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Acquired Immunodeficiency Syndrome

Acquired Immune Deficiency Syndrome

Acquired immunodeficiency syndrome (AIDS) is considered to be the most severe stage of human immunodeficiency virus (HIV) infection. It is life-threatening if therapy is not initiated immediately. Patients present with constitutional symptoms of variable severity, wasting, and numerous AIDS-defining illnesses. Clinical and laboratory criteria, especially a very low CD4+T-cell count, are used to make the diagnosis.


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Presentation

AIDS occurs in patients who suffer from a severe and long unrecognized human immunodeficiency virus (HIV) infection (caused by either HIV-1 or HIV-2 virus) [1] [2] [3]. AIDS is almost never encountered in patients with an acute HIV infection, but rather develops after the period of latency and progressive decrease in CD4+T-cell function [4] [5]. One of the most important risk factors is the lack of treatment, mostly because of a missed (or unknown) diagnosis. The progressive nature of HIV infection symptoms and infections have been grouped into two diagnostic criteria devised by the Center for Disease Control (CDC) and the World Health Organization (WHO). As per CDC criteria, three distinct categories exist - A, B, and C, with A describing features of acute or asymptomatic HIV infection [2] [6]. On the other hand, categories B and C (similarly to clinical stages 2,3 and 4 of WHO criteria) include the appearance of AIDS-related conditions. Constitutional symptoms such as fever, fatigue, or diarrhea lasting for at least one month, peripheral neuropathy and numerous infections - Listeriosis, Bacillary angiomatosis, recurrent herpes zoster involving > 1 dermatome and pelvic inflammatory disease (PID) are initial signs of AIDS [1] [2] [3] [6] [7]. Candidiasis, however, is the most important group B feature of patients with suspected HIV or AIDS and can present in the oropharynx or the genitalia. Additional disorders that belong to the B category are immune thrombocytopenic purpura (ITP), cervical dysplasia (or cervical carcinoma in situ) and oral hairy leukoplakia. When patients present with profound weight loss and poor general condition due to "wasting syndrome" caused by HIV, they are adequately classified into category C and clinical stage 4, respectively, and signs of severe AIDS include [1] [2] [3] [6] [7]:

