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Angina in HIV infection
Last reviewed: 04.07.2025
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Angina in HIV infection is included in the class of vulgar angina, since the anginal process that occurs in the pharynx refers to secondary diseases caused by AIDS, caused by the human T-lymphotropic virus type 3, which results in the rapid development of the so-called opportunistic infection, abundantly vegetating in the mucous membrane of the pharynx and its lymphadenoid formations.
[ What causes sore throat in HIV?
Along with the banal pyogenic infection, lesions of the upper respiratory tract in AIDS can be caused by fungi, pneumocysts, herpes viruses, Epstein-Barr viruses, cytomegaloviruses, etc. AIDS in a fully clinically developed stage is manifested by secondary infectious or tumor processes.
Symptoms of sore throat in HIV
As noted by a number of authors, 30-50% of patients, 3-6 weeks after infection, essentially in the latent period of HIV infection, develop symptoms reminiscent of angina in mononucleosis: fever up to 38-39.5°C, inflammation of the lymphadenoid formations of the pharynx, regional lymphadenitis, enlargement of the liver and spleen, as well as inflammatory foci in other organs. The symptoms of angina quickly pass, but the lymphopenia that occurs during this period is an indirect indication of the possibility of HIV infection.
During the latent period, the content of antibodies to HIV increases. At the same time, an increase in lymph nodes is observed, which subsequently undergo changes that characterize the stage of persistent generalized adenopathy, which for a long time (months and years) can be the only manifestation of AIDS. Unfavorable external conditions, alimentary dystrophy, vitamin deficiency, alcoholism, drug addiction, intercurrent infectious diseases aggravate the clinical course of HIV infection and lead to either generalization of opportunistic infection, which progresses towards clinically advanced disease in every third patient over the next five years.
Diagnosis of sore throat in HIV
In principle, every banal inflammation of the mucous membrane and lymphoid apparatus of the pharynx should alert the doctor to the presence of AIDS, therefore, every patient, especially in the presence of an acute inflammatory process in the pharynx and at the same time lymphopenia, should undergo a special hematological examination for HIV infection.
What do need to examine?
How to examine?
What tests are needed?
Who to contact?
Treatment of sore throat in HIV
Treatment of angina in HIV is complex with the appointment of intensive immunomodulatory treatment, drugs that increase the body's overall resistance and antiviral agents active against HIV-1 and HIV-2. These drugs include zidovudine and zalcitabine.
Zidovudine acts on viral DIC polymerase (reverse transcriptase), disrupting the synthesis of viral DNA and reducing viral replication. HIV reverse transcriptase is 20-30 times more sensitive to the inhibitory effect of zidovudine than mammalian cell polymerase. The drug is well absorbed in the intestine and penetrates into most tissues and fluids of the body, including the cerebrospinal fluid, where its concentration reaches 60% of the content in the blood serum.
Indicated for use in early (with T4 cell count less than 500/μl) and late stages of HIV infection, as well as for the prevention of transplacental HIV infection of the fetus.
Method of administration: per os; for adults, the initial dose is 200 mg every 4 hours (1200 mg/day). Dosage range is 500-1500 mg/day. Maintenance dose is 1000 mg/day in 4-5 doses.
Zalcitabine is especially active in the early stages of AIDS. Its mechanism of action is due to the inhibition of viral DNA synthesis and suppression of viral replication. It penetrates the BBB and is found in the cerebrospinal fluid. The intracellular metabolite formed under the influence of the drug is used by the viral reverse transcriptase as a substrate competing with dioxycidin triphosphate, as a result of which the biosynthesis of viral DNA and the formation of phosphodiester bridges between its chains, necessary for elongation, become impossible.
The high efficiency of treatment, started as early as possible, justifies the need to treat HIV-infected patients even in the absence of AIDS symptoms. With long-term (more than 1 year) treatment, a small number of patients experience a decrease in the effectiveness of the drug. The resistance of the virus is explained by point mutations of the viral genome in the region of the reverse transcriptase gene. Cross-resistance to zidovudine, stavudine and lamivudine, also used against HIV infection, is possible.
The drug is indicated for HIV infection in adults with clinical manifestations such as exacerbations of chronic tonsillitis, recurrent candidiasis of the pharynx and tonsils, hairy leukoplakia of the oral cavity, chronic or unexplained fevers, night sweats, weight loss. In case of insensitivity to zidovudine or decreased activity of the latter, zalcitabine is used as a monotherapeutic agent.
Method of administration: adults per os with clinically expressed stage of HIV infection 0.75 mg every 8 hours (monotherapy). Daily dose 2.25 mg. Treatment of primary infection is recommended to be carried out for at least 6 months. Combination therapy with zidovudine: 1 tablet (0.75 mg) of zalcitabine together with 200 mg of zidovudine every 8 hours. Daily doses of the drugs are 2.25 mg and 600 mg, respectively.
In addition, in HIV infection, the use of immunoglobulins against megaloviruses (pitotek), immunomodulators (interferon, methylglucamine acridone acetate, cycloferon, thymogen), antiviral agents (abacavir, didanosine, zidovudine, etc.) in various combinations is indicated.
What is the prognosis for tonsillitis in HIV?
With early initiation of specific treatment in combination with other treatment methods, angia in HIV has a relatively favorable prognosis; in later stages, it is questionable.