What are the symptoms of HIV infection and AIDS?
Primary HIV infection can be asymptomatic or cause transient nonspecific symptoms of HIV infection (acute retroviral syndrome). Acute retroviral syndrome usually begins at the 1-4 th week after infection and lasts from 3 to 14 days. It occurs with fever, weakness, rash, arthralgia, generalized lymphadenopathy, and aseptic meningitis sometimes develops. These symptoms of HIV infection are often mistaken for infectious mononucleosis or nonspecific manifestations of symptoms of respiratory viral infection.
Most patients have a period of several months to several years, during which the symptoms of HIV infection are practically absent, they are mild, intermittent and nonspecific. These symptoms of HIV infection are subsequently explained when other manifestations of HIV or opportunistic infections develop. Most often develop asymptomatic generalized lymphadenopathy, oral cavity candidiasis, herpes zoster, diarrhea, weakness and fever. In some patients, depletion develops and progresses. Usually there is asymptomatic moderate cytopenia (leukopenia, anemia, thrombocytopenia).
Eventually, when the CD4 + lymphocyte count falls below 200 cells / mm3, the symptoms of HIV infection become more pronounced and one, and more often, one, AIDS-indicator disease develops (categories B, C in Table 192-1). Detection of infections caused by Mycobacterium spp, Pneumocystis jiroveci (formerly P. Carinn), Cryptococcus neoformans or other fungal infections is crucial. The remaining infections are nonspecific, but suggest the presence of AIDS due to unusual severity or recurrent course. These include: herpes zoster, herpes simplex, vaginal candidiasis, recurrent salmonella sepsis. Some patients develop tumors (eg, Kaposi's sarcoma, B-cell lymphomas) that occur more frequently, have a more severe course, or have an uncertain prognosis in HIV-infected patients. Some patients may have dysfunction of the nervous system.
Clinical groups of HIV infection
- Asymptomatic current
- Symptoms of acute primary HIV infection
- Persistent generalized lymphadenopathy
- Cryptosporidiosis, chronic gastrointestinal lesion (> 1 month)
- CMV infection (without lesions of the liver, spleen, lymph nodes)
- Bacterial angiomatosis
- Cytomegalovirus retinitis (with loss of vision)
- Oropharyngeal candidiasis
- Vulvovaginal candidiasis: persistent, frequent, poorly treatable
- Cervical dysplasia (moderate or severe) / cervical cancer in situ
- Common symptoms are fever> 38.5 ° C or diarrhea lasting more than 1 month
- Hairy leukoplakia of the mouth
- Herpes zoster - at least 2 proven episodes of infection or lesion of more than 1 dermatome
- Autoimmune thrombocytopenic purpura
- Inflammatory diseases of the pelvic organs, especially if complicated by a tubo-ovarian abscess
- Peripheral Neuropathy
- HIV-related encephalopathy
- Herpes simplex: chronic rashes (lasting more than 1 month) or bronchitis, pneumonitis, esophagitis
- Common or extrapulmonary histoplasmosis
- Isosporiasis (chronic gastrointestinal lesion> 1 month)
- Kaposi's Sarcoma
- Burkitt's lymphoma
- Immunoblastic lymphoma
- Primary CNS lymphoma
- Common or extrapulmonary lesions caused by Mycobacterium avium or Mycobacterium kansasii
- Pulmonary and extrapulmonary diseases caused by Mycobacterium tuberculosis
- Common or extrapulmonary damage caused by Mycobacterium of other species or unspecified species
- Candidiasis of bronchi, trachea, lungs
- Candidiasis of the esophagus
- Invasive cervical cancer
- Common or extrapulmonary coccidioidomycosis
- Extrapulmonary cryptococcosis
- Pneumonia caused by Pneumocystis proved (before P. Carinii)
- Recurrent pneumonia
- Progressive multifocal leukoencephalopathy
- Recurrent salmonella septicemia
- Toxoplasmosis of the brain
- Cachexy caused by HIV
The most frequent neurologic syndromes in HIV infection
- Cryptococcal meningitis
- Cytomegalovirus encephalitis
- Primary CNS lymphoma
- Progressive multifocal leukoencephalopathy
- Tuberculous meningitis or focal encephalitis
- Toxoplasmic encephalitis
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Tumors often found in HIV-infected patients
Kaposi's sarcoma, non-Hodgkin's lymphoma, cervical cancer are AIDS-indicator tumors in HIV-infected patients. Other tumors: Hodgkin's lymphoma (especially mixed-cell and lymphopenic subtypes), primary CNS lymphoma, anal cancer, testicular cancer, melanoma and other skin tumors, lung cancer occur more frequently and are more severe. Leiomyosarcoma is a rare complication of HIV infection in children.
