Signs and tests
The following is a list of AIDS-related infections and cancers that people with AIDS acquire as their CD4 count decreases. Previously, having AIDS was defined as having HIV infection and getting one of these additional diseases. Now it is additionally defined as a CD4 count below 200, even without an opportunistic infection. Many other illnesses and corresponding symptoms may develop in addition to those listed here.
Common with CD4 count below 350 cells/ml:
- Herpes simplex virus -- causes ulcers/vesicles in the mouth or genitals, occurring more frequently and more severely in an HIV-infected patient than before HIV infection
- Tuberculosis -- infection by the tuberculosis bacteria that predominately affects the lungs, but can affect other organs such as the bowel, lining of the heart or lungs, brain, or lining of the central nervous system
- Oral or vaginal thrush -- yeast infection of the mouth or genitals
- Herpes zoster (Shingles) -- ulcers/vesicles over a discrete patch of skin caused by the varicella zoster virus
- Non-Hodgkin's lymphoma -- cancer of the lymph glands
- Kaposi's sarcoma -- Cancer of the skin, lungs, and bowel, associated with a herpes virus (HHV-8). Can occur at any CD4 count, but more likely at lower CD4 counts, and more common in men than women
CD4 count below 200 cells/ml
- Pneumocystis carinii pneumonia, "PCP pneumonia," now called Pneumocystic jiroveci pneumonia
- Candida esophagitis -- painful yeast infection of the esophagus
- Bacillary angiomatosis -- Skin lesions caused by a bacteria called Bartonella, which is usually acquired from cat scratches
CD4 count below 100 cells/ml
- Cryptococcal meningitis -- infection of the lining of the brain by a yeast
- AIDS dementia -- worsening and slowing of mental function, caused by HIV itself
- Toxoplasmosis encephalitis -- infection of the brain by a parasite, which is frequently found in cat feces; causes discrete lesions in the brain
- Progressive multifocal leukoencephalopathy -- a viral disease of the brain caused by a virus (called the JC virus) that results in a severe decline in cognitive and motor functions
- Wasting syndrome -- extreme weight loss and loss of appetite, caused by HIV
- Cryptosporidium diarrhea -- Extreme diarrhea caused by one of several related parasites
CD4 count below 50/ml
- Mycobacterium avium -- a blood infection by a bacterium related to tuberculosis
- Cytomegalovirus infection -- a viral infection that can affect almost any organ system, especially the large bowel and the eyes
In addition to the CD4 count, HIV RNA load, and basic screening lab tests, regular vaginal Pap smears are important to monitor in HIV infection, due to the increased risk of cervical cancer in immunocompromised patients. . Anal Pap smears to detect potential cancers may also be important in both HIV infected men and women.
Treatment
There is no cure for AIDS at this time. However, a variety of treatments are available that can delay the progression of disease for many years, and improve the quality of life of those who have developed symptoms.
Antiretroviral therapy suppresses the replication of the HIV virus in the body. A combination of several antiretroviral agents, termed highly active antiretroviral therapy (HAART), has been highly effective in reducing the number of HIV particles in the blood stream, as measured by a blood test called the viral load. This can help the immune system recover from the HIV infection and improve T-cell counts.
Although not a cure for HIV, and people on HAART with suppressed levels of HIV can still transmit the virus to others through sex or sharing of needles, these treatments have been enormously effective for the past ten years. There is good evidence that if the levels of HIV remain suppressed and the CD4 count remains high (above 200), life can be significantly prolonged and improved. However, HIV may become resistant to HAART in patients who do not take their medications on schedule every day. Genetic tests are now available to determine whether a particular strain is resistant to a particular drug -- these may be useful in determining the best drug combination, and adjusting the regimen if it starts to fail. These tests should be performed for any failing treatment course, and prior to starting therapy.
When HIV becomes resistant to HAART, salvage therapy is required, to try to suppress the resistant strain of HIV. Different combinations of medications are used to try to reduce viral load, and there are a variety of new drugs coming out on the market for the treatment of drug-resistant HIV.
Treatment with HAART is not without complications. HAART is a collection of different medications, each with its own side effects. Some common side effects are nausea, headache, weakness, malaise, and fat accumulation on the back and abdomen ("buffalo hump"). When used long-term, these medications increase the risk of heart attack by affecting fat breakdown, specifically through increasing lipids and glucose levels.
Any doctor prescribing HAART should carefully follow the patient for possible side effects associated with the combination of medications the patient takes. In addition, routine blood tests measuring CD4 counts and HIV viral load (a blood test that measures how much virus is in the blood) should be taken every three to four months. The goal is to get the CD4 count as close to normal as possible, and to suppress the HIV viral load to an undetectable level.
Other antiviral agents are in investigational stages and many new drugs are in development. In addition, growth factors that stimulate cell growth, such as Epogen (erthythropoetin) and G-CSF are sometimes used to treat anemia and low white blood cell counts associated with AIDS.
Medications are also used to prevent opportunistic infections (such as Pneumocystis carinii pneumonia) if the CD4 count is low enough. This keeps AIDS patients healthier for longer periods of time. Opportunistic infections are treated as they occur.
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