Clinical features

After being infected with the virus, a prodromal period of about 6 weeks follows. This prodromal syndrome resembles infectious mononucleosis with transient lymphadenopathy, fever, malaise and occasionally meningoencephalitis. The viral load may be extremely high during acute infection. The majority of infected people then experience a protracted asymptomatic period. The virus however continues to replicate during this asymptomatic period and the CD4 T-cell count steadily falls. A number of HIV-related symptoms may develop, such as generalized lymphadenopathy, persistent fever, weight loss, diarrhoea, skin changes, CNS manifestations. Haematological abnormalities include thrombocy-topaenia, leucopaenia, neutropaenia, hypergammaglob-ulinaemia and anaemia. Infections may start to occur with organisms such as herpes simplex or zoster, Pneumococcus and Salmonella. When the CD4 count falls below 0.2 X 109/l, the patient becomes susceptible to a wide spectrum of opportunistic infections (Streptococcus pneumoniae, Haemophilus influenzae, Pneumocystis carinii, toxoplasmosis, Mycobacterium tuberculosis, atypical mycobacteria, histoplasmosis, Cryptococcus, cryptosporidiosis, fungal infections, Jamestown Canyon (JC) virus infection and CMV infections), malignancies (Kaposi's sarcoma and non-Hodgkin's lymphoma) and CNS disease such as dementia may develop. This stage of infection is classified by the Centre for Disease Control (CDC) as fully developed acquired immunodeficiency syndrome (AIDS). Many staging systems for HIV have been proposed and exist. Mostly clinicians determine the stage of infection according to the patients symptoms and the CD4 count. If available, the plasma viral load is progressively more being used to predict outcome and evaluate response to therapy (Fig. 11.13 and Table 11.4).

Figure 11.13. Photographs of a patient with AIDS: (a) shows perineal scarring after recurrent peri-anal infections and (b) a mouth ulcer on the hard palate, probably due to an opportunistic viral infection.

Table 11.4. Staging of HIV infection.

CD4 cell count

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