HIV infection and AIDS - Symptoms

HIV infection has an incubation period that lasts from 2 weeks to 6 months or more.

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The main symptoms of HIV infection and the dynamics of their development

The stage of primary clinical manifestations begins with the period of seroconversion (sometimes an acute febrile phase is diagnosed at the very beginning). It should be noted that stage II often precedes the onset of seroconversion. Symptoms of HIV infection in the acute phase (often nonspecific) are severe intoxication, weakness, fever, muscle and joint pain, catarrhal phenomena (sometimes combined with a skin rash) from the upper respiratory tract, tonsillitis, polyadenitis. Transient disorders of the central nervous system are possible (from headaches to acute reversible encephalopathy with loss of orientation, memory and impaired consciousness). Antibodies to HIV are detected in the blood serum (not constantly). Antibodies to the virus are often detected at the end of the acute phase. The acute phase does not develop in all HIV-infected patients, and due to the difficulty of its diagnosis, the number of such cases is difficult to estimate. Manifest course of acute seroconversion in HIV infection is an unfavorable sign of rapid progression of the disease. The duration of this febrile condition is from 1-2 weeks to 1 month.

Subclinical stage III occurs either immediately after the acute febrile phase or begins the stage of primary manifestations. This period is characterized by positive serological reactions to HIV infection when conducting ELISA and IB in the absence of symptoms of HIV infection. The duration of the subclinical phase varies from 2-3 months to several years (most often - up to 1.5-2 years).

In the asymptomatic stage, persistent generalized lymphadenopathy may develop (on average, the duration of the infectious process is from 6 months to 5 years). During this period, the only clinical symptom of the disease is generalized lymphadenopathy - an increase in the lymph nodes (at least 1 cm in diameter) in two or more non-contiguous extra-inguinal loci, maintaining its volume for at least 3 months in the absence of any current disease. In addition to generalized lymphadenopathy, an increase in the liver, spleen; asthenic syndrome is observed.

The stage of secondary diseases is characterized by bacterial, viral, fungal, protozoal infections or tumor processes developing against the background of immunodeficiency. Stage IVA is considered as a transitional period from persistent generalized lymphadenopathy to AIDS-associated complex. In this case, the duration of the infectious process is 3-7 years or more. The following symptoms of HIV infection are noted: more pronounced asthenic syndrome, decreased mental and physical performance, night sweats, periodic rises in temperature to subfebrile numbers, unstable stool, weight loss of less than 10%. This stage of HIV infection occurs without pronounced opportunistic infections and invasions, as well as without the development of Kaposi's sarcoma and other malignant tumors. Various skin diseases are possible (sometimes these are aggravated previous ones, but more often they are acquired) caused by fungal, viral, bacterial or other lesions - seborrheic or allergic dermatitis, psoriasis, papular rash. Fungal skin lesions lead to the development of onychomycosis, dermatomycosis of the feet (hands, shins and other parts of the body). Viral lesions - herpes simplex, shingles, genital warts, molluscum contagiosum, warts. Staphylococcal and streptococcal folliculitis, impetigo and ecthyma are signs of bacterial infections. Aphthous ulcers are found on the mucous membranes; angular cheilitis and gingivitis develop. Recurrent upper respiratory tract infections (including bacterial sinusitis) often develop.

Signs and Symptoms of Disease Progression (Stage IVB) of HIV Infection and AIDS

Signs of disease progression (stage IVB) are general symptoms of AIDS without generalization of opportunistic infections or tumors that occur in later stages of HIV infection. Characterized by unexplained prolonged intermittent or constant fever and chronic diarrhea (symptoms always last more than a month), loss of more than 10% of body weight. There may be lesions of the skin and mucous membranes of fungal (oropharyngeal candidiasis, less often - genital and perianal areas), viral (hairy leukoplakia, repeated or disseminated infection with the herpes simplex virus (HSV) type 3 - Varicella Zoster), vascular (telangiectasias, hemorrhagic rashes, leukoplastic vasculitis, hyperalgesic pseudothrombophlebitic syndrome) and tumor (localized form of Kaposi's sarcoma) etiology. In case of bacterial lesions of the skin and mucous membranes, the development of vegetative, chancroid and diffuse forms of chronic pyoderma; cellulitis; pyomyositis; pyogenic granulomas; furuncles and abscesses is possible. Bacterial (including pulmonary tuberculosis), viral, fungal and protozoal lesions of internal organs (without dissemination) are detected.

