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End stage HIV infection


Last week, I spoke of the symptoms of early and chronic HIV. This week, I will speak of AIDS or end stage HIV infection. AIDS can be best described as the constellation of symptoms and complications that leads to the final demise in someone with HIV. It occurs when the immune cell (CD4+) count drops below 200. To understand the symptoms, I will remind my readers that the HIV virus infects the immune cells of the body.{{more}} The immune cells are responsible for fighting infections and preventing cancers. They are also responsible for many other functions in the body that we are not even aware of, e.g. pain relief and normal blood vessel function. AIDS is not the only condition that affects the immune system causing immunosuppression. Patients who are on anticancer medication (called chemotherapy), use steroids chronically, especially at high doses, are diabetics, are exposed to high dose radiations, and who have certain inherited diseases may be immunocompromised.

The symptoms of HIV could be nonspecific or specific. Unlike the specific symptoms, most patients experience the nonspecific constitutional symptoms like moderate weight loss, fevers and night sweats, swollen glands and weakness.

The specific symptoms are usually the cause of death for most AIDS patients. The specific symptoms are related mainly to the immune system, where the person can experience recurrent and strange infections and cancers. These infections and cancers occur in various areas of the body and can infect any organ or system, but tend to concentrate mainly in the lungs, brain, intestines and skin.

INFECTIONS: These patients contract infections easier; these infections tend to be of the type that do not affect the normal (immunocompetent) person and as such are called opportunistic infections. In the lungs, this involves the development of a chronic dry cough caused by a bug called pneumocystis. This infection is extremely rare except in people with AIDS; so when someone develops pneumocystis pneumonia (PCP) who is not on immunosuppressive medications (like chemotherapy), we doctors assume they have AIDS. AIDS patients can also develop tuberculosis (TB), not only the old aggressive type, but also the non-aggressive, fairly benign type that normal people can resist. About a half a million persons who die from TB each year have AIDS; that accounts for a quarter of all AIDS death. AIDS patients not only acquire new TB infections, but can have old, apparently healed TB reactivated. These reactivated TB infections also tend to be more resistant to treatment. In severe cases the TB can spread out of the lungs to involve the blood, the bones, the kidneys, prostate and almost any other organ in the body. TB patients would normally have a chronic cough producing mucoid (white, frothy) or bloody sputum. This is usually accompanied by weight loss, feeling weak and a low-grade fever.

The same reactivation can occur for many other organisms including the herpes virus group. This group of viruses includes the regular herpes simplex viruses 1 and 2 that cause ulcers on the mouth and genitals, the chickenpox virus that causes chickenpox and shingles, and the CMV virus that causes swollen glands. It also includes a virus called the EB virus that causes lymphoma. So, those who are worried about the very common herpes simplex 1 and 2 need to stop worrying, because there are more dangerous herpes viruses.

AIDS can also present with infections in the central nervous system or the brain and spinal cord. Again, like chest infections, these tend to be opportunistic, but the common culprits can also do it. It is important to note that the common culprits do not usually cause brain infections, because they are not common in the environment or on our skin. It is the normal environmental or body organisms that tend to cause infections. Sometimes, because of the immunocompromised state, the normal skin or surface bugs are replaced by abnormal ones that in turn cause infections. The infections may affect the covering of the brain and spinal cord (meningitis) or the substance (encephalitis). A fungus called Cryptococcus usually causes the meningitis. This used to be a rare cause of meningitis until the advent of HIV and AIDS. These people would normally complain of nausea, vomiting, headache, fever and confusion. Sometimes it causes seizures (fits) and, if not treated, death follows. Another rare bug called toxoplasma causes encephalitis or infection of the brain. This bug normally lives on the skin and intestines of domestic animals like cats and does not cause infections in normal individuals. The symptoms of encephalitis are the same as meningitis, except worse with more confusion, disorientation and coma. The eyes and lungs may also be affected. There are other ways in which the brain may be affected, but I will discuss this later.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785