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HIV / AIDS Symptoms & Complications

HIV Infection

Once the HIV virus has entered the body, the immune system comes under attack. The HIV virus multiplies and slowly begins to destroy the CD4 lymphocytes (T-cells), which are the white blood cells that are important for fighting off infections. Even if the person with HIV feels well with no symptoms, HIV is still invading the CD4 cells. The immune system weakens progressively over time and becomes susceptible to bacterial, viral, fungal and parasitic (opportunistic) infections.

As more serious symptoms and complications appear, the HIV infection may then meet the official definition of AIDS: a positive HIV-antibody ELISA followed by a confirmatory Western Blot test or other HIV virologic test (HIV nucleic acid test, HIV p24 antigen test, HIV viral culture) and either the onset of an "AIDS-defining" infection or cancer (see below), or a CD4 T-cell count of 200 cells/mm3 - a normal count ranges from 600 to 1000 cells/mm3 - or a CD4 T-cell percentage of total lymphocytes of <14.

HIV Symptoms

Initial infection with the HIV virus may produce no symptoms. The length of time between initial HIV infection and the development of AIDS varies greatly and some people may remain without symptoms for years. Even if a person does not have symptoms, they can still transmit the virus to others.

It is common to develop a brief flu-like illness 2 to 6 weeks after being infected. The symptoms may include fever, headache, sore throat, swollen lymph glands, and a rash. These symptoms are similar to many other diseases and may not be recognized as HIV infection.

Many people remain symptom free for 8 or 9 years but during this time the virus continues to multiply and destroy their immune cells. The Centers for Disease Control (CDC) suggests the following may be warning signs of HIV infection but cautions that any of these symptoms can be related to other illnesses and that only an HIV blood test can be used for an accurate diagnosis:

  • Rapid weight loss
  • Dry cough and shortness of breath
  • Recurring fever or profuse night sweats
  • Profound and unexplained fatigue
  • Swollen lymph glands in the armpits, groin, or neck
  • Diarrhea that lasts for more than a week
  • White spots or unusual blemishes on the tongue, in the mouth, or in the throat
  • Pneumonia
  • Red, brown, pink, or purplish blotches on or under the skin, or inside the mouth, nose, or eyelids
  • Memory loss, depression, or other neurological disorders.

During the last phase of HIV, which can occur up to 10 or 11 years after the initial infection, the immune system will have been severely damaged, making the body highly susceptible to a large number of bacterial, viral, fungal and parasitic (opportunistic) infections. The symptoms of some of these infections may include:

  • Shaking chills or fever higher than 100 F for several weeks
  • Soaking night sweats
  • Dry cough and shortness of breath
  • Chronic diarrhea
  • Persistent white spots or unusual lesions on the tongue or in the mouth
  • Persistent headaches
  • Blurred and distorted vision
  • Weight loss
  • Persistent, unexplained fatigue
  • Swelling of lymph nodes for more than three months.

People with HIV infection are also at greater risk of developing certain cancers, especially Kaposi's sarcoma, cervical cancer and lymphoma. Children who are HIV positive often fail to gain weight or grow normally. As the disease progresses, they may have difficulty walking or delayed mental development. They may also develop cerebral palsy. In addition, children are susceptible to the same opportunistic infections as adults and may have severe forms of common childhood illnesses such as ear infections (otitis media), pneumonia, and tonsillitis.

AIDS Symptoms and AIDS-Defining Illnesses

The symptoms of AIDS are primarily the result of infections (called opportunistic infections) that do not normally develop in individuals with healthy immune systems. In order for a patient who is infected with HIV to have AIDS, the immune system must be severely damaged. The severity of the immune system damage is measured by a CD4 lymphocyte count. If a person infected with HIV has a CD4 count of less than 200 cells/mm3, a CD4+ T-lymphocyte percentage of total lymphocytes of less than 14, or an AIDS-defining illness they are said to have AIDS. Patients are at greatest risk of developing opportunistic infections when the CD4 count gets below 200 cells/mm3.

AIDS-defining illnesses tend to occur most often in patients who have not received antiretroviral treatment for HIV infection or who fail to benefit from antiretroviral treatment.

Tuberculosis, Pneumocystis jiroveci pneumonia (PCP), candidiasis, cryptococcosis, herpes simplex virus infection (HSV), toxoplasmosis, cytomegalovirus, and Mycobacterium avium complex (MAC) infections are some of the most common HIV-related opportunistic infections seen in clinical practice.

The Centers for Disease Control (CDC) considers many of the following list of conditions as "AIDS-defining". Many other illnesses and corresponding symptoms may develop in addition to those listed here:

Tuberculosis (TB)

Tuberculosis is the most common opportunistic infection associated with HIV worldwide. Tuberculosis is an infection by the tuberculosis bacterium that predominantly affects the lungs, but it can spread through the blood and lymph nodes to the rest of the body in people with HIV.

