HIV / AIDS Symptoms & Complications

What is HIV Infection?

Once the Human Immunodeficiency Virus (HIV) has entered the body, the immune system comes under attack. The HIV virus multiplies and slowly begins to destroy the CD4 lymphocytes (T-cells), which are the white blood cells that are important for fighting off infections. Even if the person with HIV feels well with no symptoms, HIV is still invading the CD4 cells. The immune system weakens progressively over time and becomes susceptible to bacterial, viral, fungal and parasitic (opportunistic) infections.

As more serious symptoms and complications appear, the HIV infection may then meet the official definition of AIDS: a positive HIV-antibody ELISA followed by a confirmatory Western Blot test or other HIV virologic test (HIV nucleic acid test, HIV p24 antigen test, HIV viral culture) and either the onset of an "AIDS-defining" infection or cancer, or a CD4 T-cell count of 200 cells/mm3 - a normal count ranges from 600 to 1000 cells/mm3 - or a CD4 T-cell percentage of total lymphocytes of <14.

Antiretroviral therapy (ART) is the backbone of HIV treatment today and is necessary to help prevent possible life-threatening opportunistic infections and AIDS-related illnesses and cancers. 

How is AIDS defined?

If a person infected with HIV has:

• CD4 count of less than 200 cells/mm3
• a CD4+ T-lymphocyte percentage of total lymphocytes of less than 14%
• and/or an AIDS-defining illness

they are said to have AIDS. In order for a patient who is infected with HIV to have AIDS, the immune system must be severely damaged. The severity of the immune system damage is measured by a CD4 lymphocyte (white blood cell) count. Patients are at greatest risk of developing opportunistic infections when the CD4 count gets below 200 cells/mm3.

Common HIV Symptoms

It is common to develop a brief flu-like illness 2 to 6 weeks after being infected with HIV. The symptoms may include:

• Fever
• Headache
• Sore throat
• Swollen lymph glands
• Rash

These symptoms are similar to many other diseases and may not be recognized as HIV infection initially.

Initial infection with the HIV virus may produce little to no symptoms. The length of time between initial HIV infection and the development of AIDS varies greatly and some people may remain without symptoms for years. However, even though a person does not have symptoms, they can still transmit the virus to others.

Many people remain symptom free for 10 years or longer but during this time the virus continues to multiply and destroy their immune cells for people who are not on antiretroviral therapy (ART). The Centers for Disease Control (CDC) states the following may be warning signs of HIV infection but cautions that any of these symptoms can be related to other illnesses and that only an HIV blood test can be used for an accurate diagnosis:

• Rapid weight loss
• Dry cough and shortness of breath
• Recurring fever or profuse night sweats
• Profound and unexplained fatigue
• Swollen lymph glands in the armpits, groin, or neck
• Diarrhea that lasts for more than a week
• White spots or unusual blemishes on the tongue, in the mouth, or in the throat
• Pneumonia
• Red, brown, pink, or purplish blotches on or under the skin, or inside the mouth, nose, or eyelids
• Memory loss, depression, or other neurological disorders.

During the last phase of HIV, which can occur up to 10 or 11 years after the initial infection, the immune system will have been severely damaged, making the body highly susceptible to a large number of bacterial, viral, fungal and parasitic (also called opportunistic) infections.

The symptoms of some of these infections may include:

• Shaking chills or fever higher than 100 F for several weeks
• Soaking night sweats
• Dry cough and shortness of breath
• Chronic diarrhea
• Persistent white spots or unusual lesions on the tongue or in the mouth
• Persistent headaches
• Blurred and distorted vision
• Weight loss
• Persistent, unexplained fatigue
• Swelling of lymph nodes for more than three months

People with HIV infection are also at greater risk of developing certain cancers, especially Kaposi's sarcoma, cervical cancer and lymphoma.

What is the Difference Between AIDS-Defining Illness and Opportunistic Infection?

AIDS-defining illnesses tend to occur most often in patients who have not received antiretroviral treatment (ART) for HIV infection or who fail to benefit from antiretroviral treatment. AIDS-defining illnesses, as defined by the CDC, are directly linked with the deterioration of the immune system as a result of HIV infection.

