Acquired immunodeficiency syndrome, or AIDS, is a serious secondary immunodeficiency disorder. AIDS is caused by human immunodeficiency virus (HIV). There is progressive destruction of cell-mediated (T cell) immunity. Also, both conditions are characterized by subsequent effects on humoral immunity (B-cell). This is because CD4+ helper T cells play an important role in immune reactions. The patient is more susceptible to opportunistic infections such as unusual cancers and other abnormalities due to immunodeficiency. AIDS was first described by the Centers for Disease Control and Prevention (CDC) in 1981.
The Causes of AIDS
HIV has two forms: HIV-1 and HIV-2. Both have the same mode of transmission, although studies have revealed that HIV-2 develops more slowly and causes milder symptoms than HIV-1. The virus can get transmitted by contact with infected blood or bodily fluids. Also, it is associated with identifiable high-risk behaviors.
It has been represented in:
- Homosexual and bisexual men
- Neonates of infected females
- Recipients of contaminated blood
- People who use illicit drugs administered intravenously
- Heterosexual partners or partners of persons in the former groups
Symptoms and disease progression
The symptoms may vary between individuals. Although the effect in damaging the immune system is the same everywhere, the pattern of symptoms may vary depending on the opportunistic infections locally prevalent in a country. For example, in Africa, tuberculosis is a common opportunistic infection that may occur in a person with AIDS, but in Europe, it is less common. Locally, specific case definitions have been developed since some of the symptoms are non-specific and vary between countries.
Development of symptoms
- Uninfected person
- Infected with HIV - This is called the "window period," in which the body has not yet produced antibodies to HIV.
- Development of antibodies - Mild fever in some cases is observed, during seroconversion.
- Symptoms of AIDS
There is a period of 3 to 12 weeks after infection before the body responds to it by producing antibodies to HIV. Some people may experience a short bout of fever. From the time the person is infected with the virus, the person is believed to be in the carrier state, which is free of symptoms, but can pass the virus to other individuals. The time this virus takes to develop into AIDS may vary. In infected babies, it takes only about two years, whereas in adults, it may take around seven to ten years or even longer.
Signs and Symptoms of AIDS
For months or years, the person with HIV may remain asymptomatic. Initially, the only clinical evidence of infection may be laboratory evidence or seroconversion to HIV antibodies. Later, as the disease progresses, the person may develop non-specific signs and symptoms such as night sweats, weight loss, fatigue, and fever. Further, as the T-cell count goes lower, the person may develop neurological symptoms such as certain rare cancers and opportunistic infections. There is a major dysfunction of the immunological system, since HIV destroys lymph nodes and immunologic organs. Eventually, it advances to AIDS. Some individuals may develop AIDS slowly or not at all. These are termed as nonprogressors. Due to genetic differences, the virus is prevented from attaching to certain immune receptors.
The World Health Organization has produced a clinical case definition for AIDS called the "Bangui case definition." This has been produced for Africa, but it is also currently used by India.
Case definition for AIDS: Two major signs, at least one minor sign, and absence of known causes of immunosuppression.
- Chronic diarrhea for more than a month
- Chronic fever for more than a month
- Loss of ten percent body weight within a short period
- Persistent cough for more than a month
- Dermatitis - generalized itchy skin lesions
- Recurrent herpes zoster
- Oral candidiasis
- Chronic herpes simplex
- Enlargement of lymph nodes
Kaposi’s sarcoma is a diagnostic disease which by itself is sufficient for a diagnosis of AIDS.
The Stages of HIV Infection
Depending on the stage of the infection, symptoms may occur.
The Early Stage
The symptoms listed below do not determine whether someone has AIDS. The only way to know for sure is by getting tested for HIV. The early stage of HIV is characterized by a flu-like experience. It generally occurs within 2 to 4 weeks after HIV infection. During this stage of the infection, it is also possible for a patient to experience no symptoms or sickness whatsoever.
Below are some of the symptoms that an infected individual may experience during the first 2 to 4 weeks:
The symptoms can last from a few days to several weeks.
It is also possible for an infected individual to receive a negative result in an HIV test during this time. It is important to keep in mind that, despite the lack of a positive result on the test, this individual is still highly infectious and capable of passing the infection on to others. Thus, it is important to let the HIV testing center know if you feel that you may have been infected with HIV. There is also a new HIV test that can detect HIV immediately during this early stage of infection.
The Clinical Latency Stage
The next stage is the clinical latency stage. This stage is also called chronic HIV infection. People may display some or no symptoms at all. This stage can last a decade or longer for people who are not taking medicine. For people who are taking medicine, this stage can last a couple of decades because the medicine keeps the virus under control. Keep in mind, though, that people can still transmit HIV to others even if they do not display any symptoms. Believe it or not, people who are on effective antiretroviral therapy (ART) are less likely to transmit the infection than those who are not known to be virally suppressed although belonging to a high-risk group.
The Final Stage of HIV or AIDS
The final stage of the HIV virus is AIDS. The patient’s immune system is weakened, and he or she will display symptoms during this stage of the virus. The following are some of the symptoms that an individual with AIDS may experience:
- Rapid weight loss
- Recurring fever
- Profuse sweating at night
- Severe and unexplained tiredness
- Prolonged swelling of the lymph glands in the armpits, groin, or neck
- Diarrhea that lasts for about a week
- Sores in or on the mouth, anus, or genitals
- Pinkish or reddish blotches under the skin or inside the nose, mouth, or eyelids
- Neurological disorders
Diarrhea - This is a major sign and very common in people with AIDS. The diarrhea is usually clear and watery, and may be associated with abdominal cramps and vomiting. The most striking feature of AIDS is chronic diarrhea in which there is significant weight loss. In Uganda, it has led to a disease called "Slim." Diarrhea can also be often accompanied by fever and night sweats
Enlarged lymph glands - An important part of the body's immune system is lymph nodes or glands. They are located in various parts of the body. Painless lymph nodes swollen to at least 1 cm diameter is an early sign of AIDS. It is also known as persistent generalized lymphadenopathy or PGL.
