Human Immunodeficiency Virus
Human Immunodeficiency Virus
Symptoms
During primary HIV infection you may have no symptoms, or may experience a short, flulike illness [Table 1]. Symptoms of a primary HIV infection, if present, include sore throat, fever, nausea and vomiting, diarrhea, fatigue, swollen glands, muscle aches, headaches, and joint pain. Occasionally, the virus causes meningitis (inflammation of the lining of the nerves and brain) or encephalitis (inflammation of the brain). The symptoms of the initial infection clear up without treatment within a few weeks, and there may be no additional symptoms for 10 years or more.
Table 1. Symptoms of HIV Infection
| Symptoms of initial infection |
Symptoms of later disease |
Sore throat
Fever
Nausea and vomiting
Fatigue
Swollen lymph nodes
Headaches, muscle aches, joint pain
Occasionally meningitis or encephalitis |
Enlarged lymph nodes over several areas of the body
Persistent fever, night sweats, or chills
Sudden unexplained weight loss
Persistent diarrhea
Mouth sores
Persistent dry cough
Persistent oral (thrush) or vaginal yeast infections |
After the primary infection, infected persons will enter an asymptomatic phase. During the asymptomatic phase of HIV infection, the virus becomes established in the body, and a person's CD4 count will decrease. An infected person at this stage will not, however, experience any symptoms for several years.
When HIV symptoms recur, many different parts of the body may be affected. The most common persistent symptom of HIV infection is often enlarged or sore glands (lymph nodes) in the neck, armpit, and groin. Other symptoms include fatigue, chills, fever, night sweats, skin rash, persistent headache, unexplained weight loss lasting at least one month, diarrhea for several weeks or more, a persistent dry cough, a white coating on the tongue (thrush), [Figure 1] or persistent vaginal yeast infections.
Figure 1. Oral Thrush
A white coating on the tongue (oral thrush) is a common sign of HIV infection.
In its late stages (AIDS), HIV infection may spread to the central nervous system, causing dementia and other neurological disorders. In some people infected with HIV, the virus causes a cluster of symptoms known as AIDS dementia complex, or HIV encephalopathy. Symptoms of this complex include impaired ability to concentrate, increased forgetfulness, difficulty reading, or increased difficulty performing complex tasks. In addition, the complex may also include behavioral changes such as apathy, and motor difficulties such as unsteady gait, poor balance, and tremors. Late stages may also be characterized by bowel or bladder incontinence.
Multiple infections and cancer may develop as the immune system weakens [Table 2]. In addition, people with HIV may develop Kaposi's sarcoma [Figure 2], a rare cancer of the blood vessels that manifests as bluish-red nodules on the surface of the skin.
Figure 2. AIDS-related Kaposi's Sarcoma.
Kaposi's sarcoma (shown) is a rare cancer of the blood vessels that is associated with HIV. It manifests as bluish-red oval-shaped patches that may eventually become thickened. Lesions may appear singly or in clusters. Men who have sex with men (MSM) and contract HIV are far more likely to get Kaposi's sarcoma than other people infected with HIV.
Table 2. Opportunistic Infections Associated with HIV Infection
| Infection | Symptoms |
|---|
| Latent/minimally symptomatic stage |
| Candidiasis | Oral yeast infections: white patches on the gums, tongue, or lining of the mouth; pain or difficulty swallowing; loss of appetite. Vaginal yeast infections: burning, itching, discharge. |
| Tuberculosis | Cough, weight loss, night sweats, fatigue, fever, coughing up blood. |
| Herpes simplex infection | Painful blisters, ulcers, and/or itching on the lips, anus, or genitals. |
| Late stage (AIDS) |
| Pneumocystis carinii pneumonia | Fever, dry cough, difficulty breathing, weight loss, night sweats, fatigue. |
| Cryptococcal meningitis | Mild headaches, malaise, fever, nausea, fatigue, loss of appetite, altered mental status. |
| Toxoplasmosis | Altered mental states, paralysis on one side of the body, seizures, severe headaches, fever. |
| Mycobacterium avium complex (MAC) | Fever, night sweats, fatigue, weight loss, diarrhea, anemia, abdominal pain, weakness, dizziness, nausea, enlarged glands, enlarged liver and spleen. |
| Cytomegalovirus (CMV) infections | Blurry vision, pain or difficulty swallowing, fever, diarrhea, abdominal pain, weight loss. |
| Esophageal candidiasis | Pain or difficulty swallowing. |
| Histoplasmosis | Fever, weight loss, skin lesions, difficulty breathing, enlarged glands. |
|
| Chronic mucocutaneous herpes | Large, painful ulcers and/or itching on the lips, anus, or genitals that won't go away. |
| Crytosporidiosis | Diarrhea, abdominal cramping, nausea, vomiting, fatigue, gas, weight loss, loss of appetite, constipation, dehydration. |
Risk Factors
Engaging in unsafe sexual practices increases your risk of contracting HIV. Unsafe sexual practices include having sex with an HIV-infected person without using latex condoms, having multiple sex partners, and having sex with someone in a high-risk group. High-risk groups include men who have sex with men (MSM), people of either sex who have multiple sex partners, and intravenous drug users.
Sharing needles for intravenous drug use increases your risk of contracting HIV. HIV is more common among intravenous drug users than among the general population. Sharing needles or intravenous drugs puts you at serious risk of exposure to and infection with HIV. Sharing needles also increases the risk of transmitting other blood-borne pathogens such as hepatitis B and hepatitis C.
Needlesticks from an HIV-positive source constitute a risk for healthcare workers and others whose jobs bring them in contact with blood or other bodily fluids: 3 in 1,000 needlesticks from an HIV-positive source will result in HIV infection.
The HIV virus can be transmitted through the blood supply and through blood treatments, such as Factor VIII, that are derived from pooled blood products. In the early stage of the HIV epidemic, a number of people became infected with the virus through blood transfusions, and nearly 90% of boys and men with hemophilia A contracted the virus. Blood clotting factors, such as Factor VIII, are now made via recombinant genetic technology, and no longer rely on blood products from donors, eliminating the risk of HIV spread. In the developed world, the blood supply is checked thoroughly and the risk of HIV transmission in incredibly small.
An infected mother can spread HIV to her developing fetus. Taking HIV medication to prevent transmission of the virus during pregnancy, delivery and after birth has greatly diminished the risk of spreading the infection in this manner. An infected mother can also pass along the virus in her breast milk.
HIV can be spread through organ donation, from an infected donor to an uninfected recipient. Organ donors and organs now undergo extensive testing to avoid this unfortunate situation.
