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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.


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
  • 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]
  • Symptoms include generalized lymphadenopathy, fever, weight loss, and chronic diarrhea.[fpnotebook.com]
  • In some patients, persistent generalized lymphadenopathy is an outward sign of infection. During this time, the viral load, if untreated, tends to persist at a relatively steady state, but the CD4 T-cell count steadily declines.[emedicine.medscape.com]
  • "Persistent, generalized lymphadenopathy among homosexual males" . MMWR Morb Mortal Wkly Rep . 31 (19): 249–251. PMID 6808340 . Archived from the original on October 18, 2011 . Retrieved August 31, 2011 .[en.wikipedia.org]
Cough
  • 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]
  • 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]
  • TB is transmitted when a person with active TB coughs or sneezes, releasing microscopic particles into the air. If inhaled, these particles may transmit the condition.[ucsfhealth.org]
  • […] weight that’s not from increased exercise or dieting bruising more easily than normal long periods of frequent diarrhea frequent fevers and/or night sweats swelling or hardening of glands located in your throat, armpit, or groin persistent, deep, dry coughing[plannedparenthood.org]
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
  • Without treatment, a person might experience fevers, night sweats, diarrhea or swollen lymph nodes for several weeks.[cedars-sinai.edu]
  • 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]
  • Symptoms include confusion or delusional behavior, severe headaches, fever, seizures and coma.[conservapedia.com]
  • Only five patients did not present with headache, confusion, fever, or seizures. The duration of specific symptoms before presentation ranged from 5 to 28 days.[nejm.org]
Weight Loss
  • 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]
  • 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: Infections - Candidiasis[symptoma.com]
  • Eventually most patients infected with HIV experience a syndrome of symptoms that includes excessive fatigue , weight loss , and/or skin rashes .[webmd.com]
Fatigue
  • 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]
  • 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[symptoma.com]
  • Eventually most patients infected with HIV experience a syndrome of symptoms that includes excessive fatigue , weight loss , and/or skin rashes .[webmd.com]
  • These may include dyspnea, nutritional wasting, fatigue, pain, and incontinence.[medical-dictionary.thefreedictionary.com]
  • Some people experience relentless fatigue and weight loss , known as "wasting syndrome." Others may develop confusion or sleepiness due to infection of the brain with HIV, known as HIV encephalopathy .[medicinenet.com]
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]
  • In addition, studies have identified the importance of migrant labor in the creation of markets for prostitution ( 134 ).[epirev.oxfordjournals.org]
Malaise
  • […] children under 15 years 2.7 million people became newly infected with HIV Following infection with the HIV virus, individuals experience a nonspecific, flu-like seroconversion illness, manifesting as fever, sore throat, lymphadenopathy, skin rash and malaise[radiopaedia.org]
  • Examination Patients with immunodeficiency often look ill on presentation, with pale skin, general malaise, cachexia and a distended abdomen. Various skin manifestations may be apparent, such as rashes, vesicles, pyoderma, eczema and telangectasia.[patient.info]
  • During that time a variety of symptoms may occur, such as fever , enlarged lymph nodes , sore throat , muscle and joint pain, rash, and malaise .[britannica.com]
  • Manifestations include the following: Acute seroconversion manifests as a flulike illness, consisting of fever, malaise, and a generalized rash The asymptomatic phase is generally benign Generalized lymphadenopathy is common and may be a presenting symptom[emedicine.medscape.com]
Diarrhea
  • 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]
  • 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[symptoma.com]
  • (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]
Failure to Thrive
  • 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]
  • Symptoms of HIV in infants and children may include: Failure to thrive or failure to gain weight or grow Oral thrush or severe diaper rash Pneumonia Diarrhea Ear infections Colds Symptoms of HIV in adolescents may include: Headache Diarrhea Nausea and[iuhealth.org]
  • 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]
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
  • 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[symptoma.com]
  • Neuropathy University of Chicago 5841 South Maryland Ave, MC 2030 Chicago, IL 60637 Tel: (773)702-5659 Fax: (773)702-5577 Internet: For a Complete Report This is an abstract of a report from the National Organization for Rare Disorders (NORD).[webmd.com]
  • 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 (2002). "AIDS-related malignancies".[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

