HIV/AIDS

HIV Symptom Free Period
    Becoming infected with HIV and becoming sick from AIDS are two different events.
For most people, it takes many years from the time someone is infected with HIV to
the time that they develop symptoms of AIDS. Some people get sick sooner and others
stay well longer, especially with treatment. However, there is almost always a
significant period of time after infection when an HIV-positive individual will have
no symptoms at all -- often 10 years or more. 

    Keeping in mind the two separate events (becoming HIV-infected versus actually
developing AIDS) can help you to remember that there are also two separate time
periods when someone may show symptoms related to HIV-infection. 

HIV Early Symptoms
What are the early symptoms of HIV/AIDS?
 
    Many people do not develop any symptoms when they first become infected with
HIV. Some people, however, get a flu-like illness within three to six weeks after
exposure to the virus. This illness, called Acute HIV Syndrome, may include fever,
headache, tiredness, nausea, diarrhoea and enlarged lymph nodes (organs of the
immune system that can be felt in the neck, armpits and groin). These symptoms
usually disappear within a week to a month and are often mistaken for another viral
infection.
 
    During this period, the quantity of the virus in the body will be high and it
spreads to different parts, particularly the lymphoid tissue. At this stage, the
infected person is more likely to pass on the infection to others. The viral quantity
then drops as the body's immune system launches an orchestrated fight. 
More persistent or severe symptoms may not surface for several years, even a decade
or more, after HIV first enters the body in adults, or within two years in children
born with the virus. This period of "asymptomatic" infection varies from individual
to individual. Some people may begin to have symptoms as soon as a few months, while
others may be symptom-free for more than 10 years. However, during the "asymptomatic"
period, the virus will be actively multiplying, infecting, and killing cells of the
immune system. 

    Once HIV enters the human body, it attaches itself to a White Blood Cell (WBC)
called CD4. Also, called T4 cells, they are the main disease fighters of the body.
Whenever there is an infection, CD4 cells lead the infection-fighting army of the
body to protect it from falling sick. Damage of these cells, hence can affect a
person's disease-fighting capability and general health. 

    After making a foothold on the CD4 cell, the virus injects its RNA into the cell.
The RNA then gets attached to the DNA of the host cell and thus becomes part of the
cell's genetic material. It is a virtual takeover of the cell. Using the cell's
division mechanism, the virus now replicates and churns out hundreds of thousands of
its own copies. These cells then enter the blood stream, get attached to other CD4
cells andcontinue replicating. As a result, the number of the virus in the blood rises
and that of the CD4 cells declines. 

    Because of this process, immediately after infection, the viral load of an infected
individual will be very high and the number of CD4, low. But, after a while, the body's
immune system responds vigorously by producing more and more CD4 cells to fight the virus.
Much of the virus gets removed from the blood. To fight the fast-replicating virus, as
many as a billion CD4 cells are produced every day, but the virus too increases on a
similar scale. The battle between the virus and the CD4 cells continues even as the
infected person remains symptom-free. 

    But after a few years, which can last up to a decade or even more, when the number
of the virus in the body rises to very high levels, the body's immune mechanism finds
it difficult to carry on with the battle. The balance shifts in favour of the virus and
the person becomes more susceptible to various infections. These infections are called
Opportunistic Infections because they swarm the body using the opportunity of its low
immunity. At this stage, the number of CD4 cells per millilitre of blood (called CD4 Count),
which ranges between 500 to 1,500 in a healthy individual, falls below 200. The Viral
Load, the quantity of the virus in the blood, will be very high at this stage. 

    Opportunistic infections are caused by bacteria, virus, fungi and parasites. Some
of the common opportunistic infections that affect HIV positive persons are: Mycobacterium
avium complex (MAC), Tuberculosis (TB), Salmonellosis, Bacillary Angiomatosis (all caused
by bacteria); Cytomegalovirus (CMV), Viral hepatitis, Herpes, Human papillomavirus (HPV),
Progressive multifocal leukoencephalopathy (PML) (caused by virus); Candidiasis,
Cryptococcal meningitis (caused by fungus) and Pneumocystis Carinii pneumonia (PCP).
Toxoplasmosis. Cryptosporidiosis (caused by parasites). HIV positive persons are also
prone to cancers like Kaposi's sarcoma and lymphoma. 