Generalized Lymphadenopathy
  • The standard surveillance definition of AIDS does not apply to suspected subclinical or mild cases of AIDS--to the extent they occur--or to cases involving persistent generalized lymphadenopathy or other conditions in persons from high-risk groups.[cdc.gov]
  • Symptoms include generalized lymphadenopathy, fever, weight loss, and chronic diarrhea.[icd10data.com]
  • In some patients, generalized lymphadenopathy, fever, weight loss, dementia, or chronic diarrhea occurs much earlier in the course of the infection.[medical-dictionary.thefreedictionary.com]
Cough
  • A 33-year-old male presented with a history of fever and cough and was diagnosed to have pulmonary tuberculosis and acquired immunodeficiency syndrome (AIDS).[ncbi.nlm.nih.gov]
  • This is the case of a patient with multiple secondary sexually transmitted infectious diseases, lymphadenopathy, B-cell lymphoma, a productive cough, a clinical picture suggestive of pulmonary tuberculosis, eosinophilia, and a new-onset acquired immunodeficiency[ncbi.nlm.nih.gov]
  • .  Coughing or sneezing Sharing cups, plates and other eating utensils Sharing water or food Handshakes, touching or hugging Using the same toilet Insect bites 6. Sore throatFeverNight sweatingFatigueColdNausea 7.[slideshare.net]
  • Such individuals present with weight loss, fever, night sweats, cough, sputum production, coughing-up blood, etc. Tuberculosis can also affect other organs such as the bowel, brain, lining of central nervous system (brain and spinal cord), etc.[dovemed.com]
  • […] opportunistic infection — an infection that occurs when your immune system is impaired — such as Pneumocystis carinii pneumonia (PCP)  A CD4 lymphocyte count of 200 or less — a normal count ranges from 800 to 1,200 which causes  Soaking night sweats , Dry cough[slideshare.net]
Chronic Cough
  • There may be a chronic cough with crepitations in both lungs. Hepatomegaly and splenomegaly may be detected in the abdomen. In infants, crusting around the anus may be a sign of chronic diarrhoea.[patient.info]
Fever
  • Pneumocystis carinii and fever improved immediately when ST mixture and highly active antiretroviral therapy (HAART) were performed.[ncbi.nlm.nih.gov]
  • A 33-year-old male presented with a history of fever and cough and was diagnosed to have pulmonary tuberculosis and acquired immunodeficiency syndrome (AIDS).[ncbi.nlm.nih.gov]
  • The authors present a rare case of primary psoas abscess in patient affected by acquired human immunodeficiency syndrome, showing a mass in the inferior lumbar region through the lumbar triangle of Petit and fever.[ncbi.nlm.nih.gov]
  • Here, I report the case of a 31-year-old immigrant Burmese woman who exhibited epigastralgia, fever, weight loss and an epigastric mass.[ncbi.nlm.nih.gov]
  • World English acquired immunodeficiency syndrome acquired immunodeficiency syndrome noun Medicine The disorder resulting from infection with human immunodeficiency virus (HIV), characterized by a reduction in the number of helper T lymphocytes with fever[oxforddictionaries.com]
Weight Loss
  • Here, I report the case of a 31-year-old immigrant Burmese woman who exhibited epigastralgia, fever, weight loss and an epigastric mass.[ncbi.nlm.nih.gov]
  • The case of a 41-year-old male with AIDS who presented with weight loss, abdominal pain, ascites, edema, nausea, vomiting, and diarrhea is discussed. A computed tomography (CT) scan of the abdomen showed avid enhancement of the stomach mucosa.[ncbi.nlm.nih.gov]
  • loss, lymphadenopathy, and the occurrence of opportunistic infections and malignant tumours; abbreviated AIDS.[oxforddictionaries.com]
  • The first symptoms of the illness are generally night sweats, weight loss, and oral thrush.[conservapedia.com]
  • loss and brain tumors.[cedars-sinai.edu]
Fatigue
  • Fatigue was defined by patient self-report. The outcomes were the prevalence of fatigue and the potential risk factors of fatigue.[ncbi.nlm.nih.gov]
  • Symptoms may include night sweats and fatigue, fever, cough, difficulty breathing, weight loss. Most likely to occur when the CD4 T cell count falls below 200.[conservapedia.com]