  • 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]
  • […] labor and short-term treatment of the infant after birth.[stanfordchildrens.org]
  • Toxicity commonly complicates the treatment of toxoplasmosis.[nejm.org]
  • Encouraging early treatment is crucial for persons that test HIV positive (Levenson 1996).[family.jrank.org]
  • Without treatment of the mother and without breastfeeding, the risk of transmission to the baby is about 25%. With treatment of the mother before and during birth and with treatment of the baby after birth, the risk decreases to less than 2%.[medicinenet.com]

Prognosis

  • Chagasic meningoencephalitis has a bad prognosis when no specific treatment is initiated or when it is delayed [10,20,24].[scielo.br]
  • Some conditions such as selective IgAD have a good prognosis.[patient.info]
  • AIDS Symptoms AIDS Pathophysiology AIDS Transmission AIDS Treatment AIDS Prognosis History of AIDS AIDS Stigma[news-medical.net]
  • What is the prognosis for HIV infection? Left untreated, HIV is almost always a fatal illness with half of people dying within nine months of diagnosis of an AIDS-defining condition. The use of ART has dramatically changed this grim picture.[medicinenet.com]

Etiology

  • 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]
  • Eine Ubersicht nach zwei Jahren 1983 acquired immune deficiency syndrome in humans, clinical review of diagnosis, etiology, epidemiology, prophylaxis, and treatment, includes information on parasitic opportunistic infections associated with syndrome [[agris.fao.org]
  • A useful feature to differentiate the etiology is the absence of lesions in basal ganglia in Chagas' disease, which is generally a common target in toxoplasmic encephalitis [3,10,29].[scielo.br]
  • (Etiology) The causes of Acquired Immunodeficiency Syndrome include: The human immunodeficiency virus type 1 (HIV-1) causes AIDS.[dovemed.com]
  • Commentary: considerations for use of racial/ethnic classification in etiologic research. Am J Epidemiol 2001 ; 154 : 291 –8. 85. Mays VM, Ponce NA, Washington DL, et al. Classification of race and ethnicity: implications for public health.[epirev.oxfordjournals.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]
  • 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]
  • These estimates can be obtained through epidemiologic studies or special surveys in specific populations.[cdc.gov]
  • In Uganda, which is often cited for its comprehensive, multisectoral response to HIV/AIDS ( 41 ), attributing epidemiological changes to specific interventions is difficult.[scielosp.org]
  • Outbreak measures for HIV infection The epidemiology of HIV is closely monitored in Victoria. Public health action is informed by enhanced epidemiological information notified to the department.[www2.health.vic.gov.au]
Sex distribution
Age distribution

Pathophysiology

  • AIDS Symptoms AIDS Pathophysiology AIDS Transmission AIDS Treatment AIDS Prognosis History of AIDS AIDS Stigma[news-medical.net]
  • The textbook, now in its 28th 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]
  • Pathophysiology HIV produces cellular immune deficiency characterized by the depletion of helper T lymphocytes (CD4 cells). The loss of CD4 cells results in the development of opportunistic infections and neoplastic processes.[emedicine.medscape.com]

Prevention

  • […] infections and prevention of mother-to-child transmission.[scielosp.org]
  • All the biological prevention strategies depend on behavioural adherence to the given prevention tool, and can be undermined by human rights violations and gender-power imbalances that conspire to reduce access to prevention services.[oxfordmedicine.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]
  • As a result, effective prevention of AIDS/HIV transmission among the migrant population remains challenging.[bmcpublichealth.biomedcentral.com]
  • Control measures for HIV infection Preventive measures Preventive measures for HIV centre on personal and institutional factors.[www2.health.vic.gov.au]

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.

Symptoms

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