The incidence of non-Hodgkin's lymphoma in HIV-infected patients increases 50 to 200 times. Most of them are B-cell aggressive histologically highly differentiated lymphomas. In this disease, extranodal structures such as red bone marrow, gastrointestinal tract and other organs that are rarely affected by non-HIV-associated non-Hodgkin's lymphoma are involved in the process, the central nervous system and the body cavity (pleural, pericardial and abdominal).
Typically, the disease manifests itself by a rapid increase in lymph nodes or extranodal formations or systemic manifestations, such as weight loss, night sweats and fever. Diagnosis is established by biopsy with histological and immunochemical examination of tumor cells. Abnormal lymphocytes in the blood or unexplained cytopenia indicate the involvement of the red marrow in the process and require a biopsy. Determining the stage of the tumor may require the study of CSF, as well as CT or MRI of the chest, abdominal cavity and all other localizations where a tumor is suspected. The prognosis is poor for CD4 + lymphocytes <100 cells / μl, age over 35 years, poor functional state, red bone marrow affection, opportunistic infections in the history and highly differentiated histological subtype of lymphoma.
Non-Hodgkin's lymphoma is treated with systemic polychemotherapy (cyclophosphamide, doxorubicin, vincristine and prednisolone), usually in combination with antiretroviral drugs, blood growth factors, prophylactic antibiotics and antifungal agents. Therapy may be limited to the development of severe myelosuppression, especially when a combination of myelosuppressive antitumor drugs and antiretroviral drugs is used. Another possible option is the use of intravenously anti-CD20 monoclonal antibodies (rituximab), which are effective in treating non-Hodgkin's lymphoma in patients without HIV infection. Radiation therapy reduces the size of large tumors and reduces pain and bleeding probability.
Primary lymphoma of the central nervous system
Primary CNS lymphomas develop in HIV-infected patients at a higher frequency than in the general population. The tumor consists of moderately and highly differentiated malignant B cells derived from CNS tissue. It is manifested by the following symptoms: headache, epileptic seizures, neurological defects (paralysis of the cranial nerves), change in mental status.
Urgent therapy includes the prevention of cerebral edema and radiation therapy of the brain. A tumor is usually sensitive to radiation therapy, but the average life expectancy does not exceed 6 months. The role of anti-tumor chemotherapy is unknown. Life expectancy increases with the use of HAART.
Cervical cancer in HIV-infected patients is difficult to treat. In HIV-infected women, the incidence of human papillomavirus is increased, the persistence of its oncogenic subtypes (types 16, 18, 31, 33, 35 and 39), as well as intraepithelial dysplasia of the cervix (60%), but they do not a significant increase in the incidence of cervical cancer. Cervical cancer in these women is more severe, more difficult to treat and has a higher incidence of relapse after recovery. The commonly recognized risk factors for HIV-infected patients are: infection with human papillomavirus subtypes 16 or 18, the number of CD4 + lymphocytes <200 cells / μl, age over 34 years. HIV infection does not worsen the course of VIDM and cervical cancer. To control the progression of the process it is important to often take smears on Papanicolaou. Carrying out HAART can cause the cessation of papillomavirus infection, regression of VDSM, its effect in cervical cancer has not been studied.
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Squamous cell carcinoma of the anus and vulva
Squamous cell carcinoma of the anus and vulva is caused by human papillomavirus and is more common in HIV-infected patients. The reason for the high frequency of this pathology in HIV-infected patients is the frequent occurrence of high-risk behaviors among them, that is, anal intercourse, and not HIV itself. Often there is anal dysplasia, against which squamous cell carcinoma of the anus can be very aggressive. Treatment includes surgical extirpation of the tumor, radiotherapy, combined modal chemotherapy with mitomycin or cisplatin in combination with 5-fluorouracil.