  • These may include dyspnea, nutritional wasting, fatigue, pain, and incontinence.[medical-dictionary.thefreedictionary.com]
  • .  Persistent white spots or unusual lesions on tongue or in face  Persistent headaches, Blurred and distorted vision ,Persistent fatigue , Swelling of lymph nodes for more than three months  There is more likely to develop certain cancers, especially[slideshare.net]
  • Mycobacterium Avium Complex — This is a bacterial infection that can cause persistent fever, night sweats, fatigue, weight loss, anemia, abdominal pain, dizziness, diarrhea and weakness.[ucsfhealth.org]
Prostitute
  • There were small reported rates of homosexuality, anal intercourse, and prostitution. Of respondents, 22% reported alcohol use and 22% had tried recreational drugs. None had ever taken drugs intravenously.[pediatrics.aappublications.org]
  • Currently, most new infections worldwide are spread by promiscuous heterosexual sex and prostitution. "We owe it to Ryan to make sure that the fear and ignorance that chased him from his home and his school will be eliminated.[conservapedia.com]
  • A small number of participants (67 or 2.4%) engaged reported promiscuous sexual behavior with both prostitutes and other sexual partners.[bmcpublichealth.biomedcentral.com]
  • A variation in the HLA-G gene, for example, was identified in a subset of female prostitutes who had remained HIV-negative despite having had sexual contact with more than 500 HIV-positive men.[britannica.com]
  • Evidence for HTLV-III infection in prostitutes in Tamil Nadu (India). Indian Journal of Medical Research , 85, 335–8. Find this resource: Medline Simonsen, L., Kane, A., Lloyd, J., Zaffran, M., and Kane, M. (1999).[oxfordmedicine.com]
Anemia
  • In univariate analysis, the significant differences in demographic characteristics between patients with and without fatigue were: gender [OR 2.29; 95% CI (1.05-4.98)], education level [OR 0.40; 95% CI (0.18-0.85)], anemia [OR 3.80; 95% CI (1.27-11.31[ncbi.nlm.nih.gov]
  • Moyamoya syndrome is associated with meningitis, tuberculosis, syphilis, head trauma, head irradiation, brain tumor, von Recklinghausen's disease, tuberous sclerosis, Marfan syndrome, sickle cell anemia, arteriosclerosis, hypertension, and oral contraceptive[ncbi.nlm.nih.gov]
  • Bacterial infection that can cause persistent fever, night sweats, fatigue, weight loss, anemia, abdominal pain, dizziness, diarrhea and weakness. Most likely occurs when the CD4 T cell count falls below 50. Mycobacterium tuberculosis (TB).[conservapedia.com]
  • When the CD4 drops below 50, a widespread body infection may occur causing symptoms such as fever, night sweats, diarrhea, anemia, hepatitis, and sepsis Non-Hodgkin’s lymphoma (a type of cancer involving white blood cell lymphocytes and the lymph node[dovemed.com]
  • Spleen removal may be necessary because of conditions like cirrhosis of the liver , sickle cell anemia , or trauma to the spleen. Aging also weakens your immune system.[healthline.com]
Diarrhea
  • The case of a 41-year-old male with AIDS who presented with weight loss, abdominal pain, ascites, edema, nausea, vomiting, and diarrhea is discussed. A computed tomography (CT) scan of the abdomen showed avid enhancement of the stomach mucosa.[ncbi.nlm.nih.gov]
  • Common presentations include headache, fits, altered mental status, or paralysis Cryptosporidium diarrhea, which is marked by the presence of extreme watery-diarrhea and caused by the parasite Cryptosporidium.[dovemed.com]
  • Without treatment, a person might experience fevers, night sweats, diarrhea or swollen lymph nodes for several weeks.[cedars-sinai.edu]
  • (vii) If HIV were to cause AIDS, it would have a paradoxical, country-specific pathology, causing over 90% Pneumocystis pneumonia and Kaposi sarcoma in the U.S. but over 90% slim disease, fever, and diarrhea in Africa.[ncbi.nlm.nih.gov]