    The Center for Disease Control (CDC), Atlanta has listed a series of diseases as
AIDS-defining. When these diseases appear, it is a sign that the infected individual
has entered the later stage of HIV infection and has started developing AIDS. The
progression of HIV positive persons into the AIDS stage is highly individual. Some
people can reach the AIDS stage in about five years, while some remain disease free
for more than a decade. Measurement of the viral load and the CD4 count helps a doctor
in assessing an infected person's health condition. 

Later Symptoms of HIV
Following are the later symptoms of HIV:
Lack of energy
Weight loss
 
Frequent fevers and sweats
 
A thick, whitish coating of the tongue or mouth (thrush) that is caused by a yeast
infection and sometimes accompanied by a sore throat
Severe or recurring vaginal yeast infections
Chronic pelvic inflammatory disease or severe and frequent infections like herpes
zoster
 
Periods of extreme and unexplained fatigue that may be combined with headaches,
lightheadedness, and/or dizziness
 
Rapid loss of more than 10 pounds of weight that is not due to increased physica
 exercise or dieting
Bruising more easily than normal
 
Long-lasting bouts of diarrhoea
 
Swelling or hardening of glands located in the throat, armpit, or groin
 
Periods of continued, deep, dry coughing
 
Increasing shortness of breath
 
The appearance of discoloured or purplish growths on the skin or inside the mouth
 
Unexplained bleeding from growths on the skin, from mucous membranes, or from any
opening in the body
 
Recurring or unusual skin rashes
 
Severe numbness or pain in the hands or feet, the loss of muscle control and reflex,
paralysis or loss of muscular strength
 
An altered state of consciousness, personality change, or mental deterioration
 
Children may grow slowly or fall sick frequently. HIV positive persons are also found
to be more vulnerable to some cancers.
 

AIDS Symptoms
    HIV virus causing AIDS enters the blood and quickly penetrates white cells. Then they
program the white cells, after which there is often little or no trace of the AIDS virus at
all. This situation usually lasts for six to twelve weeks. During this time the person is
free of HIV or AIDS symptoms and antibody tests for AIDS and HIV are negative. 

First Symptoms of AIDS Illness (HIV Infection)
    First thing that starts developing in a flu like illness, which may look like glandular
fever with swollen glands in the neck and armpits. At this stage the blood test will usually
become positive as it picks up the tell-tale antibodies. Most people do not realise what is
happening, although when they later develop AIDS they look back and remember it clearly. Most
people have produced antibodies in about twelve weeks. 

Latent infection
    The person in this stage has a positive HIV test. The virus often seems to disappear
completely from the blood again. At least nine out of ten who see these HIV and AIDS symptoms
will develop further problems. 

    San Francisco studies show that in developed countries, without use of the latest
therapies: 
50% with HIV develop AIDS in ten years
 
70% with HIV develop AIDS in fourteen years
 
Of those with AIDS, 94% are dead in five years
    The next HIV AIDS symptoms stage begins when the immune system starts to break down. This
is often preceded by subtle mutations in the virus, during which it becomes more aggressive
in damaging white cells. Several glands in the neck and armpits may swell and remain swollen
for more than three months without any explanation. This is known as persistent generalised
lymphadenopathy (PGL). 

Early HIV Virus Progression
    As the HIV disease progresses, the person starts showin up other AIDS symptoms. A simple
boil or warts may spread all over the body. The mouth may become infected by thrush (thick
white coating), or may develop some other problem. Dentists are often the first to be in a
position to make the diagnosis. People may develop severe shingles (painful blisters in a
band of red skin), or herpes. They may feel overwhelmingly tired all the time, have high
temperatures, drenching night sweats, lose more than 10% of their body weight, and have
diarrhoea lasting more than a month. No other cause is found and a blood test will usually
be positive. Some used to call this stage ARC, or AIDS related complex. 

Late HIV Illness - The AIDS Symptoms
    The final stage is AIDS. Most of the immune system is intact and the body can deal with
most infections, but one or two more unusual infections become almost impossible for the body
to get rid of without medical help, usually intensive antibiotics. 

    These infections can be a nightmare for doctors and patients. The desperate struggle is
to find the new germ, identify it, and give the right drug in huge doses to kill it. The germ
may be hiding deep in a lung requiring a tube (bronchoscope) to be put down the windpipe into
the lung to get a sample. The person is sedated for this. It may be hiding in the fluid covering
the brain and spinal cord, requiring a needle to be put into the spine (lumbar puncture). It
may be hiding in the brain itself. It may hide in the liver or gall-bladder or bowel. It can
hide anywhere.