Types of HIV Infections (AIDS)

The average (the mean) incubation time for HIV infection is 10 years. Incubation time means the time from initial infection until the development of "full-blown AIDS," discussed below. The average is a bell curve, with 10 years at the center. Some individuals develop illness sooner than 10 years and some later than 10 years.

Most symptoms and diseases common to HIV infection are listed in Figures 4, 5 and 6. The presence of these symptoms and diseases varies from one patient to another. These diseases may occur in sequence or simultaneously.

Obviously, many of these symptoms can be caused by a number of common illnesses. These diseases are listed here for the sake of education, not for the purpose of self-diagnosis. In case of any persistent illness, consult your health care provider.

The popular classification system of HIV infections, used here, is a collection of haphazard definitions that evolved as the AIDS epidemic unfolded. These labels are ones of convenience, not ones of scientific or medical accuracy. Medical authorities use different, more complex, classification systems.

Basically, four loosely defined different stages of HIV infection exist: I ) the healthy carrier state, 2) the lymphadenopathy syndrome (LAS), 3) AIDS-related complex (ARC), and 4) AIDS or "frank AIDS," or "full-blown AIDS." These forms or the symptoms of each may overlap the other.

Healthy Carrier State

A carrier is someone who is infected with a disease and shows no clinical symptoms, but who is capable of infecting other people with the disease. ("Clinical" means "seen in the doctors office.")

HIV has been isolated (removed) and cultured ("grown" in a laboratory dish) from healthy people who show no clinical signs of HIV infection.

It is not yet clear when an HIV-infected person becomes infectious. At this time, the only safe practice is to assume that anyone carrying the virus is capable of transmitting it to others.

Lymphadenopathy Syndrome (LAS)

Lymphadenopathy Syndrome (LAS) is a mild form of HIV infection, generally characterized by some of the symptoms in Figure 4.

Lymphadenopathy means "disease of the lymphatic system." The lymphatic system is the human body's second fluid system which contains a clear fluid called lymph (see Figure 3). The lymphatic system aids the blood system by draining fluid out of the body' s tissues. The lymphatic system is not a closed loop like the bloodstream, meaning it does not flow in a circle, and it has no pump like the heart. Nevertheless, lymph flows from smaller vessels into larger lymph ducts in the upper chest. In doing so, lymphatic fluid passes through a series of filtering stations called lymph nodes, or lymph glands. Lymph nodes filter bacteria (one-celled organisms), foreign substances, and dead white blood cells out of the fluid.

The lymphatic system is a vital part of the body's immune system. Lymph nodes store and mature lymphocytes and other white blood cells and also manufacture antibodies. T-cells and macrophages can migrate back and forth between the blood system and the lymphatic system, perhaps exposing newly generating cells to HIV during their formative stages.

Figure 3: The Lymphatic System

[Figure 3: ]

One of the key signs of lymphadenopathy is swollen lymph glands. Of course, any infection, such as the flu, causes the lymph nodes to swell; but, nodal swelling due to normal infections passes quickly. With HIV infection, this nodal swelling may persist for months, with no other signs of a temporary infectious disease. Consequently, lymphadenopathy is sometimes called persistent generalized lymphadenopathy (PGL).

• Unexplained fever
• Difficulty in swallowing
• Swollen glands
• Fatigue/Lethargy
• Night sweats and chills
• Apathy
• Gradual loss of weight
• Diarrhea
• Sore throat
• Impotence

AIDS-related Complex (ARC)

AIDS-related Complex is a more advanced level of HIV infection. Symptoms generally include the symptoms of lymphadenopathy, plus abnormal body conditions revealed by laboratory tests, and/or the presence of one or more opportunistic infections.

A person with ARC has a discomforting illness. His or her everyday activity may be restricted and he or she is probably manifesting bouts of illness that require short-term or long-term medical treatment in and out of the hospital.

Acquired Immune Deficiency Syndrome (AIDS)

AIDS is the "full-blown" syndrome, also called "frank" AIDS. Patients suffering from AIDS often have any number of the opportunistic diseases listed in Figure 6. These diseases develop because of the widespread failure of the immune system. Drug treatments are available for many of these infections; but, without the support of the immune system, the drugs fail to cure the disease fully or are unable to keep the disease from returning. These opportunistic infections, curable under other circumstances, cause the death of most AIDS patients.

• Anergy: lack of skin allergic response
• Anemia: lack of red blood cells
• Autoimmune Disorders: immune system attacks own body
• Candidiasis/Oral Thrush: See Figure 6
• Hyperplasia: excessive growth of normal cells in organ
• Kidney Dysfunction: kidneys fail or function poorly
• Leukopenia: decreased number of leukocytes (white blood cells that engulf germs)
• Lymphomas: lymphatic system cancers
• Lymphopenia: decreased number of lymphocytes
• Nerve Damage: possible blindness, deafness, paralysis
• Oral Thrush: caused by Epstein-Barr Virus (Figure 6)
• Wasting: severe weight loss, perhaps death, from diarrhea and malnutrition

Pneumocystis carinii pneumonia (PCP).