  • […] indicative of AIDS if the patient has a positive serologic or virologic test for HTLV-III/LAV: (1) disseminated histoplasmosis (not confined to lungs or lymph nodes), diagnosed by culture, histology, or antigen detection; (2) isosporiasis, causing chronic diarrhea[cdc.gov]
Chronic Diarrhea
  • diarrhea (over 1 month), diagnosed by histology or stool microscopy; (3) bronchial or pulmonary candidiasis, diagnosed by microscopy or by presence of characteristic white plaques grossly on the bronchial mucosa (not by culture alone); (4) non-Hodgkin's[cdc.gov]
  • The patient had a history of chronic diarrhea, progressive dyspnea and loss of approximately 20kg in eight months. Seven days prior to admission, he began a progressive decrease in consciousness.[scielo.br]
  • Other common symptoms include chronic diarrhea and nerve problems. It is most likely to occur when a person’s CD4 T cell count falls below 100 cells per cubic millimeter of blood.[ucsfhealth.org]
  • The parasite grows in your intestines and bile ducts, leading to severe, chronic diarrhea in people with AIDS. Cancers common to HIV/AIDS Kaposi's sarcoma.[mayoclinic.org]
  • Symptoms include generalized lymphadenopathy, fever, weight loss, and chronic diarrhea.[fpnotebook.com]
Failure to Thrive
  • The clinical manifestations were failure to thrive; 9 children, persistent gastroenteritis; 8, recurrent fever; 5, bacterial infections; 5, hepatosplenomegaly; 5, candidiasis; 1, scabies; 1, skin rash; 2, tuberculous (TB) meningitis; 1 and paraplegia;[ncbi.nlm.nih.gov]
  • Testing can be done within the first few months, but it is also important to recognize the early signs: recurrent infections and failure to thrive.[healthline.com]
  • Common gastrointestinal symptoms include diarrhoea, malabsorption and failure to thrive or losing weight.[patient.info]
  • As the disease progresses, characteristics are a general failure to thrive, anergy, and any of a variety of recurring infections, most commonly Pneumocystis pneumonia, tuberculosis, meningitis, and encephalitis caused by aspergillosis, candidiasis, cryptococcosis[medical-dictionary.thefreedictionary.com]
  • […] to thrive ( B20 ) physical retardation due to malnutrition ( E45 ) ICD-10-CM Diagnosis Code R75 Inconclusive laboratory evidence of human immunodeficiency virus [HIV] 2016 2017 2018 2019 Billable/Specific Code Applicable To Nonconclusive HIV-test finding[icd10data.com]
Loss of Appetite
  • […] of appetite, leading to a disproportionate loss of strength in different muscles in the body The CD4 lymphocyte count predicts the type of opportunistic infections and cancers an HIV-infected individual can develop as the count decreases Sometimes, an[dovemed.com]
  • An overgrowth of yeast causes white patches on gums, tongue or lining of the mouth, pain, difficulty in swallowing and loss of appetite. Candida in the esophagus, trachea, bronchi or lungs is AIDS defining.[ucsfhealth.org]
Lesion of the Tongue
  • The signs and symptoms of some of these infections may include: Soaking night sweats Recurring fever Chronic diarrhea Persistent white spots or unusual lesions on your tongue or in your mouth Persistent, unexplained fatigue Weight loss Skin rashes or[mayoclinic.org]
Social Isolation
  • This includes having regular dental checks and their own accommodation. [ 19 ] There may be an element of social isolation and psychological issues may need to be addressed.[patient.info]
  • Direct mechanisms are those that increase the likelihood of a person coming into contact with someone who is HIV positive, for example, through residential segregation and the social isolation of marginalized populations.[epirev.oxfordjournals.org]
Peripheral Neuropathy
  • neuropathy that could cause symptoms such as tingling, numbness, or pain in the lower extremities Hairy leukoplakia characterized by the presence of parallel hairy lines (projections) on the tongue, which is very specific to HIV/AIDS Gum disease (gingivitis[dovemed.com]
  • "Symptom management and self-care for peripheral neuropathy in HIV/AIDS". AIDS Care . 19 (2): 179–89. doi : 10.1080/09540120600971083 . PMID 17364396 . Boshoff C, Weiss R (May 2002). "AIDS-related malignancies". Nature Reviews.[en.wikipedia.org]