TB causes a long-term cough that may produce blood and may also cause fever, weight loss and night sweats. The disease can strike people with HIV no matter what the level of their CD4 count, which means that TB can often occur years before other problems associated with HIV develop.

Everyone who is HIV-positive should have a simple skin test for TB. If the test is positive, a chest X-ray and other tests will determine if the infection is active. If the TB is not active, preventative treatments are available.

Tuberculosis is more worrisome than many other opportunistic infections because of the ease with which it is spread (by coughing or sneezing) from one person to another. Multidrug Resistant-Tuberculosis (MDR-TB) is resistant to traditional treatments and is of particular concern to people with HIV and AIDS.

Anyone with HIV can get Tuberculosis but it is more likely to occur in those with CD4 counts of less than 200 cells/mm3 .

Herpes Simplex Virus (HSV)

Herpes Simplex Virus, which usually causes genital herpes, may be transmitted during unprotected sex. Initial symptoms include pain or irritated skin in the genital area and later sores that may erupt and ooze and bleed. Although these sores eventually heal, the virus periodically reappears, causing the same symptoms. The symptoms of HSV are more severe in people with HIV and the sores may take longer to heal (more than one month in duration). The herpes virus isn't life-threatening in adults, but it may cause brain damage, blindness or death in infants infected during delivery.

Anyone with HIV can get Herpes Simplex, regardless of their CD4 count.

Candidiasis

Candidiasis (thrush) is a yeast infection of the mouth or genitals and is a very common HIV-related infection. The symptoms include inflammation and a thick white coating on the mucous membranes of the mouth, tongue, vagina or esophagus (Candida esophagitis). Children may have especially severe symptoms in the mouth or esophagus, which can make eating painful and difficult. Uncomplicated, severe or recurrent vulvovaginal candidiasis may also occur. Candidiasis of the bronchi, trachea, lungs or esophagus is considered "AIDS-defining", but oral or vulvovaginal candidiasis are not considered "AIDS-defining".

Anyone with HIV can get Candidiasis but it is more dangerous in those with CD4 counts of less than 200 cells/mm3 .

Lymphomas (Immunoblastic, Burkitt’s Lymphoma, Primary Lymphoma of the Brain are AIDs-defining Lymphomas)

Non-Hodgkin's Lymphoma is a cancer of the lymph glands originating in the lymphocytes, a type of white blood cell involved in fighting infection. NHL usually starts in the lymph nodes but can also start in the liver, lungs or gastrointestinal tract. The most common symptom of NHL is swollen (usually painless) lymph nodes in the neck, armpit or groin. Other symptoms include fever, night sweats, fatigue, itchy skin and weight loss, aches, and sometimes coughing, difficulty breathing and chest pain.

Non-Hodgkin lymphoma has become more common in the past few decades. This may be related to the rise in the number of people who have a suppressed immune system, such as people infected with human immunodeficiency virus (HIV) and those who have had an organ transplant and need to take drugs that alter the immune system.

Other AIDS-defining lymphomas include Burkitt’s Lymphoma and Brain Lymphoma.

Anyone with HIV can get Non-Hodgkin's Lymphoma but it is more likely in those with CD4 counts of less than 200 cells/mm3 .

Salmonella Septicemia, Recurrent

Salmonellosis (food poisoning) is an infection caused by the salmonella bacterium, which is contracted from contaminated food or water. Symptoms include severe diarrhea, fever, chills, abdominal pain and sometimes vomiting. The risk of contracting salmonellosis can be reduced by hand washing and by cooking meat and eggs thoroughly.

Salmonella septicemia usually is treated with antibiotics. Drug therapy may be required for life to prevent relapses. HIV patients should avoid having reptiles as pets due to the possible transmission of salmonella.

Anyone with HIV can get Salmonellosis, regardless of their CD4 count.

Invasive Cervical Cancer and Human Papillomavirus (HPV)

Human Papillomavirus is one of the most common causes of sexually transmitted disease. Some types of this virus cause common warts while others cause warts on the genitals. HPV infection is especially serious because it puts women at risk of invasive cervical cancer; the risk is further increased in women with HIV.

Anyone with HIV can get Human Papillomavirus but women with CD4 counts of less than 50 cells/mm3 are more likely to develop HPV-related growths in the cervix.

Cryptosporidiosis, chronic intestinal (greater than 1 month's duration)

Cryptosporidiosis is an infection contracted by ingesting contaminated food or water. The parasite grows in the intestines and bile ducts and can cause severe chronic diarrhea. Symptoms are chronic in patients with AIDS, lasting longer than one month.

Anyone with HIV can get Cryptosporidiosis, however it is particularly dangerous for those with a CD4 count of 50 cells/mm3 or less.