Oral thrush - This is a common symptom in which there is a furry white coating on the tongue, roof of the mouth, and sometimes vagina caused by the yeast Candida albicans. In persons with AIDS, this symptom can persist for a long time. It can spread from the mouth to the gullet and lungs. In healthy individuals, Candidiasis is usually not seen.
Chronic herpes simplex - Herpes simplex is a virus. It produces sores in and around the mouth or in the rectal or genital areas. In a person with AIDS, these sores are severe and recur more often, whereas in healthy individuals, these sores are few in number when they occur.
Recurrent Shingles - It starts out as a painful rash with blisters, usually on the face, limbs or trunk. If it occurs on the face, it may affect the eyes, causing pain and blurred vision.
Pneumocystis carinii pneumonia - This is caused by a fungus. It appears as a dry cough that is persistent, and as it spreads, it may develop into fatal pneumonia.
Kaposi’s sarcoma - This is cancer of the cells in the lymph system or blood vessels. It may appear as dark brown or purple raised areas on the skin or in the mouth. It may also appear as enlarged skin nodules and spread to internal organs, causing their enlargement or bleeding from the lungs or digestive tract. Some may experience mild symptoms, while others may become very ill.
Cryptococcal meningitis - This is caused by a yeast-like fungus. Symptoms include fever, mild headache, nausea, vomiting, and blurred vision. If untreated, it can be fatal
Other symptoms of AIDS
Tuberculosis - This is one of the most common opportunistic infections associated with AIDS in developing countries. It is also a major cause of death in people with AIDS. Symptoms are persistent cough, increasing weakness, mild fever, night sweats, appetite loss, and weight loss.
AIDS dementia complex - The virus can damage the brain, spinal cord, and nerves by passing the blood-brain barrier. Symptoms can be unusual and strange behavior, confusion, paralysis, and uncoordinated movements.
AIDS-related complex (ARC) - This was a term used for people who did not fit the initial case definition of AIDS developed by the Centers for Disease Control and Prevention in Atlanta. However, due to the availability of tests for HIV-1 and HIV-2 as well as the WHO's case definition, this term is now used less often.
Diagnosing the Symptoms of AIDS
The signs and symptoms of AIDS may manifest differently in different stages. The initial stages start with fever, chills, and dullness. These symptoms progress to involving the entire body and many organs as well. Once the symptoms appear, do not leave it to guesswork. Instead, seek medical advice from the doctor treating you and focus on early diagnosis in order to start medication and therapy as soon as possible.
Complete reliance on your knowledge of the symptoms alone is not enough. Run a series of thorough investigations and diagnostic tests to support or rule out HIV or AIDS. A number of such tests can be taken at any time. Some of the tests that help determine the presence of the infection are the following:
- ELISA, or Enzyme Linked Immuno Sorbent Assay, is the most common test that helps in detecting HIV infection. This can be followed by one or more tests in a span of a few months. A repeat test is recommended for some patients. Sometimes, a western blot test is done, which is a blood test to confirm the presence of the virus.
- A saliva sample is taken from the patient using a cotton swab and tested for the presence of HIV. It takes a few days to analyze the sample. If the results are positive, a blood sample is also taken to confirm the same.
Taking Care of the Symptoms
After diagnosis, the condition of the patient is observed and treatment begins. This depends on what stage the patient is in. For chronic cases, admission, varied medication, and additional tests are done. The doses are milder for the initial stages. However, a person with the HIV virus alone may not necessarily have AIDS. Even if they have tested HIV positive, treatment is done to suppress the negative effects of the virus. Many times, patients ignore treatment at this stage. This is when the virus may manifest itself in stronger versions later in life. Sometimes, it takes years to cause infection to the immune system and related organs. Proper counseling, treatment, and family support work well for the patient. A lot of care and patience is required in part of the doctor, caregivers, and also the patient.
Do not ignore symptoms like prolonged fever, rapid weight loss, fatigue or tiredness, rashes, muscle pain, neurological issues, unexplained diarrhea, mouth sores, pneumonia, lymphatic swellings, etc. Always remember that the condition can be managed, even if not cured, to maximize longevity to the best extent possible. If the patient follows the proper treatment, it is possible to live a normal life among others and overcome the challenges of the condition.
- Certain unusual cancers
- Opportunistic infections due to immunodeficiency
The Bottom Line
It is always important to get regular checkups and get tested if you suspect anything unusual. It can be a very scary moment when a person gets tested for HIV. However, it is important for yourself and others to get tested if you suspect you may have contracted the infection. Early detection of the virus will help in controlling it and preventing AIDS. HIV can affect more than just one part of the body at one time. When a virus attacks the immune system, it is very dangerous and can cause a lot of problems. The only way to truly know if anything is wrong is to get an HIV test. Contact your local health clinic to schedule an appointment immediately. As stated before, some people may not show symptoms until a couple of weeks after having gotten infected with the virus. Watch for symptoms and any changes in the usual as these may be signs of HIV.