B7. Clinical outcome and symptoms of AIDS

Human immunodeficiency virus (HIV) is a retrovirus which causes HIV infection. If left untreated, it will lead to acquired immunodeficiency syndrome (AIDS), a condition characterised by a CD4+ T-cell count of < 200/µL and/or the presence of so-called AIDS-defining condition, whichever occurs first.

38 million people worldwide live with AIDS, and every year around 1,7 million people are infected. 60% of new cases are in sub-Saharan Africa.

With proper lifelong modern treatment, people with HIV can live normal lives and have a zero risk of developing AIDS. Unfortunately, most people who are affected by HIV do not have access to modern treatment.

Etiology

Risk factors

Men who have sex with men
Intravenous drug needle sharing
Blood transfusion
- Nowadays very uncommon (1 in 2 million)
- Screening for it began in the 1990s

Clinical features

At around week 5 after the primary infection, acute HIV syndrome occurs with non-specific symptoms like fever, fatigue, rashes, headache, lymphadenopathy. It may be symptomatic. This lasts for 1 – 2 weeks.

After the acute HIV syndrome, a clinical latent period occurs, as the patient remains asymptomatic for 3 – 4 years, until the CD4+ T-cell count reaches around 200-300/µL. At that point the CD4+ count is so low that opportunistic infections and neoplasms occur. These are the so-called AIDS-defining conditions, and include:

In addition to these, other opportunistic conditions can occur:

Specific cutaneous clinical features

Acute HIV syndrome (Before AIDS develops)
- Maculopapular morbilliform rash
Eosinophilic folliculitis
- Pruritic, erythematous papules on follicles
- Affects the upper body only
Oral hairy leucoplakia
- EBV
- White plaques
- On inferolateral surface of tongue
Bacillary angiomatosis
- Bartonella
- Multiple erythematous papules and nodules
- Bleed easily