HIV infection and AIDS: symptoms

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

[1], [2], [3], [4], [5]

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 at the outset they diagnose an acute febrile phase). It should be noted that stage II often precedes the onset of seroconversion. Symptoms of HIV infection in the acute phase (often have a nonspecific character) - severe intoxication, weakness, fever, pain in the muscles and joints, catarrhal phenomena (sometimes in combination with a rash on the skin) from the upper respiratory tract, tonsillitis, polyadenitis. Possible transient disruption of the central nervous system (from headaches to acute reversible encephalopathy with loss of orientation, memory and impaired consciousness). In the serum, antibodies to HIV are detected (not always). Often antibodies to the virus are detected at the end of the acute phase. The acute phase does not develop in all HIV-infected patients, and due to the difficulty in diagnosing it, the number of such cases is difficult to assess. The manifestation of acute seroconversion in HIV infection is an unfavorable sign of rapid disease progression. The duration of this fever 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 characterizes the positive serological responses to HIV infection when carrying out ELISA and IB in the absence of symptoms in 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, the development of persistent generalized lymphadenopathy is possible (on average, the duration of the infectious process ranges from 6 months to 5 years). At this time, the only clinical symptom of the disease is generalized lymphadenopathy, an increase in lymph nodes (not less than 1 cm in diameter) in two or more untransmitting out-of-well loci that retains its volume for at least 3 months in the absence of any current disease. In addition to generalized lymphadenopathy, there is an increase in the liver, spleen; asthenic syndrome.

The stage of secondary diseases is characterized by bacterial, viral, fungal, protozoal infections or tumor processes developing against the background of immunodeficiency. The IVA stage is considered as a transitional period from persistent generalized lymphadenopathy to an AIDS-associated complex. The duration of the infectious process is 3-7 years or more. They note the following symptoms of HIV infection: more pronounced asthenic syndrome, decreased mental and physical performance, night sweats, periodic temperature rises to subfebrile digits, unstable stools, weight loss of less than 10%. This stage of HIV infection occurs without pronounced opportunistic infections and invasions, and without the development of Kaposi's sarcoma and other malignant tumors. Various skin diseases (sometimes exacerbated earlier, but more often - acquired) are possible, caused by fungal, viral, bacterial or other damage - seborrheic or allergic dermatitis, psoriasis, papular rash. Fungal skin damage leads to the development of onychomycosis, dermatomycosis of the feet (brushes, legs and other areas of the body). Viral lesions - herpes simplex, shingles, pointed condylomas, molluscum contagiosum, warts. Staphylococcal and streptococcal folliculitis, impetigo and ecthyma are signs of bacterial infections. Aphthous ulceration is found on the mucous membranes; develops an angular cheilitis, gingivitis. Often, recurrent infections of the upper respiratory tract develop (including bacterial sinusitis).

Signs and symptoms of disease progression (stage IVB) of HIV infection and AIDS

Signs of disease progression (stage IVB) are common symptoms of AIDS without generalization of opportunistic infections or tumors that occur in later stages of HIV infection. Characterized by unexplained long-term fever intermittent or persistent type and chronic diarrhea (duration of symptoms is always more than a month), loss of more than 10% of body weight. There may be lesions of the skin and mucous membranes of the fungus (oropharyngeal candidiasis, rarely - genital and perianal areas), viral (hairy leukoplakia, recurrent or disseminated infection with herpes simplex virus (HSV) of the third type - Varicella Zoster), vascular (telangiectasia, hemorrhagic rash, leukoplastic vasculitis, hyperalgesic pseudotrombophlebitic syndrome) and tumor (localized form of Kaposi's sarcoma) etiology. With bacterial lesions of the skin and mucous membranes, it is possible to develop a vegetative, chancreiform and diffuse forms of chronic pyoderma; cellulite; pyomyositis; piogenic granules; furuncles and abscesses. Identify bacterial (including pulmonary tuberculosis), viral, fungal and protozoal lesions of internal organs (without dissemination).

Patients are observed a tendency to anemia, thrombocytopenia and leukopenia. Mainly caused by lymphopenia and. Only to a small extent, neutropenia. The virus actively multiplies and exerts a suppressor effect on the immune system; increasing signs of immunodeficiency. Determine the decrease in the number of CD4 + lymphocytes to 200-300 cells in 1 μl, CD8-lymphocytes - up to 1300 cells in 1 μl; while the ratio of the number of CD4 + - to the number of CD8 + lymphocytes is reduced to 0.5. With a decrease in the number of CD4-lymphocytes in adults with HIV infection, up to 200 cells per 1 μl, it is recommended to initiate intensive drug prophylaxis for opportunistic infections.

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

Clinical conditions and symptoms that occur at the IVB stage of HIV infection and AIDS

The main protozoal infections are toxoplasmosis of the brain, proceeding in the form of encephalitis, and cryptosporidiosis. Which occurs as an enterocolitis with a long (more than a month) diarrhea. There are cases of isosporidiosis, microsporidiosis, visceral leishmaniasis, giardiasis and amebiasis.

