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INITIAL SYMPTOMS:
Acute infection lasting 1-2 weeks: mononucleosis-like syndrome (fever, pharyngitis, lymphadenopathy, headache, and fatigue) within a few weeks after infection; [CCDM]
PRIMARY FINDINGS:
The two phases of HIV infection are primary and chronic. The chronic phase has an asymptomatic period followed by a symptomatic period. About 1/2 to 2/3 of patients experience an acute HIV syndrome 1-6 weeks (usually about 3 weeks) after exposure. The illness usually lasts about 10-15 days. Common findings are fever, sweats, lymphadenopathy, sore throat, rash, myalgia, arthralgia, thrombocytopenia, leukopenia, diarrhea, and headache. Less common symptoms are nausea/vomiting, elevated liver enzymes, hepatosplenomegaly, and thrush. About 6% of patients with acute HIV syndrome have neuropathy and encephalopathy. The rash resembles measles, roseola, or urticaria and may affect the palms and soles.
CHRONIC FINDINGS
Patients with chronic infection are monitored with laboratory tests: HIV RNA assay measures the viral load; CD4 count measures the risk for opportunistic infections. The average length of the asymptomatic period is about 10 years. AIDS is defined by a CD4 count of less than 200 and an immunocompromised state in which the patient is susceptible to many cancers and infections. Possible indicators of AIDS include generalized adenopathy, chronic diarrhea, generalized herpes simplex, chronic candidiasis, and unexplained weight loss, fever, or dementia.
AIDS-RELATED OPPORTUNISTIC INFECTIONS, TUMORS, AND SYNDROMES:
Bacillary angiomatosis
Candida esophagitis
Cervical cancer, invasive
Coccidioidomycosis, disseminated or extrapulmonary
Cryptococcosis, extrapulmonary
Cryptosporidiosis, chronic intestinal
Cytomegalovirus disease (other than liver, spleen, or nodes)
Encephalopathy, HIV-related
Hairy leukoplakia, oral
Herpes simplex, chronic ulcers; or bronchitis, pneumonia, or esophagitis
Herpes zoster (shingles) with >2 episodes or >1 dermatome
Histoplasmosis, disseminated or extrapulmonary
HIV nephropathy
Isosporiasis, chronic intestinal
Kaposi sarcoma
Lymphoma, Burkitt's
Lymphoma, primary, of brain
Mycobacterium avium complex or M. kansasii, disseminated or extrapulmonary
Pneumocystis jiroveci pneumonia
Pneumonia, recurrent
Progressive multifocal leukoencephalopathy
Salmonella septicemia, recurrent
Toxoplasmosis of brain
Tuberculosis
Wasting syndrome due to HIV
EPIDEMIOLOGY:
Acquired immunodeficiency syndrome (AIDS) is a sexually transmitted disease and a global epidemic that began in the closing two decades of the twentieth century. From 2000-2020, a projected 68 million people will die prematurely from this disease. Seventy percent of HIV-positive persons live in Sub-Saharan Africa, and 2.4 million Africans died of AIDS in 2002. Without medical care and antiretroviral medications, the survival time of AIDS patients in Africa is often less than one year. Infection is transmitted mainly by sexual contact or contact with contaminated blood or needles. In the USA about 50% of infections are transmitted by men who have sex with men. In other parts of the world, most infections are transmitted by needles used to inject mood-altering drugs (Eastern Europe and central Asia) or by heterosexual intercourse (Africa). In some parts of Africa, HIV prevalence rates exceed 90% in sex workers and 50% in STD clinic patients. Anal intercourse and the presence of concurrent ulcerative STDs facilitate HIV transmission. Children are infected from their HIV-positive mothers during pregnancy, delivery, and breast feeding. The risk of occupational infection after exposure to infected blood from needle injuries is less than 0.5% for HIV compared to about 25% for hepatitis B. Worldwide, new HIV infections decreased from an estimated 3.2 million in 2001 to 2.1 million in 2013. Most HIV carriers are asymptomatic and unaware of the risk to their partners and children. [PPID, p. 1469-1673; CCDM, p. 287-94; ID, p. 163, 2363; Merck Manual, p. 1625-42; Guerrant, p. 541; Cohen, p. 994-9] "The continuing rise in the population of people living with HIV infection reflects the combined effects of continued high rates of HIV infection and the beneficial impact of antiretroviral therapy (ART) resulting in fewer deaths. . . . As of December 2008, approximately 4 million people in low-and middle-income countries were receiving ART--a 10-fold increase over a period of 5 years." [Cecil, p. 2170]
For updated text and symptoms of infectious diseases, see iddx.com.