SYMPTOMS AND PHASES OF HIV

INFECTION & AIDS

JHM
 Introduction
• HIV/Aids is often called the “silent epidemic”
due to the second stage of the disease that
usually involves few if any symptoms.
• This means that a person can be infected for
many years without showing any symptoms.
• The World Health Organisation (WHO) clinical
staging system for HIV/Aids was developed in
1990 using clinical parameters to guide clinical
decision making for management of HIV/Aids.
• It is used for limited resource settings where
there is limited access to laboratory service.
 Stages of infection
• Although HIV infection can theoretically be
divided into 4 different phases, it is important to
note that HIV-infection cannot in practice be
precisely demarcated into separate and distinct
phases with easily identifiable boundaries.
• The health of the HIV positive person will depend
on the health of his or her immune system, on 
CD4 cell count and viral load in the blood, as well
as on the exposure to infections and diseases in
the environment.
• HIV/AIDS is seen as a chronic disease nowadays,
because HIV-positive people can live with the
infection for many years if they look after their 
immune systems.
• Antiretroviral medication made it possible for
many individuals who have been very sick with
HIV/Aids, to become fully functioning again - with
a low, or even undetectable viral load.
• It is also not possible to say exactly what
symptoms and diseases will be associated with
HIV-infection in a specific person.
• Because of the unique way in which HIV attacks
and disarms the immune system, all kinds of
bacteria, fungi, protozoa, viruses and cancers are
able to invade the body.
• That is the reason why we talk about AIDS as a
syndrome - a collection of many illnesses and
infections.
HIV-infection can, however, theoretically be divided
into the following phases or stages:
 Stage 1: The primary HIV infection phase (or acute
sero-conversion illness)
 Stage 2: The asymptomatic latent phase.  The minor
symptomatic phase
 Stage 3: The major symptomatic phase and
opportunistic diseases
 Stage 4: AIDS-defining conditions: the severe
symptomatic phase
Stage 1: The primary HIV infection phase
• The acute phase of HIV infection (also called acute
sero-conversion illness) begins as soon as sero-
conversion has taken place.
• Seroconversion is the process of rapid HIV
replication and the build-up of HIV-anti-bodies
• This also usually coincides with the time when an 
HIV test will show that a person is HIV positive.
• Sero conversion is preceded by a Window period.
This period is between the onset of the HIV infection
and the appearance of detectable antibodies to the
virus.
• The window period is about 3 to 4 weeks and may
be longer with some individuals
• Sero-conversion usually occurs four to eight
weeks after an individual has been infected with
the HIV.
• About 30%-60% of people infected with HIV
develop flu-like symptoms such as sore throat,
headache, mild fever, fatigue, muscle and joint
pains, swelling of the lymph nodes, rash, and
(occasionally) oral ulcers.
• These symptoms usually last from between one
and two weeks.
• Because of the rapid replication of the virus,
the viral load is usually very high during the
acute phase.
• Immediate and aggressive treatment with 
anti-retroviral therapy (ART) at this stage may
be effective in reducing the viral load to
undetectable levels
Stage 2: The asymptomatic latent phase
• The second phase of HIV infection is the
asymptomatic latent or silent phase.
• In this stage, an infected person displays no
symptoms.
• Infected individuals are often not even aware
that they are carrying the HIV, and may
therefore unwittingly infect new sex partners.
• Even though the infected person may be ignorant
of its presence, the virus nevertheless remains
active in the body during this stage and it
continues to damage and undermine its victim’s
immune system.
• A positive HIV test is often the only indication of
HIV infection during this latent phase.
• HIV-infected people can remain healthy for a long
time, show no symptoms and carry on with their
work in a normal way.
• Some people remain HIV positive for many years
without any manifestation of clinical disease
while others may deteriorate rapidly, develop
AIDS and die within months.
• In some cases the only symptom during this
phase is swollen glands.
Stage 3: The minor symptomatic phase
• In the third phase of infection, minor and early
symptoms of HIV disease usually begin to manifest.
• At this stage the viral load is high and the immune
system is not coping and manifests itself by the
occurrence of opportunistic infections.
• This phase usually starts when people with HIV
antibodies begin to present with one or more of the
following symptoms:
• Mild to moderate swelling of the lymph nodes in the
neck, armpits and groin
• Occasional fevers
• Oral candidiasis (thrush)
• Pulmonary tuberculosis
• Oral hairy leukoplakia
• Shingles (or Herpes zoster)
• Skin rashes and nail infections
• Sores in the mouth that come and go
• Recurrent upper respiratory tract infections
• Weight loss up to 10% of the person’s usual body
weight
• General feelings of tiredness and non-feeling-well
 Stage 4: AIDS (major symptomatic
phase of HIV infection and
opportunistic diseases)
• The fourth stage is known as AIDS. 
• Major symptoms and opportunistic
diseases begin to appear as the immune system
continues to deteriorate.
• At this point, the CD4 cell count becomes very
low while the viral load becomes very high.
• The following symptoms are usually an indication of
advanced immune deficiency:
 Oral and vaginal thrush infections which are very
persistent and recurrent (Candidaisis)
 Oesophageal candidaisis  (thrush in the food pipe)
 Extra pulmonary Tuberculosis (TB affecting other
parts of the body besides the lungs)
 Recurrent herpes infections such as cold sores
(herpes simplex)
 Recurrent herpes zoster (or shingles)
 Bacterial skin infections and skin rashes
 Bacterial pneumonia
• Kaposi’s sarcoma, or a rare form of skin cancer
(painless reddish-brown or bluish-purple patches or
swelling on the skin and mucous membranes such as
in the mouth). Kaposi’s sarcoma can also occur in the
lungs and gastro-intestinal tract.
• Pneumocystis Carinii Pneumonia (PCP)
• Fever for more than a month
• Persistent diarrhoea for more than a month leading
to wasting syndrome
• Weight loss (more than 10 percent of the usual body
weight)
• Generalised lymphadenopathy (or, in some cases,
the shrinking of previously enlarged lymph nodes)
• Toxoplasmosis of brain
• Cytomegalovirus
• Cryptococcal meningitis
• Peripheral neuropathy (Nervous system problems
- often complain of pains, numbness or “pins and
needles” in the hands and feet
• Abdominal discomfort, headaches
• Oral hairy leucoplakia (thickened white patches
on the side of the tongue)
• Persistent cough and reactivation of tuberculosis
HIV progression to AIDS
 Kaposi’s sarcoma (KS)
• Kaposi’s sarcoma (shown) is
a rare cancer of the blood
vessels that is associated
with HIV. It manifests as
bluish-red oval-shaped
patches that may eventually
become thickened. Lesions
may appear singly or in
clusters.
Oral Hairy Leukoplakia
Oral Candidiasis (thrush)
Oral candidaisis
Vaginal candidaisis
Herpes Zoster
Herpes zoster
Genital Herpes
Kaposi Sarcoma
HIV (arrows) Infecting a T-lymphocyte