Workup

Because many disorders are a part of the clinical presentation of AIDS, physicians must maintain a high index of suspicion when any of the mentioned illnesses or infections appear together with a poor general condition. For this reason, a comprehensive workup is necessary to rule out HIV infection and AIDS as a possible cause [2]. Firstly, a detailed patient history must include assessment of potential risk factors such as unprotected sexual intercourse, particularly male homosexual (as the vast majority of patients in the developed world are males belonging to the men having sex with men - MSM population), contact with blood products (through intravenous drug use) or a positive family history in the setting of vertical transmission [2] [6] [7]. Moreover, the appearance of any of the infections (or their respective signs and symptoms) in recent months should be noted, and a detailed and complete physical examination may confirm cutaneous, pulmonary, or general manifestations of AIDS and warrant a laboratory investigation to diagnose the clinical entity. A neurological exam (including the mini-mental status examination) must be carried out in all patients suspected to have severe HIV infection, in order to assess the extent of neurological involvement and detect AIDS-related dementia. In addition to a complete blood count (CBC), which will show lymphopenia in virtually all patients, an extensive biochemical panel is necessary to evaluate organ status - lipid profile, liver and kidney function, and a full electrolyte panel [2] [3] [7]. If the diagnosis of HIV is not already known, testing for HIV antibodies is the first step in confirming this infection, followed by a CD4+T-cell count and isolation of viral RNA through polymerase chain reaction (PCR) analysis. Classification of patients harboring an HIV infection, supplementary to clinical criteria, is based on the CD4+T-cell count as well, and a number of < 200/µL is diagnostic for AIDS [2]. Additional recommended procedures include syphilis testing with the Venereal disease research laboratory test (VDRL) and rapid plasma reagin (RPR) tests, detection of anti-toxoplasma antibodies, purified protein derivative (PPD) test for tuberculosis, and determine possible coinfection by hepatitis viruses (A, B, or C) [3] [6] [7].

Anergy
  • As the disease progresses, characteristics are a general failure to thrive, anergy, and any of a variety of recurring infections, most commonly Pneumocystis pneumonia, tuberculosis, meningitis, and encephalitis caused by aspergillosis, candidiasis, cryptococcosis[medical-dictionary.thefreedictionary.com]

Treatment
  • After adjusting for other factors, a shorter time of treatment with TCM, male sex, older age, lower CD4 T-cell counts, and long-term treatment with cART were risk factors of mortality.[ncbi.nlm.nih.gov]
  • Family's denial of infection as well as 'hiding information' concerning patient's health from physicians involved in her treatment caused a delay in proper on-time patient treatment.[ncbi.nlm.nih.gov]
  • […] for treatment of AIDS.[ncbi.nlm.nih.gov]
  • Surgical treatment appears to be an important measure to reduce the tissue parasite load in patients with severe immunodeficiency.[ncbi.nlm.nih.gov]
  • Achieving the WHO/UNAIDS antiretroviral treatment 3 by 5 goal: what will it cost? Lancet 2004;364:63-4. 9. Mukherjee J. Basing treatment on rights rather than ability to pay: 3 by 5. Lancet 2004; 363:1071-2. 10.[scielosp.org]

Prognosis
  • When patients with penicilliosis/AIDS were diagnosed early and treated with standardized antifungal therapy and combined antiretroviral therapy, their prognosis improved.[ncbi.nlm.nih.gov]
  • Physicians should pay attention to this rare case of progressive outer retinal necrosis associated occlusive vasculitis with very poor prognosis in spite of aggressive treatment.[ncbi.nlm.nih.gov]
  • Critical issues surrounding the diagnosis, screening of blood products, treatment of complicating infections and cancers, and prognosis for immunologic recovery in affected persons are unresolved.[annals.org]
  • The high mortality and grim ultimate prognosis seen may have implications for pediatricians attempting to identify the proper limits of medical intervention for this group of patients. respiratory failure acquired immunodeficiency syndrome Pneumocystis[pediatrics.aappublications.org]

Etiology
  • Ménétrier disease is a rare disorder of unknown etiology. An overexpression of TGF-alpha has been proposed to play a role in the pathophysiology.[ncbi.nlm.nih.gov]
  • This study was undertaken to determine the etiology of acute respiratory failure and the outcome of children with AIDS and AIDS-related complex.[pediatrics.aappublications.org]
  • AIDS was defined for national reporting before its etiology was known and has encompassed only certain secondary conditions that reliably reflected the presence of a severe immune dysfunction.[cdc.gov]
  • Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10data.com]
  • Luthy, R. acquired immune deficiency syndrome in humans, clinical review of diagnosis, etiology, epidemiology, prophylaxis, and treatment, includes information on parasitic opportunistic infections associated with syndrome Cryptosporidium Toxoplasma gondii[agris.fao.org]

