AIDS natural history, complications, and prognosis

Overview
Acquired immune deficiency syndrome  (AIDS) is a collection of symptoms and infections resulting from the specific damage to the immune system caused by the human immunodeficiency virus (HIV) in humans, and similar viruses in other species (SIV, FIV, etc.)

Natural History
Currently there is no cure for AIDS but taking treatment dramatically increased the amount of time people with HIV remain alive. Research continues in the areas of drug treatments and vaccine development. Unfortunately, HIV medications are not always available in the developing world, where the bulk of cases now occur. Opportunistic infections and other coinfections that might be common in HIV-infected persons, such as sexually transmitted infections, can also have adverse effects on the natural history of HIV infection.

Prognosis
Without treatment, the net median survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype, and the median survival rate after diagnosis of AIDS in resource-limited settings where treatment is not available ranges between 6 and 19 months, depending on the study. In areas where it is widely available, the development of HAART as effective therapy for HIV infection and AIDS reduced the death rate from this disease by 80%, and raised the life expectancy for a newly-diagnosed HIV-infected person to about 20 years.

Complications
HIV infection weakens patients immune system, making them highly susceptible to variety of infections and certain types of cancers.

1. Infections common to HIV/AIDS

 * Tuberculosis (TB).
 * Salmonellosis.
 * Cytomegalovirus (CMV).
 * Candidiasis.
 * Cryptococcal meningitis.
 * Toxoplasmosis.
 * Cryptosporidiosis.

2. Cancers common to HIV/AIDS
AIDS-associated Kaposi sarcoma presents with cutaneous lesions that begin as one or several red to purple-red macules, rapidly progressing to papules, nodules, and plaques, with a predilection for the head, neck, trunk, and mucous membranes.
 * 2.A. Kaposi's sarcoma.

AIDS-associated Kaposi sarcoma simulated the greatest interest as one of the first illnesses associated with AIDS. Different from the classic form of Kaposi sarcoma, Tumors usually appear on the head, back, neck, muscular palate and the area of the gingiva.

In more advanced cases, they can be found in the stomach and intestines, the lymph nodes, and the lungs. KS-AIDS was first described in 1981 by three separate groups, most notably by Robert A. Schwartz and his collaborators at the University of Arizona.

To read more about AIDS-related Lymphome, click here.
 * 2.B. Lymphomas.

3. Other complications
Although HIV doesn't appear to invade the neuron, it can still cause neurological symptoms such as:
 * 3.A. Wasting syndrome.
 * 3.B. Neurological complications.
 * Confusion
 * Forgetfulness
 * Depression
 * Anxiety

One of the most common neurological complications in AIDS patient is AIDS dementia complex, to read more about it, click here AIDS stigma exists around the world in a variety of ways, including ostracism, rejection, discrimination and avoidance of HIV infected people; compulsory HIV testing without prior consent or protection of confidentiality; violence against HIV infected individuals or people who are perceived to be infected with HIV; and the quarantine of HIV infected individuals. Stigma-related violence or the fear of violence prevents many people from seeking HIV testing, returning for their results, or securing treatment, possibly turning what could be a manageable chronic illness into a death sentence and perpetuating the spread of HIV.
 * 3.C. Stigma associated with AIDS

AIDS stigma has been further divided into the following three categories:


 * 1) Instrumental AIDS stigma&mdash;a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.
 * 2) Symbolic AIDS stigma&mdash;the use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease.
 * 3) Courtesy AIDS stigma&mdash;stigmatization of people connected to the issue of HIV/AIDS or HIV- positive people.

Often, AIDS stigma is expressed in conjunction with one or more other stigmas, particularly those associated with homosexuality, bisexuality, promiscuity, and intravenous drug use.

In many developed countries, there is an association between AIDS and homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice such as anti-homosexual attitudes. There is also a perceived association between AIDS and all male-male sexual behavior, including sex between uninfected men. The strongest risk factor for excess mortality are :
 * 3.D. Death
 * Viral load more than 400 copies/mL.
 * CD4 count less than 200 cells/mL.
 * Cytomegalovirus retinitis.

Related Chapters

 * Immune reconstitution inflammatory syndrome