A group of fungal infections are candidiasis of the esophagus and trachea, bronchi and lungs; pneumonia caused by P. Carinii; extrapulmonary cryptococcosis (occurs, as a rule, in the form of meningitis) and fungal meningoencephalitis. Often develop disseminated endemic mycosis - histoplasmosis. Coccidioidosis and aspergillosis.

The main virus diseases are infections caused by herpes simplex viruses. Herpes simplex virus leads to the development of long-lasting (more than a month) persistent signs of damage to the skin and mucous membranes; and also causes the emergence of a generalized form of infection (of any duration) with involvement of the bronchi, lungs, esophagus and nervous system in the pathological process. In patients with HIV, cytomegalovirus infection is diagnosed not only in the liver, spleen and lymph nodes but also in other organs (as a rule, the generalized form of the disease develops, with the defeat of the retina, central nervous system, lungs, esophagus and large intestine). Less commonly are disseminated shingles: progressive multifocal leukoencephalopathy (papovavirus); infection caused by the Epstein-Barr virus.

The most frequently developing bacterial infections are atypical disseminated mycobacteriosis with lung, skin, peripheral lymph nodes. Gastrointestinal tract, central nervous system and other organs; extrapulmonary tuberculosis; netifoid salmonella septicemia. Less often diagnosed staphylococcal and streptococcal bacteremia, as well as legionellosis.

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

The etiology of secondary diseases complicating the IV stage of HIV infection largely determines the household, climatic and natural living conditions of the HIV-infected patient.

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

During the unfolded AIDS, thrombocytopenia develops and deep immunosuppression. The number of T-lymphocytes is less than 700-800 cells in 1 μl, CD4 + lymphocytes - less than 200 cells in 1 μl; there is a sharp decrease in the number of CD8 + lymphocytes to 400-500 cells in 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 in 1 μl, the likelihood of a lethal outcome increases. The inconsistency of the system of humoral immunity develops. Symptoms of HIV infection are progressing, terminal V stage is coming to an end with the patient's death.

[6],

Period of primary clinical manifestations (acute phase)

The acute phase of HIV infection can occur secretly or have multiple nonspecific symptoms of HIV infection. In 50-70% of cases, a period of primary clinical manifestations occurs, while fever is noted; lymphadenopathy; erythematous maculopapular rash on the face, trunk and extremities; myalgia or arthralgia. Less often, patients complain of diarrhea, headache, nausea, vomiting. Possible enlargement of the liver and spleen. 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 a few 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, often the period of the acute phase is asymptomatic. During this period, the diagnosis can be confirmed only by PCR. PCR allows detecting the RNA of the virus. Sometimes the protein p24 is the HIV antigen.

Antibodies to HIV during the acute phase, as a rule, do not show. 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 in later terms - only in 0.5-1%. In the stage of AIDS, a significant decrease in the antibody content in the blood is recorded.

Asymptomatic period of HIV infection

The next period of HIV infection is asymptomatic, which lasts for several years - patients feel satisfactory and lead a normal lifestyle.

[7], [8]

Generalized lymphadenopathy

After an acute infection, the development of persistent generalized lymphadenopathy is possible. In exceptional cases, the disease can immediately progress up to the terminal stage (AIDS).

With persistent generalized lymphadenopathy, an increase in at least two groups of lymph nodes (from 1 cm or more in adults, with the exception of inguinal lymph nodes and from 0.5 cm in children) is noted, which lasts at least 3 months. The most common are cervical, occipital and axillary lymph nodes.

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

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

The period of secondary clinical manifestations of HIV infection and AIDS

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

With the passage of time, such infections become lingering and resistant to standard methods of treatment, which causes the development of more serious complications. The patient may be bothered by fever, increased night sweats, diarrhea, weight loss.

Against the backdrop of increasing immunosuppression, severe progressive diseases develop, which usually do not occur in people with a normally functioning immune system. Such conditions are called AIDS-indicator.

Classification of HIV infection

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

• Stage of incubation (stage I).
• Stage of primary manifestations (stage II).
  • Variants of the current.
    • Asymptomatic period (PA stage).
    • Acute HIV infection without secondary diseases (stage PB).
    • Acute HIV infection with secondary diseases (stage MI).
• 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; repeated pharyngitis and sinusitis; shingles (stage IVA).
  • The phases of the current.
    • 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 is more than 10%; unexplained diarrhea or fever lasting more than a month; fibrous leukoplakia; Tuberculosis of the lungs: persistent repeated viral, bacterial, fungal and protozoal lesions of internal organs; localized Kaposi's sarcoma; repeated or disseminated shingles (stage IVB).
  • The phases of the current.
    • 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 mycobacteriosis; malignant tumors; lesions of the central nervous system of different etiology (stage IVB).
  • The phases of the current.
    • 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).

[9], [10], [11], [12],