Caused by fungus-like single-celled parasite, Pneumocystis carinii, common world-wide. Infects lungs. Previous to AIDS, found in kidney transplant patients whose immune system had been chemically suppressed. Occurs in 60% to 80% of AIDS patients. Initially responsible for 30% to 50% of deaths among AIDS patients, now brought under better control due to chemical prophylaxis, that is, chemically treating the patient before symptoms occur.

Kaposi's sarcoma (KS).

Malignant skin cancer. Appear first as pink, purple or brown lesions (wounds), usually on arms and/or legs; then spreading around body. In AIDS patients, may spread to gastrointestinal tract, lungs, other internal organs. Initially occurred in 46% of homosexual AIDS patients, in only 3.8% of heterosexual IV drug abuser AIDS patients. Onset is statistically associated, in homosexual males, with oral-anal sex and fecal (feces) contact-possible infectious agent involved.

Toxoplasmosis.

Caused by Toxoplasmosa gondii. Infects blood and many tissues. Common to humans, many domestic and wild animals. Humans may catch from droppings of cats and undercooked meat, especially mutton. In AIDS patients, tendency to infect tissues of central nervous system (brain and nerves). Also causes pneumonia and hepatitis inflammation/dysfunction of the liver). Many minor, non-life-threatening outbreaks occur in day-care centers. In AIDS patients, can be a major cause of mortality.

Candidiasis.

Caused by species of Candida, a fungus common to skin, mouth, vagina, gastrointestinal tract of humans. In AIDS patients, usually takes oral form: white spots or patches on lateral sides of tongue, perhaps inside mouth on mucous membranes of cheeks; commonly lodges under nailbeds and skin around armpits, groin, and rectum. Sometimes affects lungs. Frequently, first clinical (as seen in doctor's office) sign of HIV infection .

Cryptococcosis.

Caused by Cryptococcus neoformans, a fungus found in pigeon manure. Common among humans and other mammals, especially cats. Causes pneumonia in rare instances, most often causes meningitis (inflammation of the spinal cord and brain membranes). Also causes endocarditis (inflammation of lining of heart); and skin ulcers. Some increasing success with drug therapy.

Herpes infections.

Caused by herpes simplex viruses 1 (cold sores on lips) and 2 (sores on genitals). In HIV-infected patients, herpes simplex infections form chronic ulcers, often affecting face and sometimes the eyes; anal area often affected in homosexual males. Herpes infections are commonly found in people who are not infected with HIV; forming a cluster(s) of small, painful blisters, often, but not necessarily, on face.

Herpes zoster infection.

Caused by another herpes virus. Also known as shingles or chickenpox. Herpes zoster viruses may remain latent (inactive) for years (perhaps left over from childhood), but may be reactivated by HIV infection, causing inflammation of the spinal and cranial ganglia (nerve roots). In AIDS patients, can be disseminated (widespread) throughout the body. Often an initial clinical symptom in HIV-infected individuals. Herpes zoster is common among people not infected with HIV.

Mycobacterium infection.

Caused by Mycobacterium avium intracellulare, a bacterium commonly found in human saliva. Causes type of tuberculosis in humans, producing lesions in lungs. Disseminated, it cause problems in the intestines, blood, liver, and spleen.

Epstein-Barr infection.

Caused by Epstein-Barr virus (EBV), suspected cause of mononucleosis and some lymphomas (cancers of the lymph tissue). Implicated in number of auto-immune conditions (body's immune system attacking itself, as sometimes occurs in advanced HIV infection.) Thought to disrupt T-cell function. In HIV-infected, causes oral hairy leukoplakia, fuzzy white spots on the tongue which do not rub off as does "hairy tongue" caused by smoking. Possibly remains dormant until HIV infection occurs.

Cytomegalovirus (CMV) infection.

Normally present in salivary glands of humans. Often widely scattered throughout the body in patients with advanced HIV infection. Causes problems in eyes, colon, lungs, liver, and adrenal glands. Suspected in promoting appearance of Kaposi's sarcoma. After PCP prophylaxis became effective, CMV infection became the major cause of mortality among AIDS patients. Cytomegalovirus is frequently spread in day-care centers, where it has been shown to survive on toys and plexiglass for 30 minutes.

Cryptosporidiosis.

An enteritis (inflammation/swelling of intestines) caused by Cryptosporidia muris and/or C. difficile; a one-celled parasite common to domestic and wild animals. Many minor, non-life-threatening outbreaks occur in day-care centers. In AIDS patients, may be major cause of mortality.

Tuberculosis (TB).

Caused by Mycobacterium tuberculosis, a bacterium and a non-opportunistic infection found in non-HIV-infected people. Infects lungs, disseminated in some AIDS patients. A major killer in the past, social hygiene education and effective medical treatment eliminated TB from most of the Western world, except among populations lacking adequate access to medical care. Statistically associated with AIDS (found in some AIDS patients), it may reflect socio-economic status rather than being an opportunistic infection due to AIDS. Infection may occur prior to HIV infection as a damaged immune system is not required to catch TB.

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