B7. Clinical outcome and symptoms of AIDS

From greek.doctor

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