Lesson 6

After completing this lesson, you will be able to: 

·        describe the symptoms of infection with HIV in adults and children;

·        suggest some therapies for HIV infection; and

·        share with your pupils the characteristics of persons infected with HIV.

Symptoms in Adults

In the period immediately after infection with HIV, no specific symptoms are noticeable. However, within one to three weeks after infection, most people experience the following:

·        flu-like symptoms, such as fever, sore throat, headache;

·        skin rash;

·        tender lymph nodes; and

·        a vague feeling of discomfort.

These symptoms usually go away after a week or two. Often, if they occur at all, they are so mild they are hardly noticeable, although for some people they are severe enough to warrant calling a doctor. It is important to keep in mind that these symptoms are almost identical to those of many other illnesses. That is why testing is so important. Very often people who have the symptoms are worrying unnecessarily. Only by taking the HIV test can someone reliably know their HIV status. Everything else is just guessing and HIV is too important an issue to merely guess about.

The symptoms last one to four weeks. During this phase, known as acute retroviral syndrome, HIV reproduces rapidly in the blood. The virus circulates in the blood throughout the body, particularly concentrating in organs of the lymphatic system. The normal immune defenses against viral infections eventually activate to battle HIV in the body, reducing but not eliminating HIV in the blood. Infected individuals typically enter a prolonged asymptomatic phase, a symptom-free period that can last ten years or more. While persons who have HIV may remain in good health during this period, HIV continues to replicate, progressively destroying the immune system. Often an infected person remains unaware that he or she carries HIV and unknowingly transmits the virus to others during this phase of the infection.

When HIV infection reduces the number of CD4 cells to around 200 per microlitre of blood, the infected individual enters an early symptomatic phase that may last a few months to several years. HIV-infected persons in this stage may experience a variety of symptoms that are not life-threatening but may be debilitating. These symptoms include

·        extensive weight loss and fatigue (wasting syndrome);

·        periodic fever;

·        recurring diarrhea;

·        and thrush, a fungal mouth infection.

An early symptom of HIV infection in women is a recurring vaginal yeast infection. Unlike earlier stages of the disease, in this early symptomatic phase the symptoms that develop are severe enough to cause people to seek medical treatment. Many may first learn of their infection in this phase.

If CD4 cell levels drop below 200 cells per microlitre of blood, the late symptomatic phase develops. This phase is characterised by the appearance of any of 26 opportunistic infections and rare cancers. The onset of these illnesses, sometimes referred to as AIDS-defining complications, is one sign that an HIV-infected person has developed full-blown AIDS. Without medical treatment, this stage may last from several months to years. The cumulative effects of these illnesses usually cause death.

Symptoms in Children

HIV infection in children progresses more rapidly than in adults, most likely because the immune system in children have not yet built up immunity to many infectious agents. The disease is particularly aggressive in infants—more than half of infants born with an HIV infection die before age two. Once a child is infected, the child’s undeveloped immune system cannot prevent the virus from multiplying quickly in the blood. This extensive virus burden speeds the progression of the disease. In contrast, when adults become infected with HIV, their immune system generally fights the infection. Therefore, HIV levels in adults remain lower for an extended period, delaying the progression of the disease.

Children develop many of the opportunistic infections that befall adults but also exhibit symptoms not observed in older patients. Among infants and children, HIV infection produces wasting syndrome and slows growth (generally referred to as failure to thrive). HIV typically infects a child’s brain early in the course of the disease, impairing intellectual development and coordination skills. While HIV can infect the brains of adults, it usually does so toward the later stages of the disease and produces different symptoms.

Children show a susceptibility to more bacterial and viral infections than adults. More than 20 percent of HIV-infected children develop serious, recurring bacterial infections, including meningitis and pneumonia. Some children suffer from repeated bouts of viral infections, such as chicken pox. Healthy children generally develop immunity to these viral illnesses after an initial infection.