Pneumocystis Jiroveci Pneumonia (PCP)

Pneumocystis Jiroveci Pneumonia, also known as Pneumocystis Carinii Pneumonia (PCP) is the most common opportunistic infection that occurs with AIDS in the United States. The fungus that causes the PCP infection is spread through breathing or coughing. Symptoms include persistent cough, fever, trouble breathing (lips and nail-beds may become blue), fatigue, and weight loss. Medication such as sulfamethoxazole/trimethoprim is frequently used to treat and prevent PCP.

PCP is particularly dangerous for those with a CD4 count of less than 200 cells/mm3 .

Recurrent Pneumonia

Studies have shown that persons with HIV-related immunosuppression are at an increased risk of bacterial pneumonia. Recurrent episodes of pneumonia (two or more episodes within a 1-year period) are required for AIDS case reporting because pneumonia is a relatively common diagnosis and multiple episodes of pneumonia are more strongly associated with immunosuppression than are single episodes. Patients with CD4 counts less 200 cells/µL may be at higher risk of recurrent episodes of pneumonia.

Kaposi's Sarcoma (KS)

Kaposi's sarcoma is the most common AIDS-related cancer. It is a tumor of the blood vessel walls. Common symptoms are pink, red or purple lesions on the skin and in the mouth. The first spots, sores or bumps usually appear on the face, nose, mouth, arms, upper body or legs. The lesions vary from pinhead size to the size of a large coin and may be painless. Sometimes the skin lesions are painful and can cause itching and sores in the mouth or throat may cause eating or swallowing problems. Kaposi's sarcoma can also affect the internal organs, including the digestive tract, lymph nodes and lungs.

Anyone with HIV can get Kaposi's Sarcoma, but it is more likely in those with CD4 counts of less than 200 cells/mm3 .

Coccidioidomycosis, disseminated or extrapulmonary

A fungal infection that progresses to chronic localized disease of the lungs or other organs such as bone, skin, and meninges. Lung involvement is most common in patients with AIDS.

Cryptococcal Meningitis

Cryptococcal meningitis, caused by a fungus, is the most common central nervous system infection associated with HIV. Meningitis is an inflammation of the membranes and fluid surrounding the brain and spinal cord (meninges). Symptoms include headache, high fever, stiff neck, and sensitivity to light. Meningitis is a serious disease that can cause severe complications and even prove fatal in a short amount of time.

Cryptococcal Meningitis is particularly dangerous in those with a CD4 count of 50 cells/mm3 or less.

Toxoplasmosis

Toxoplasmosis, caused by a parasite spread primarily by cats, is the most common cause of brain lesions in people with advanced HIV disease where toxoplasmosis often leads to encephalitis, an infection of the brain. Symptoms may include disorientation, seizures, fatigue, headaches and difficulty walking or speaking.

Toxoplasmosis is particularly dangerous in those with a CD4 count of 100 cells/mm3 or less.

Progressive Multifocal Leukoencephalopathy (PML)

Progressive Multifocal Leukoencephalopathy is an extremely serious viral disease of the brain. PML causes a quick decline in cognitive and motor functions. Symptoms vary and may include speech problems, weakness on one side of the body, loss of vision in one eye, or numbness in one arm or leg. PML is a late-stage disease that occurs only when the immune system is severely damaged.

Mycobacterium Avium Complex (MAC)

Mycobacterium Avium Complex is a common AIDS infection caused by a bacterium related to tuberculosis. Normally, the bacterium causes an infection of the respiratory tract but, in advanced HIV or AIDS, a systemic infection can affect almost any internal organ, including the bone marrow, liver or spleen.MAC causes nonspecific symptoms such as cough, fever, night sweats, weight loss, fatigue, stomach pain, and diarrhea.

MAC is particularly dangerous in those with a CD4 count of 50 cells/mm3 or less.

Cytomegalovirus (other than liver, spleen or nodes) and CMV retinitis (with loss of vision)

Cytomegalovirus infection (CMV) is a viral infection that can affect almost any organ system. A healthy immune system inactivates the virus and it therefore remains dormant in the body. If the immune system weakens, the virus resurfaces. Symptoms include fatigue, fever, enlarged lymph nodes and pain in the muscles or throat. CMV can cause damage to the eyes (retinitis), digestive tract (diarrhea), lungs (pneumonia), liver (hepatitis), or other organs.

CMV is particularly dangerous in those with a CD4 count of 50 cells/mm3 or less.

Other Conditions and Complications

Wasting Syndrome due to HIV

Extreme weight loss and anorexia caused by HIV.

AIDS Dementia

Worsening and slowing of mental function caused by HIV.

Encephalopathy, HIV-related

Damage to the brain due o HIV disease. It may result in a form of dementia in advanced HIV disease.

Histoplasmosis, disseminated or extrapulmonary

Isosporiasis, chronic intestinal (greater than 1 month's duration)

See Also:

Last updated: 2014-02-03 by Leigh Anderson, PharmD

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