HIV Symptoms Diane Havlir, MD Professor of Medicine and Chief, HIV/AIDS Division University of California, San Francisco (UCSF) WorldMedSchool; July 2, 2013 1
Clinical Manifestations of HIV! Result from Inflammatory reactions to HIV (retroviral syndrome, chronic diarrhea ) Immune impairment that increases susceptibility to Infections that occur in immune competent hosts (Tuberculosis, Bacterial pneumonia) Unusual opportunistic infections (Pneumocystis) Certain malignancies (Lymphoma)! Increase in frequency and severity with CD4 decline! Are influenced by regional disease epidemiology ( TB, fungal diseases)
Stage 1: Primary HIV infection! 2/3 patients develop symptoms acute retroviral syndrome! Presents 1-6 weeks after infection! Flu like illness
Acute Retroviral Syndrome Fever 86 Lethargy 74 Myalgias Rash Headache Pharyngitis 59 57 55 52 Adenopathy 44 0 10 20 30 40 50 60 70 80 90 100 Patients % Vanhems P, AIDS. 2000
Stage 2: Asymptomatic Fauci, Annals of Internal Medicine! Follows acute HIV infection! Lasts for a period of years! Characterized by few or no symptoms except for lymphadenopathy! However, there is ongoing inflammation, end organ effects (heart, kidney) in presence of declining CD4+ cells
Stage 3: Symptomatic! Constitutional symptoms Fever, night sweats Diarrhea Weight loss! Dermatologic manifestations! Mucocutaneous conditions Shingles (Varicella Zoster) X X Seborrheic dermatitis XX X X Onchymoycosis (Tinea Pedis)
Oral Hairy Leukoplakia Associated with Epstein- Barr virus (EBV) in superficial tongue layers Hairy projections of keratinized squamous epithelium Ribbed appearance on side of tongue Painless Oral Thrush Caused by Candida albicans White plaques or curd like exudates Hard and soft palate Beefy red oral mucosa Vaginal candidiasis typical presentation in women
HIV and TB co-infection! Most common opportunistic infection in HIV! Wide variety of clinical presentations Pulmonary TB Extrapulmonary TB Miliary TB! Symptoms present weeks to months! When CD4 cell counts are low More disseminated TB Atypical presentations of TB
Pulmonary Tuberculosis Symptoms present for weeks to months Fever, productive cough, weight loss Cavitation may be seen with high CD4+ cell counts, but rarely with low CD4 + MiliaryTuberculosis More common with low CD4+ count (AIDS) Wasting syndrome most common presentation Widespread TB in all organs including lymph nodes in the abdomen
Extrapulmonary Tuberculosis More common in HIV+ vs HIV- TB Examples TB pleurisy Cervical lymph nodes (scrofula) Spinal disease(pott s disease) TB of the cervical notes xxxxxx
Stage 4: AIDS Over 30 conditions meet the clinical case definition of AIDS Often, more than one illness is present Progressive multifocal leukoencephalopathy! Constitutional symptoms AIDS wasting Chronic diarrhea! Opportunistic infections! Malignancies! HIV associated cardiomyopathy! HIV associated nephropathy! HIV associated dementia
Kaposi s sarcoma Caused by HHV-8 Purple patches, plaques, papular lesions Progress gradually Cutaneous disease most common Can cause visceral disease including pulmonary and lymphatic disease at low CD4 cell counts
Pneumocystis pneumonia Caused by Pneumocystis jiroveci Gradual onset over period of weeks Fever, dry cough, chest pain Shortness of breath Lung exam may include crackles and rhonchi Chest radiograph: Diffuse interstitial infiltrates
Gastrointestinal Diseases Cryptosporidiosis Salmonella infections Mycobacterium avium
Central Nervous System Infections Toxoplasmosis of the Central Nervous System Cryptococcal Meningitis
Diseases of the Eye Cytomegalovirus Retinitis Squamous cell carcinoma of the eye
Pediatric HIV Diseases Lymphocytic Interstitial Pneumonitis (LIP) Inflammatory condition, polyclonal proliferation of B and T cells Symptoms present for weeks to months Cough and tachypnea but no fever Reticular pattern on chest radiograph
CD4 Cell Count SUMMARY : HIV DISEASE SYMPTOMS 500 350 200 50 Stage 1: Primary Infection Flu like illness Stage 2: Asymptomatic Infection Lymphadenopathy and chronic inflammation Thrush, OHL, TB, bacterial pneumonias Include infections, malignancies, syndromes and end organ damage Occur at predictable CD4+ thresholds Vary in distribution globally Preventable with antiretroviral therapy Stage 3: Symptomatic Infection Pneumocystis Toxoplasmosis, cryptococcus Stage 4: AIDS CMV retinitis M. avium TIME IN YEARS 10