What Is Acute HIV Infection?

A typical HIV infection goes through the following stages from infection to death: acute HIV infection, asymptomatic HIV infection, pre-AIDS, and eventually progressing to AIDS.

Clinical manifestations of AIDS

A typical HIV infection goes through the following stages from infection to death: acute HIV infection, asymptomatic HIV infection, pre-AIDS, and eventually progressing to AIDS.

Chinese name

Clinical manifestations of AIDS

Classification

Acute HIV infection, asymptomatic HIV infection

Belongs to

AIDS

Types of

medicine

2.1 Respiratory diseases

2.1.1 Pneumocystis carinii pneumonia (PCP) is the most common AIDS-indicating disease and the most common opportunistic infection that threatens the life of an infected person. Early detection and timely treatment are important means to reduce PCP mortality. PCP often occurs when CD4 + cells are <200 cells / L. Effective preventive medication can reduce the incidence of PCP. The onset of PCP is slow, with fever, night sweats, fatigue, discomfort, and weight loss in the early stages, and shortness of breath after a few weeks. The patient subsequently felt post-sternal discomfort, dry cough, and difficulty breathing. The earliest abnormal manifestations of the patient were a marked decrease in partial oxygen pressure and a reduction in the efficiency of carbon dioxide diffusion. A chest X-ray showed no abnormalities in 20% of patients, and a typical PCP chest radiograph was diffuse or symmetrical hilar interstitial infiltration. The detection of Pneumocystis carinii from the sputum and bronchial lavage fluid drained from the patient is the basis of the pathogenic diagnosis.

2.1.2 The incidence of bacterial pneumonia in HIV-infected persons is 10 to 20 times higher than that of the general population. The common pathogens include streptococcus, pneumococcus, and Haemophilus influenzae. Generally, the onset of the disease is more rapid, often with high fever, chest pain, and sputum. 75% of patients showed extensive infiltration on chest X-rays or typical focal, unilobular or multilobular pulmonary consolidation. Conventional antibacterial treatments work well, but are prone to relapse. Another cause of extensive pulmonary infiltration is lymphocytic interstitial pneumonia, which is more common in children. 2.1.3 Pulmonary tuberculosis is a new indication of AIDS in 1993, and it is the most common lung disease in HIV-infected people in Africa. In recent years, the number of tuberculosis patients in developed countries has increased. Tuberculosis can occur at any stage of HIV infection. In the early stages of HIV infection, the clinical manifestations of the patients are similar to those of the general population. The pure tuberculosis protein derivative (PPD) test is positive, and chest X-rays show lesions in the upper lung lobe (often with holes), and extrapulmonary dissemination rarely occurs. However, the late stage of HIV infection is not typical. The PPD test is negative. The chest radiograph shows diffuse infiltration (often involving the middle and lower lung lobes) and sometimes causes disseminated extrapulmonary tuberculosis. Therefore, those with advanced HIV infection and respiratory symptoms Attention should be paid to differential diagnosis. The diagnosis of tuberculosis is based on the culture of respiratory tract specimens (usually sputum) to Mycobacterium tuberculosis, but once sputum examination finds acid-fast staining bacteria should be highly suspect. The effect of standard anti-TB treatment is acceptable. But among HIV-infected patients, resistance to multiple anti-tuberculosis drugs has been found, and treatment of these patients remains to be resolved.

2.1.4 Kaposi's sarcoma (KS) is also one of the common and serious lung diseases that cause HIV infection. Symptoms include difficulty breathing, coughing, and occasional blood coughing. Although most patients have skin manifestations of KS at the same time, they may have only pulmonary manifestations. Chest radiographs show multiple nodular, irregularly bordered lesions with enlarged mediastinum and occasional pleural effusion. Chest CT is helpful for differential diagnosis. Its diagnosis relies on tracheoscopy to detect intratracheal lesions or tissue biopsies. If treatment is not timely, the disease progresses rapidly and the prognosis is poor.

2.2 Digestive and liver diseases

2.2.1 Poststernal discomfort, swallowing pain, and difficulty swallowing They are the main manifestations of esophagitis, and their causes include Candida, CMV, HSV infection, and gastric acid reflux. Except for gastric acid reflux, other conditions often occur in CD4 + cells <100 / L. Since candidal esophagitis is the most common, experts recommend that all esophagitis be treated with anti-candida first. If no improvement is seen within 3 to 5 days of treatment, then endoscopic examination is performed and specimens are taken for tissue biopsy.