Patients show a tendency toward anemia, thrombocytopenia, and leukopenia, caused mainly by lymphopenia and, to a lesser extent, neutropenia. The virus actively replicates and exerts a suppressive effect on the immune system; signs of immunodeficiency increase. A decrease in the number of CD4+ lymphocytes to 200-300 cells per 1 μl and CD8 lymphocytes to 1,300 cells per 1 μl is determined; the ratio of the number of CD4+ to the number of CD8+ lymphocytes decreases to 0.5. When the number of CD4 lymphocytes in adults suffering from HIV infection decreases to 200 cells per 1 μl, intensive drug prophylaxis of opportunistic infections is recommended.

Stage IVB corresponds to full-blown AIDS. As a rule, symptoms of HIV infection of this phase are detected in a long-term infectious process (more than 5 years). Growing immunodeficiency leads to the development of two main clinical manifestations of AIDS (opportunistic infections caused by opportunistic flora, and neoplasms). Any pathogenic microorganisms can cause unusually severe clinical conditions.

Clinical conditions and symptoms occurring at stage IVB of HIV infection and AIDS

The main protozoan infections are toxoplasmosis of the brain, which occurs as encephalitis, and cryptosporidiosis, which occurs as enterocolitis with prolonged (more than a month) diarrhea. There are cases of isosporidiosis, microsporidiosis, visceral leishmaniasis, giardiasis and amoebiasis.

The group of fungal infections includes candidiasis of the esophagus and trachea, bronchi and lungs; pneumonia caused by P. carinii; extrapulmonary cryptococcosis (usually occurs in the form of meningitis) and fungal meningoencephalitis. Disseminated endemic mycoses often develop - histoplasmosis, coccidioidomycosis and aspergillosis.

The main viral diseases are infections caused by herpes simplex viruses. The herpes simplex virus causes long-term (over a month) signs of skin and mucous membrane lesions; and also causes the occurrence of a generalized form of infection (of any duration) with the involvement of the bronchi, lungs, esophagus and nervous system in the pathological process. In patients suffering from HIV, cytomegalovirus infection is diagnosed not only of the liver, spleen and lymph nodes, but also of other organs (as a rule, a generalized form of the disease develops, with damage to the retina, central nervous system, lungs, esophagus and colon). Less common are disseminated herpes zoster: progressive multifocal leukoencephalopathy (papovavirus); infection caused by the Epstein-Barr virus.

The most common bacterial infections are atypical disseminated mycobacteriosis with lesions of the lungs, skin, peripheral lymph nodes, gastrointestinal tract, central nervous system and other organs; extrapulmonary tuberculosis; non-typhoidal salmonellosis septicemia. Less commonly diagnosed are staphylococcal and streptococcal bacteremia, as well as legionellosis.

Indicator tumor processes of AIDS are disseminated Kaposi's sarcoma (in this case, not only dermatological signs are noted, but also lesions of internal organs) and primary non-Hodgkin's lymphomas of the brain (less often - of other localizations).

The etiology of secondary diseases that complicate stage IV HIV infection is largely determined by the living conditions, climate and natural environment of the HIV-infected patient.

The diagnosis of full-blown AIDS can be made on the basis of pronounced signs of encephalopathy or cachexia - the result of the direct effect of the virus on the central nervous system and digestive organs. Such signs include significant involuntary weight loss (more than 10% of the initial); the presence of chronic diarrhea and fever (intermittent or constant) for a month or more; as well as chronic weakness. In this case, opportunistic infections or neoplasms are often absent.

During the period of advanced AIDS, thrombocytopenia and profound immunosuppression develop. The number of T-lymphocytes is less than 700-800 cells per 1 μl, CD4+-lymphocytes - less than 200 cells per 1 μl; there is a sharp decrease in the number of CD8+-lymphocytes to 400-500 cells per 1 μl. The ratio of the number of CD4+- to the number of CD8+-lymphocytes does not exceed 0.3. With a decrease in the number of CD4+-lymphocytes to 50 cells per 1 μl, the probability of a fatal outcome increases. Failure of the humoral immune system develops. Symptoms of HIV infection progress, the terminal V stage occurs, ending in the death of the patient.

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Period of primary clinical manifestations (acute phase)

The acute phase of HIV infection may be latent or have multiple non-specific symptoms of HIV infection. In 50-70% of cases, the period of primary clinical manifestations occurs, with fever; lymphadenopathy; erythematous-maculopapular rash on the face, trunk and limbs; myalgia or arthralgia. Less often, patients complain of diarrhea, headache, nausea, vomiting. Enlargement of the liver and spleen is possible. Neurological symptoms of HIV infection - meningoencephalitis or aseptic meningitis - are found in about 12% of patients. The duration of the acute phase of infection is from several days to two months. As a rule, due to the similarity of the signs of the acute phase with the symptoms of influenza and other common diseases, it is difficult to recognize HIV infection at this stage. In addition, the acute phase is often asymptomatic. During this period, the diagnosis can only be confirmed by PCR. PCR allows detecting the RNA of the virus. Sometimes the protein p24, the HIV antigen, is determined.

