Symptoms of AIDS
AIDS is characterized by severe immunodeficiency manifesting as opportunistic infections, unusual neoplasms, and constitutional symptoms including fever, night sweats, weight loss, and lymphadenopathy, occurring in patients with advanced HIV infection (typically with CD4 counts below 200 cells/mm³). 1
Constitutional Symptoms
- Unexplained weight loss (often significant, averaging 34 pounds) 2
- Persistent fever (temperature >38.5°C)
- Night sweats
- Chronic fatigue
- Persistent generalized lymphadenopathy (though not correlated with prognosis) 1
Opportunistic Infections
AIDS is defined by the presence of specific opportunistic infections that occur due to severe immunosuppression:
Respiratory System
- Pneumocystis carinii pneumonia (now called Pneumocystis jirovecii)
- Tuberculosis
- Bacterial pneumonia
- Mycobacterium avium-intracellulare infection 3
Gastrointestinal System
- Oral candidiasis (thrush)
- Oral hairy leukoplakia
- Esophageal candidiasis causing swallowing difficulties
- Cryptosporidiosis causing chronic diarrhea
- Cytomegalovirus colitis
- Chronic diarrhea with malabsorption 2
Neurological System
- Cryptococcal meningitis
- Toxoplasma encephalitis
- Progressive multifocal leukoencephalopathy (PML) caused by JC virus
- HIV-associated neurocognitive disorders
- Peripheral neuropathy 1
Skin and Mucosal Manifestations
- Seborrheic dermatitis
- Herpes zoster (shingles) involving multiple dermatomes
- Molluscum contagiosum
- Persistent herpes simplex infections
- Fungal skin infections 1
AIDS-Defining Malignancies
- Kaposi's sarcoma (purplish-brown skin lesions that can also affect internal organs)
- Non-Hodgkin lymphoma
- Invasive cervical cancer
- Primary central nervous system lymphoma 3, 4
Laboratory Findings
- CD4+ T-cell count <200 cells/mm³ or CD4+ percentage <14%
- Lymphopenia
- Polyclonal hypergammaglobulinemia
- Cutaneous anergy (inability to mount delayed-type hypersensitivity responses) 3
Physical Examination Findings
- Wasting syndrome (HIV cachexia)
- Lipodystrophy (in patients on antiretroviral therapy)
- Hepatosplenomegaly
- Funduscopic abnormalities (CMV retinitis in advanced disease)
- Anogenital lesions (condylomata, herpes, etc.) 1
Clinical Course
The progression from HIV infection to AIDS typically occurs over a median of 10 years without treatment, with a range from a few months to ≥12 years. Studies have shown that AIDS develops in 55-62% of untreated HIV-infected individuals within 12 years after infection 1.
Key Considerations
- Symptoms may be atypical or minimal in some patients 5
- The presence of opportunistic infections often indicates profound immunosuppression
- Patients with AIDS often have multiple concurrent infections 3
- Response to treatment for opportunistic infections may be slower and less complete than in immunocompetent individuals 3
Clinical Pitfalls to Avoid
- Failing to recognize that AIDS symptoms may be subtle or atypical
- Attributing symptoms to a single infection when multiple pathogens may be present
- Overlooking non-infectious causes of symptoms such as drug toxicities or malignancies
- Delaying diagnosis by not considering HIV/AIDS in patients with recurrent infections or unusual presentations
Early recognition of AIDS symptoms is critical as prompt initiation of antiretroviral therapy and prophylaxis against opportunistic infections can significantly improve morbidity and mortality outcomes.