AIDS-defining illnesses can also be classified as opportunistic infections, but the opposite is not always true. Opportunistic infections occur from agents like viruses, bacteria and fungi that only cause disease when the immune system is weak, as with HIV/AIDS. AIDS-defining illnesses tend to occur in the later stage of the disease with a very low CD4 count. On the other hand, opportunistic infections may occur with high white blood cell counts and are not always life-threatening.

List of AIDS-Defining Illnesses in HIV/AIDS

The Centers for Disease Control (CDC) considers the following list of conditions as "AIDS-defining". Many other illnesses and corresponding symptoms may develop in addition to those listed here:

• Bacterial infections, multiple or recurrent
• Candidiasis of bronchi, trachea, or lungs
• Candidiasis of esophagus
• Cervical cancer, invasive
• Coccidioidomycosis, disseminated or extrapulmonary
• Cryptococcosis, extrapulmonary
• Cryptosporidiosis, chronic intestinal (>1 month's duration)
• Cytomegalovirus disease (other than liver, spleen, or nodes), onset at age >1 month
• Cytomegalovirus retinitis (with loss of vision)
• Encephalopathy, HIV related
• Herpes simplex: chronic ulcers (>1 month's duration) or bronchitis, pneumonitis, or esophagitis (onset at age >1 month)
• Histoplasmosis, disseminated or extrapulmonary
• Isosporiasis, chronic intestinal (>1 month's duration)
• Kaposi sarcoma
• Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complex
• Lymphoma, Burkitt (or equivalent term)
• Lymphoma, immunoblastic (or equivalent term)
• Lymphoma, primary, of brain
• Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonary
• Mycobacterium tuberculosis of any site, pulmonary, disseminated, or extrapulmonary
• Mycobacterium, other species or unidentified species, disseminated or extrapulmonary
• Pneumocystis jirovecii pneumonia
• Pneumonia, recurrent
• Progressive multifocal leukoencephalopathy
• Salmonella septicemia, recurrent
• Toxoplasmosis of brain, onset at age >1 month
• Wasting syndrome attributed to HIV

List of Common Opportunistic Infections in HIV/AIDS

The symptoms of AIDS are primarily the result of infections (opportunistic infections) that do not normally develop in individuals with healthy immune systems.

• Candidiasis (fungal infection) of the bronchi, trachea, esophagus, or lungs
• Coccidioidomycosis - a type of fungal pneumonia due to Coccidioides immitis
• Cryptococcosis - fungal infection due to Cryptococcus neoformans
• Cryptosporidiosis - diarrheal disease is caused by the protozoan parasite Cryptosporidium
• Cytomegalovirus diseases - may affect eye (can lead to blindness with CMV retinitis), lungs, stomach
• Encephalopathy, HIV-related - brain disease
• Herpes simplex virus infection (HSV)
• Histoplasmosis - fungal lung infection due to Histoplasma capsulatum
• Isosporiasis, chronic intestinal
• Invasive cervical cancer
• Kaposi's Sarcoma
• Lymphoma, multiple forms
• Mycobacterium avium complex (MAC), or other Mycobacterium infections
• Pneumocystis jiroveci pneumonia (PCP) - fungal lung infection previous called Pneumocystis carinii
• Pneumonia, recurrent
• Progressive multifocal leukoencephalopathy
• Salmonella septicemia, recurrent
• Toxoplasmosis of the brain
• Tuberculosis
• Wasting syndrome due to HIV

are some of the most common HIV-related opportunistic infections seen in clinical practice.

HIV Symptoms in Children

Children who are HIV positive often fail to gain weight or grow normally. As the disease progresses, they may have difficulty walking or delayed mental development, or cerebral palsy. In addition, children are susceptible to the same opportunistic infections as adults and may have severe forms of common childhood illnesses such as ear infections (otitis media), pneumonia, and tonsillitis.

