AIDS Health Article

Signs and tests

The following is a list of AIDS-related infections and cancers that people with AIDS may get as their CD4 count decreases. In the past, having AIDS was defined as having HIV infection and getting one of these additional diseases. Today, according to the Centers for Disease Control and Prevention, a person is diagnosed as having AIDS if they have a CD4 cell count below 200, even if they don't have an opportunistic infection.

AIDS may also be diagnosed if a person develops one of the numerous infections and cancers that occur with HIV infection. These infections are unusual in people with a healthy immune system.

CD4 cells are a type of immune cell. They are also called "T cells" or "helper cells."

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/small blisters in the mouth or genitals, happens more frequently and usually much more severely in an HIV-infected person than before HIV infection
• Tuberculosis -- infection by the tuberculosis bacteria that mostly 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 (brain and spinal cord)
• Oral or vaginal thrush -- yeast infection of the mouth or vagina
• Herpes zoster (shingles) -- ulcers/small blisters over a patch of skin. it is 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 happen at any CD4 count, but is more likely to happen at lower CD4 counts, and is more common in men than in women

Common with 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

Common with CD4 count below 100 cells/mL:

• Cryptococcal meningitis -- infection of the lining of the brain
• AIDS dementia -- worsening and slowing of mental function, caused by HIV itself
• Toxoplasmosis encephalitis -- infection of the brain by a parasite, called Toxoplasma, which is frequently found in cat feces; causes lesions (sores) 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 mental and physical functions
• Wasting syndrome -- extreme weight loss and loss of appetite, caused by HIV itself
• Cryptosporidium diarrhea -- Extreme diarrhea caused by one of several related parasites

Common with 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, a test called HIV RNA load may be used to monitor patients. Basic screening lab tests and regular cervical Pap smears are important to monitor in HIV infection, due to the increased risk of cervical cancer in immunocompromised women. 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 help keep symptoms at bay and improve the quality of life of those who have already 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. Preventing the virus from replicating can help the immune system recover from the HIV infection and improve T-cell counts.

HAART is 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. But HAART has been enormously effective for the past 10 years. There is good evidence that if the levels of HIV remain suppressed and the CD4 count remains high (above 200 cells/mL), 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 HIV strain is resistant to a particular drug. This information may be useful in determining the best drug combination for each individual, and adjusting the drug regimen if it starts to fail. These tests should be performed any time a treatment strategy begins to fail, and prior to starting therapy.

When HIV becomes resistant to HAART, other drug combinations must be used to try to suppress the resistant strain of HIV. There are a variety of new drugs coming out on the market for the treatment of drug-resistant HIV.

Treatment with HAART has complications. HAART is a collection of different medications, each with its own side effects. Some common side effects are nausea, headache, weakness, malaise (a general sick feeling), and fat accumulation on the back ("buffalo hump") and abdomen. When used for a long time, these medications increase the risk of heart attack by increasing the levels of fat and glucose in the blood.

Any doctor prescribing HAART should carefully watch 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 3-4 months. The goal is to get the CD4 count as close to normal as possible, and to suppress the HIV amount of virus in the blood to an undetectable level.

Other antiviral medications are being investigated. 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 uiroveci pneumonia) if the CD4 count is low enough. This keeps AIDS patients healthier for longer periods of time. Opportunistic infections are treated when they happen.