Human Immunodeficiency Virus (HIV) (cont.)
Eric S. Daar, MD
Dr. Daar received his undergraduate degree from UCLA and medical degree from Georgetown University School of Medicine. He completed an internship and residency in internal medicine at Cedars-Sinai Medical Center and his clinical and research fellowship in infectious diseases at Cedars-Sinai Medical Center and UCLA.
In this Article
- Human immunodeficiency virus (HIV) facts
- What is the history of HIV, and when was HIV discovered?
- What tests are used in the diagnosis of HIV?
- How is HIV spread (transmitted)?
- What are symptoms and signs of HIV infection and AIDS in men, women, and children?
- What happens after an exposure to the blood or genital secretions of an HIV-infected person?
- What laboratory tests are used to monitor HIV-infected people?
- What are HIV treatments and medications? What are the key principles in managing HIV infection?
- When should antiviral therapy be started?
- What is the initial therapy for HIV?
- What are nucleoside and nucleotide analogue reverse transcriptase inhibitors (NRTIs)?
- What are nonnucleoside analogue reverse transcriptase inhibitors (NNRTIs)?
- What are protease inhibitors?
- What are fusion inhibitors?
- What is a CCR5 antagonist?
- What is an integrase strand transfer inhibitor?
- What HIV drugs are in development?
- What are side effects of HIV therapy?
- What happens if the patient's viral load increases while on HIV therapy?
- What are the risks of missing doses or stopping antiviral therapy?
- Should patients with the flu- or mono-like illness of primary HIV infection be treated?
- What about treatment for HIV during pregnancy?
- What can be done for people who have severe immunosuppression?
- What is the future for HIV-infected individuals with regards to treatment simplification and cure research?
- What is in the future for preventing HIV transmission?
- HIV-AIDS Rxlist FAQs
- Find a local Infectious Disease Specialist in your town
What are symptoms and signs of HIV infection and AIDS in men, women, and children?
The time from HIV infection to the development of AIDS varies. Rarely, some individuals develop complications of HIV that define AIDS within one year, while others remain completely asymptomatic after as many as 20 years from the time of infection. However, in the absence of antiretroviral therapy, the time for progression from initial infection to AIDS is approximately eight to 10 years. The reason why people experience clinical progression of HIV at different rates remains an area of active research.
Within weeks of infection, many people will develop the varied symptoms of primary or acute infection, which typically has been described as a mononucleosis- or influenza-like illness but can range from minimal fever, aches, and pains to very severe symptoms. The most common symptoms of primary HIV infection are
It is not known, however, why only some HIV-infected people develop these symptoms. It also is also not completely known whether or not having the symptoms is related in any way to the future course of HIV disease. Regardless, infected people will become symptom-free (asymptomatic) after this phase of primary infection. During the first weeks of infection when a patient may have symptoms of primary HIV infection, antibody testing may still be negative (the so-called window period). If there is suspicion of early infection based upon the types of symptoms present and a potential recent exposure, consideration should be given to having a test performed that specifically looks for the virus circulating in the blood, such as a viral load test or the use of an assay that identifies HIV p24 antigen, for example, the new fourth-generation antibody/antigen combination test. Identifying and diagnosing individuals with primary infection is important to assure early access into care and to counsel them regarding the risk of transmitting to others. The latter is particularly important since patients with primary HIV infection have very high levels of virus throughout their body and are likely to be highly infectious. Once the patient enters the asymptomatic phase, infected individuals will know whether or not they are infected if a test for HIV antibodies is done.
Shortly after primary infection, most individuals enter a period of many years where they have no symptoms at all. During this time, CD4 cells may gradually decline, and with this decline in the immune system, patients may develop the mild symptoms of HIV such as vaginal or oral candidiasis thrush (a fungal infection), fungal infections of the nails, a white brush-like border on the sides of tongue called hairy leukoplakia, chronic rashes, diarrhea, fatigue, and weight loss. Any of these symptoms should prompt HIV testing if it is not being done for other reasons. With a further decline in function of the immune system, patients are at increasing risk of developing more severe complications of HIV, including more serious infections (opportunistic infections), malignancies, severe weight loss, and decline in mental function. From a practical perspective, most physicians think about patients with HIV diseases as having no symptoms, mild symptoms, or being severely symptomatic. In addition, many would characterize a patient's level of immunosuppression by the degree and type of symptoms they have as well as the CD4 cell count. The Centers for Disease Control and Prevention have defined the presence of a long list of specific diseases or the presence of less than 200 CD4 cells per mm3 as meeting a somewhat arbitrary definition of AIDS. It is important to note that with effective antiretroviral therapy many of the signs and symptoms of HIV as well as severity of immunosuppression can be completely reversed, restoring even the most symptomatic patients to a state of excellent health.
Get breaking medical news.