Tuberculosis (TB)

Tuberculosis is the most common opportunistic infection associated with HIV worldwide. Tuberculosis is an infection by the tuberculosis bacterium that predominantly affects the lungs, but it can spread through the blood and lymph nodes to the rest of the body in people with HIV.

TB causes a long-term cough that may produce blood and may also cause fever, weight loss and night sweats. The disease can strike people with HIV no matter what the level of their CD4 count, which means that TB can often occur years before other problems associated with HIV develop.

Everyone who is HIV-positive should have a simple skin test for TB. If the test is positive, a chest X-ray and other tests will determine if the infection is active. If the TB is not active, preventative treatments are available.

Tuberculosis is more worrisome than many other opportunistic infections because of the ease with which it is spread (by coughing or sneezing) from one person to another. Multi-drug Resistant-Tuberculosis (MDR-TB) is resistant to traditional treatments and is of particular concern to people with HIV and AIDS.

Anyone with HIV can get Tuberculosis but it is more likely to occur in those with CD4 counts of less than 200 cells/mm3 .

Herpes Simplex Virus (HSV)

Herpes Simplex virus, which usually causes genital herpes, may be transmitted during unprotected sex. Initial symptoms include pain or irritated skin in the genital area and later sores that may erupt and ooze and bleed. Although these sores eventually heal, the virus periodically reappears, causing the same symptoms.

The symptoms of HSV are more severe in people with HIV and the sores may take longer to heal (over one month in duration). The herpes virus isn't life-threatening in adults, but it may cause brain damage, blindness or death in infants infected during delivery.

Anyone with HIV can get Herpes Simplex, regardless of their CD4 count.

Candidiasis in HIV

Candidiasis (thrush) is a yeast infection of the mouth or genitals and is a very common HIV-related infection. The symptoms include inflammation and a thick white coating on the mucous membranes of the mouth, tongue, vagina or esophagus (Candida esophagitis). Children may have especially severe symptoms in the mouth or esophagus, which can make eating painful and difficult. Uncomplicated, severe or recurrent vulvovaginal candidiasis may also occur.

Candidiasis of the bronchi, trachea, lungs or esophagus is considered "AIDS-defining", but oral or vulvovaginal candidiasis are not considered "AIDS-defining".

Anyone with HIV can get Candidiasis but it is more dangerous in those with CD4 counts of less than 200 cells/mm3.

Read More: 

Lymphomas in HIV

Non-Hodgkin's Lymphoma (NHL) is a cancer of the lymph glands originating in the lymphocytes, a type of white blood cell involved in fighting infection. NHL usually starts in the lymph nodes but can also start in the liver, lungs or gastrointestinal tract. The most common symptom of NHL is swollen (usually painless) lymph nodes in the neck, armpit or groin. Other symptoms include fever, night sweats, fatigue, itchy skin and weight loss, aches, and sometimes coughing, difficulty breathing and chest pain.

Non-Hodgkin lymphoma has become more common in the past few decades. This may be related to the rise in the number of people who have a suppressed immune system, such as people infected with human immunodeficiency virus (HIV) and those who have had an organ transplant and need to take drugs that alter the immune system.

Other AIDS-defining lymphomas include Burkitt’s Lymphoma and Brain Lymphoma.

Anyone with HIV can get Non-Hodgkin's Lymphoma but it is more likely in those with CD4 counts of less than 200 cells/mm3 .

Salmonella in HIV

Salmonellosis (food poisoning) is an infection caused by the salmonella bacterium, which is contracted from contaminated food or water. Symptoms include severe diarrhea, fever, chills, abdominal pain and sometimes vomiting. The risk of contracting salmonellosis can be reduced by hand washing and by cooking meat and eggs thoroughly.

Salmonella septicemia usually is treated with antibiotics. Drug therapy may be required for life to prevent relapses. HIV patients should avoid having reptiles as pets due to the possible transmission of salmonella.

Anyone with HIV can get Salmonellosis, regardless of their CD4 count.

HPV in HIV

Human Papillomavirus (HPV) is one of the most common causes of sexually transmitted disease. Some types of this virus cause common warts while others cause warts on the genitals.