer covering of the virus.

But none of the currently available drugs can cure HIV infection. What they can do is suppress the virus to a greater or lesser degree. As most of these viruses have become resistant to a single drug, a combination of drugs are usually prescribed called HAART - Highly Active AntiRetrovirus Therapy.

The disease can remain in remission for many years after treatment, but flare up again at any time.

The viral load and the CD4 count (a type of white blood cell) should be regularly monitored to determine the response to the treatment.

It has been estimated that there are more than 35 million infected people in the world today ( amfAR, The Foundation for AIDS Research).

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