2.2.2 Diarrhea, malabsorption and weight loss Diarrhea is a common symptom of HIV-infected people. Although HIV itself can cause intestinal mucosal lesions and malabsorption, other pathogens are generally present. Investigations have shown that Cryptosporidium infection is the most common cause of diarrhea in AIDS patients. Cryptosporidium can cause severe, aqueous, cholera-like diarrhea, with painful intestinal cramps, and sometimes nausea and vomiting. In patients with CD4 + cells> 200 / L, the diarrhea is often self-limiting, while in patients with CD4 + cells <200 / L, diarrhea is difficult to alleviate, and the patient's weight is significantly reduced and diarrhea-wasting syndrome appears. Diagnosis is mainly based on microscopic examination of the feces of the patient, looking for worm eggs, which can only be ruled out after repeated repeated tests are negative. CMV and HSV can cause mucosal ulcers in various parts of the digestive system, sometimes cause diarrhea, and even cause bowel perforation. Bacterial intestinal pathogens include Salmonella, Shigella, and Campylobacter jejuni. Clinical manifestations are fever, diarrhea, and blood and stool bacterial cultures are often positive. Clostridium diarrhea can also occur if patients regularly take antibiotics. Infecting the intestine with disseminated mycobacterium avian infection can also cause diarrhea. Therefore, for patients with diarrhea, laboratory tests should include blood and stool bacterial culture, and direct microscopy of stool (repeated 3 or more times). If the cause is still not found, endoscopic examination is performed for tissue biopsy.

2.2.3 Hepatitis and cholangitis The main manifestations of hepatitis in AIDS patients are fever, abdominal pain, liver enlargement, and abnormal liver function. Possible causes are atypical mycobacteria or herpes simplex virus infection. Those who are receiving antiretroviral therapy may also be caused by the toxic effects of the drug on the liver. In addition, people with homosexuality, bisexuality, or intravenous drug use are often co-infected with hepatitis B and C. Endoscopic retrograde cholangiography showed cholecystitis cholangitis characterized by distal bile duct stenosis and proximal dilatation, which may be related to Cryptosporidium and CMV infection.

2.3 Nervous system diseases

HIV-infected persons often develop neurological disorders. Includes transient meningoencephalitis, spinal cord disease, peripheral neuritis, and HIV-associated motor cognitive impairment syndrome, toxoplasmosis encephalopathy, primary lymphoma, metabolic encephalopathy, and neurosyphilis. It is estimated that 10% to 40% of patients are associated with AIDS-related mental disorders, memory loss, emotional indifference, and lack of concentration. On physical examination, tendon reflexes and muscle tone enhancement, CT and MRI showed brain atrophy, non-specific changes in white matter. Cerebrospinal fluid examination showed no specific findings. The common causes of intracranial space-occupying lesions are toxoplasmic encephalopathy and primary lymphoma. Both are similar in clinical manifestations with neurological symptoms and signs. Usually first treated by toxoplasmosis encephalopathy. If after 14 days of treatment, there is no improvement or symptoms worsen, then a brain biopsy is performed. When an AIDS patient complains of a new neurological symptom or signs of an abnormal nervous system, a comprehensive neurological examination should be performed. If meningitis, encephalitis, or brain occupying lesions are suspected, further examination is performed, including CT and / or MRI, and lumbar puncture. Cerebrospinal fluid examination includes Gram stain, Indian ink stain, Cryptococcus antigen detection, sugar and protein content determination, cell count, syphilis VDRL test, culture (including conventional culture, acid-fast bacilli culture, fungal culture).

2.4 tumor

In AIDS patients, there are two more common tumors: Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma. Kaposi's sarcoma is associated with human herpes virus type 8 and is more common in HIV-infected men in homosexual and bisexual men. It can occur at all stages of HIV infection, even at higher levels of CD4 + cells (200-500 / L). May invade skin, mucous membranes, internal organs (lung, gastrointestinal tract) and lymph nodes. When KS invades the skin, single or multiple light purple pink nodules appear in the initial stage of the skin, and then the nodule color gradually deepens, enlarges, and the border is unclear. It can fuse into a sheet and the surface may have ulcers. The longitudinal direction of the lesion is consistent with the local skin texture. Skin lesions are more common in the head and face, trunk, and limbs. When KS invades the lymph nodes, it can cause local lymphadenopathy, lymphatic reflux disorders, and some patients have lower limb edema. KS invades the internal organs, and patients can present with symptoms of space-occupying lesions and sometimes cause bleeding.

The occurrence of non-Hodgkin's lymphoma is related to EB virus, which can invade the central nervous system, bone marrow, gastrointestinal tract, and lymph nodes. The disease has a poor prognosis and often relapses after chemotherapy.

The prognosis of HIV-infected people is related to the type and subtype of HIV they are infected with. Generally speaking, HIV-1 infected people have a faster clinical course than HIV-2. HIV-1 infected people who have not been treated with antiretroviral drugs have Clinical outcomes can be divided into three types: a typical progression process (approximately 70% to 80%) after 8 to 10 years; a rapid progression process within 2 to 5 years; and the long-term survival of an infected person who has remained healthy for more than 10 years Or no progress (10%).