Antibodies to HIV are usually not detected during the acute phase. In the first 3 months after infection, antibodies to HIV appear in 90-95% of patients, after 6 months - in the remaining 5-9%, and at a later stage - only in 0.5-1%. At the AIDS stage, a significant decrease in the content of antibodies in the blood is recorded.

Asymptomatic period of HIV infection

The next period of HIV infection is asymptomatic, lasting several years - patients feel well and lead a normal life.

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Generalized lymphadenopathy

After acute infection, persistent generalized lymphadenopathy may develop. In exceptional cases, the disease may progress immediately to the terminal stage (AIDS).

In persistent generalized lymphadenopathy, an increase in at least two groups of lymph nodes is observed (from 1 cm or more in adults, with the exception of inguinal lymph nodes, and from 0.5 cm in children), persisting for at least 3 months. The cervical, occipital and axillary lymph nodes are most often enlarged.

The duration of the persistent generalized lymphadenopathy stage is approximately 5-8 years. During the entire period, a consistent decrease and increase in lymph nodes is recorded. In the lymphadenopathy stage, a gradual decrease in the level of CD4+ lymphocytes is noted. Patients suffering from asymptomatic infection or persistent generalized lymphadenopathy are identified during a random examination (as a rule, patients do not seek medical attention).

The total duration of the incubation period, acute phase period and asymptomatic period varies (from 2 to 10-15 years or more).

The period of secondary clinical manifestations of HIV infection and AIDS

The asymptomatic period is followed by the chronic phase, which has symptoms of HIV infection, characterized by the development of various diseases of viral, bacterial, fungal and protozoal nature, often proceeding favorably and requiring traditional methods of treatment. As a rule, repeated diseases of the upper respiratory tract (otitis, sinusitis and tracheobronchitis, tonsillitis); superficial lesions of the skin, mucous membranes (localized form of recurrent herpes simplex, recurrent herpes zoster, candidiasis of the mucous membranes, dermatomycosis and seborrhea) are recorded.

Over time, such infections become protracted and resistant to standard treatment methods, which leads to the development of more serious complications. The patient may experience fever, increased night sweats, diarrhea, and weight loss.

Against the background of increasing immunosuppression, severe progressive diseases develop that are not usually found in people with a normally functioning immune system. Such conditions are called AIDS-indicating.

Classification of HIV infection

The classification of HIV infection was revised by Academician V.I. Pokrovsky in 2001.

• Incubation stage (stage I).
• Stage of primary manifestations (stage II).
  • Flow options.
    • Asymptomatic period (PA stage).
    • Acute HIV infection without secondary diseases (stage PB).
    • Acute HIV infection with secondary diseases (stage PV).
• Latent (subclinical) stage (stage III).
• Stage of secondary diseases (clinical manifestations; stage IV).
  • Weight loss is less than 10%; fungal, viral, bacterial lesions of the skin and mucous membranes; recurrent pharyngitis and sinusitis; herpes zoster (stage IVA).
  • Phases of the flow.
    • Progression.
      • In the absence of antiretroviral therapy.
      • Against the background of antiretroviral therapy.
    • Remission.
      • Spontaneous.
      • After previous antiretroviral therapy.
      • Against the background of antiretroviral therapy.
  • Weight loss of more than 10%; unexplained diarrhea or fever lasting more than a month; hairy leukoplakia; pulmonary tuberculosis: persistent recurrent viral, bacterial, fungal, and protozoal lesions of internal organs; localized Kaposi's sarcoma; recurrent or disseminated herpes zoster (stage IVB).
  • Phases of the flow.
    • Progression.
      • In the absence of antiretroviral therapy.
      • Against the background of antiretroviral therapy.
    • Remission.
      • Spontaneous.
      • After previous antiretroviral therapy.
      • Against the background of antiretroviral therapy.
  • Cachexia; generalized viral, bacterial, mycobacterial, fungal, protozoal or parasitic diseases. For example, candidiasis of the esophagus, bronchi, trachea and lungs; Pneumocystis pneumonia; extrapulmonary tuberculosis; disseminated Kaposi's sarcoma; atypical mycobacterioses; malignant tumors; CNS lesions of various etiologies (stage IVB).
  • Phases of the flow.
    • Progression.
      • In the absence of antiretroviral therapy.
      • Against the background of antiretroviral therapy.
    • Remission.
      • Spontaneous.
      • After previous antiretroviral therapy.
      • Against the background of antiretroviral therapy.
• Terminal stage (stage V).

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