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Human Immunodeficiency Virus
	Natural History of HIV Infection Laboratory Tests for HIV Infection Manifestations of HIV Human Immunodeficiency Virus (HIV) Management of HIV infection HIV Update Predictors of HIV Disease Progression WHO Clinical case definition for AIDS in South East Asia

                                    Clinical Features & Symptoms

• Fatigue

• Weight loss

• Fevers

• Night sweats

• Swollen lymph nodes in neck, armpits, and groin

• Sinus fullness and drainage

• Pain when swallowing

• Mouth sores

• Dry cough

• Shortness of breath

• Diarrhea or other bowel changes

• Personality changes

• Difficulty concentrating

• Confusion

• Tingling, numbness, and weakness in the limbs

• Dry skin

• Nail changes

• Recurrent Herpes Simplex

HIV infection may be suspected when a woman has the following:

• Recurrent vaginal yeast infections (more than 3 infections per year.)

• Recurrent Pelvic Inflammatory disease.

• Abnormal Pap test

HIV may be suspected in a child who has the following:

• Persistent yeast infection of the mouth (thrush)

• Recurrent bacterial infections

• Delays in growth or development

• Swollen lymph nodes in neck, armpits, and groin

• Enlargement of the liver and spleen

Almost all of these symptoms can be caused by other illnesses.

AIDS is diagnosed when an HIV-infected person has a CD4+ cell count below 200 cells per microliter of blood and specific opportunistic infections and/or cancers.

Primary Infection
The initial infection with HIV is a subclinical type of infection and may not be of much consequence. A small part of the infected may develop within 2-3 weeks Rash, Fever and Lymphadenopathy. Some get pharyngitis, erythematous maculopapular rash, arthralgia, myalgia, retro orbital headache, malaise, diarrhea and vomiting. Opportunistic infections are not seen at this stage.  A large majority remain a symptomatic. After a long incubation period varying from 1 to 12 years (usually 5-7 years)  majority of the HIV infected develop frank clinical problems. The clinical picture is also too variable and depends from patient's level of immune system.

Many develop serious opportunistic infections especially Pn.carrini pneumonia and Kaposi's sarcoma. Kaposi's sarcoma is a cancer of the walls of the blood vessels or lymphatic system. It usually appears as pink-to-purple spots on the skin. It can also occur internally. Kaposi's sarcoma can be fatal if it develops in certain sites such as the lungs.

Some HIV infected develop symptoms like diarrhoea, weight loss, candidiasis, fever and leucopaenia.
Brain involvement occurs in a large number of infected patients. This can be in the form of Dementia, Psychosis, Encephalitis, Multiple cerebral abscess, Cerebral toxoplasmosis, Herpes encephalitis, Cerebral lymphomas, Kaposi's sarcoma, Stroke, Mylopathy, Neuropathy, Fungal infection.
The diverse nature of the neurological complications underlines the importance of considering HIV infection in any neurological patient.

In Africa majority of patients present with severe weight loss. Multiple parasite infection is very common in african patients and thus diarrhoea is also very common.

Thrombocytopaenic purpura may be isolated manifestation of HIV infection.

Two tests are used to diagnose HIV infection. They detect antibodies to HIV.

• ELISA ( Enzyme-linked immunosorbent assay. If it is negative, no further tests are needed.

• Western Blot Assay. It is used to confirm a positive ELISA test.

It can take up to 6 months, usually 3 months from the time of exposure to HIV until antibodies can be detected. During this period the person can spread infection to others.

HIV infection is diagnosed only after 2 or more positive ELISA tests are confirmed by a positive Western blot assay.

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Predictors of HIV Disease Progression

Some Interesting Topics

 

	Natural History of HIV Infection
	Laboratory Tests for HIV Infection
	Manifestations of HIV
	Human Immunodeficiency Virus (HIV)
	Management of HIV infection
	HIV Update
	Predictors of HIV Disease Progression
	WHO Clinical case definition for AIDS in South East Asia

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 Dr. Manbir Singh