Wasting Syndrome and Weight Loss

 

Weight loss and wasting syndrome are two AIDS-related complications that, if not adequately treated, can be life threatening. Even though anti-HIV therapies have helped reduce the risk of weight loss and wasting syndrome, both problems still occur. Is there a difference between weight loss and wasting? Yes. As its name implies, weight loss refers to a loss of body weight. Wasting syndrome refers to a loss of body mass or size, most notably muscle mass (sometimes referred to as "lean body mass"). Very often, both occur at the same time. However, this is not always the case. It is possible that someone who is losing weight might not lose muscle mass. It is also possible that someone losing muscle mass might not lose a lot of weight. For example, some HIV-positive people lose a lot of muscle. Yet they may experience an increase in fat. This can cause weight to stay the same, even though muscle wasting is going on. In people who do not have HIV, weight loss is not usually a serious problem. For example, someone who goes on a diet will eventually lose weight. To make up for the lack of food being eaten, the body will naturally burn fat – either in the blood or stored in cells – to help meet its energy needs. At the same time, the body works to protect protein during periods of dieting or physical activity. Protein is needed to build muscle, cells, and organs in the body. In other words, most people can afford to lose fat. They cannot afford to lose protein.

In people with HIV, especially during periods of illness (e.g., MAC or tuberculosis), the energy demands of the body increase. Turning fat into energy also requires a lot of work in the body. To help save energy, the body may go after protein to fuel its energy needs. This is because protein is much easier to convert into energy than fat. Also, protein is needed to help repair damaged organs and to replace immune system cells lost during periods of illness.

Figuring out the underlying cause of weight loss is very important. In some cases, the cause of weight loss or wasting is obvious, particularly when an opportunistic infection (OI) that is known to cause weight loss has been diagnosed. Other times, weight loss or wasting can be a symptom of an underlying OI that has not yet been diagnosed. Thus, weight loss that cannot be easily explained often requires that doctors examine their HIV-positive patients carefully, especially if they are losing weight.

There are a number of treatment strategies that have been proven effective in terms of weight gain and, in some cases, muscle growth and maintenance:

Diet Improvements: Diet improvement is crucial for virtually all HIV-infected individuals suffering from mild to severe forms of weight loss. Forms of dietary improvement include nutritional counseling and oral nutrition supplements. In terms of counseling, a registered dietitian can help identify weaknesses in an existing diet and make suggestions regarding dietary needs and how best to tailor them to meet individual tastes, schedules, and tolerances. Nutritional supplementation can also be extremely useful.

Treating Side Effects or General Symptoms of HIV: There are a number of treatments available to control symptoms, including drug side effects that make eating undesirable. Drugs to control nausea and vomiting (antiemetics), diarrhea (antidiarrheals), and decreased appetite (appetite stimulants) are widely available.

Treating the Opportunistic Infection (OI): Treating an active opportunistic infection, especially one that causes malabsorption, can halt and possibly reverse weight loss. Unfortunately, there are no effective treatments for intestinal diseases such as cryptosporidiosis and microsporidiosis, however a number of recent reports have suggested that anti-HIV may be extremely helpful in terms of boosting the immune response against these chronic infections and ultimately increasing weight. But, like appetite stimulants, treatments for OIs associated with weight gain usually contribute to fat accumulation, not muscle.
 

Hormonal Therapy: Treating metabolic disorders associated with wasting has been a large focus of research over the past few years. In particular, results from clinical trials of anabolic therapies have suggested that certain agents can increase and protect muscle mass in HIV-positive people with wasting and weight loss.

Immune-Based and Anti-HIV Therapies: In terms of treating immune system disorders, promising results have been seen using the drug thalidomide (Synovir), a drug that was once banned because of its ability to cause birth defects in pregnant women taking the drug. Yet, the most promising therapy in terms of stabilizing the immune system has been taking the anti-HIV drug combinations currently recommended. By drastically reducing the amount of virus circulating in the body, anti-HIV therapy allows the immune system to recover from the damage of HIV. In fact, a large number of studies have demonstrated that people receiving anti-HIV therapy, especially those with wasting, gain a great deal of weight while on therapy.