The following points highlight the four major diseases in aids. The diseases are: 1. Cytomegalovirus (CMV) 2. Bacterial infections in HIV 3. Fungal infections 4. Secondary neoplasms of AIDS.
Disease # 1. Cytomegalovirus (CMV):
(a) CMV is a herpes vims, and infection is very common. 90 per cent of homosexual men are victimized.
(b) CD4 count is normally below 50/mm3 when clinical disease appears.
(c) Many organs are involved including the eyes, CNS, liver, gut, adrenals, mouth and lung.
(d) CMV can cause colitis presenting with diarrhea, weight loss, anorexia and fever.
Disease # 2. Bacterial Infections in HIV:
(a) Bacterial infections are very prevalent in AIDS causing tuberculosis. The diagnosis in this case is very difficult.
(b) TB may accelerate HIV disease and the prognosis is poor.
(c) There is the threat of multi-drug resistant TB.
Disease # 3. Fungal Infections:
(a) Oral candidosis is almost common at some stage of HIV infection. Lesions in the mouth may initially respond to topical anti-fungal agents such as nystatin or amphotericin but in advanced stages fluconazole is required.
(b) When Candida spreads to oesophagus, painful dysphagia is frequent and barium swallow may reveal a very ragged looking mucosal surface.
(c) The Candida infection if is firmly established, anti-fungal therapy is to be continuous and liver function tests should be monitored.
(d) The initial symptoms of cryptococcal meningitis are fatigue, fever and weight loss followed by headache, nausea, vomiting. Diagnosis is made by Indian ink staining of the CSF to identify the organism. CT scan of the brain is usually normal and CSF examination may show a monocytosis and raised protein. Amphotericin is the standard therapy.
(e) Protozoal infection is very common in man. The brain is the most common site for lesions which is usually present with focal neurological symptoms, convulsions, confusion, lethargy or coma. Retina is also involved. Diagnosis is usually made by cranial CT scan which shows a characteristic ring enhancing lesion surrounded by cerebral oedema.
Disease # 4. Secondary Neoplasms of AIDS:
(a) DNA has been identified in AIDS—associated Kaposi’s sarcoma which is most common in homosexual male AIDS patients and sexually transmitted HIV infection. This suggests that a cofactor transmitted by the sexual route is required for its development. The most common site of involvement is the skin. The mouth, the hard palate, tip of nose, penis and lower legs are also favoured sites.
(b) Lymph nodes are the second most common site. Stomach or rectal involvement may present with pain, bleeding or obstruction.
(c) Treatment with doxorubicin has produced good responses.
(d) There is an increased incidence of cervical dysplasia and neoplasia in HIV infected women and anal carcinoma in HIV infected homosexual men. Women with HIV infection should have regular cervical smears. The association between these carcinomas and HIV is due to a greater incidence of infection by the Human Papilloma virus in HIV—infected patients.
(e) Skin disease is very common in HIV infected patients. The common skin diseases are seborrhoeic dermatitis, secondary syphilis, fungal infections, drug eruptions. Skin disease consists of weight loss, diarrhoea and dermatitis.
(f) Oral disease is prominent in HIV infection and maintenance of good dental and oral hygiene is very important in these patients. Careful inspection of the mouth is essential.
(g) Nausea and vomiting are common in AIDS and are the result of drug therapy, particularly in high dose of cotrimoxazole in the treatment of pneumonia. But this usually responds to metoclopramide.
(h) Pulmonary disease is very common to AIDS. Pneumocystis infection is largely confined to the lung. There is often background of fatigue, weight loss and fever and other signs of HIV infection. The respiratory rate is increased with cyanosis indicating severity of the disease. The treatment for Pneumocystis pneumonia is high dose of cotrimoxazole, initially given intravenously.
(i) Meningitis may occur during the period of a sero-conversion following HIV infection. The other causes of meningitis include bacteria, tuberculosis, syphilis, other fungal infections and HIV itself.
(j) A positive HIV test shows a variety of reactions ranging from anger, guilt, anxiety to depression. Patients with HIV infection may present with symptoms of organic brain syndromes.
(k) Nephropathy is usually seen in AIDS patients who are intravenous drug users or due to heroin use than HIV infection. A large number of nephrotoxic drugs like amphotericin B, foscarnet and pentamidine are commonly used in AIDS patients.