Epidemiology
  • A historical framework for social epidemiology. In: Berkman LF, Kawachi I, eds. Social epidemiology. New York, NY: Oxford University Press, 2000:3–12. 2. Krieger N. A glossary for social epidemiology.[epirev.oxfordjournals.org]
  • During submission, authors are given the option to submit papers to one of the following tracks: Basic Science , Clinical Science, Translational Research , Epidemiology , Implementation Science , Prevention Research , and Critical Review .[journals.lww.com]
  • This study is an observational and retrospective study aimed at the characterising IFI incidence and describing the epidemiology, clinical diagnostic and therapeutic features and denouement in HIV/AIDS patients.[ncbi.nlm.nih.gov]
  • The hypothesis that HIV causes AIDS is examined in terms of Koch's postulates and epidemiological, biochemical, genetic, and evolutionary conditions of viral pathology.[ncbi.nlm.nih.gov]
  • A steadily growing body of epidemiologic evidence indicates an infectious (probably viral) cause of the immunodeficiency although the responsible agent(s) remains obscure.[annals.org]
Sex distribution
Age distribution

Pathophysiology
  • Currently suggested pathophysiological mechanisms of the disease are mostly derived from stroke cases. Although rare, cerebral toxoplasmosis may strengthen the pathophysiologic mechanism of disease.[ncbi.nlm.nih.gov]
  • An overexpression of TGF-alpha has been proposed to play a role in the pathophysiology. HIV-1 tat gene product has been shown to stimulate TGF-alpha production leading to a positive feedback autocrine loop.[ncbi.nlm.nih.gov]
  • AIDS Symptoms AIDS Pathophysiology AIDS Transmission AIDS Treatment AIDS Prognosis History of AIDS AIDS Stigma[news-medical.net]
  • The textbook, now in its 29th edition, includes a general discussion of the pathophysiology of HIV infection, organ system pathology of AIDS, and descriptions of the opportunistic infections and neoplasms associated with AIDS, and a general discussion[library.med.utah.edu]

Prevention
  • […] infections and prevention of mother-to-child transmission.[scielosp.org]
  • Evidence-based HIV behavioral prevention from the perspective of the CDC’s HIV/AIDS Prevention Research Synthesis Team. AIDS Education and Prevention , 18(4 Suppl. A), 21–31.[oxfordmedicine.com]
  • Studies to advance the treatment and prevention of HIV-associated comorbidities (cancer, metabolic, neurologic, cardiovascular) and coinfections especially TB and Hepatitis C are of high interest to JAIDS.[journals.lww.com]
  • Center for Disease Control and Prevention (2002). Guidelines for using antiretroviral agents among HIV-infected adults and adolescents. Morbidity and Mortality Weekly Report, 1 , RR-07. Google Scholar 3.[link.springer.com]
  • Avoid casual sex partners and unprotectedsexNever share injecting needlesMedical personnel should take appropriateprecaution to prevent potential transmission gain enough knowledge on HIV/AIDSDo HIV screening test 9.  AIDS is caused by HIV.[slideshare.net]

References

Article

  1. Campbell-Yesufu OT, Gandhi RT. Update on Human Immunodeficiency Virus (HIV)-2 Infection. Clin Infect Dis. 2011;52(6):780-787.
  2. Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.
  3. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  4. Ortblad KF, Lozano R, Murray CJL. The burden of HIV: insights from the Global Burden of Disease Study 2010. AIDS (London, England). 2013;27(13):2003-2017.
  5. GBD 2015 HIV Collaborators. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015. Lancet HIV. 2016 Aug; 3(8):e361–e387.
  6. Centers for Disease Control and Prevention (CDC). Revised surveillance case definition for HIV infection--United States, 2014. MMWR Recomm Rep. 2014;63(RR-03):1-10.
  7. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.

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Last updated: 2018-06-21 17:43