Acquired Immune Deficiency

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Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is

a disease of the human immune system caused by the human immunodeficiency virus (HIV).[1]

The illness interferes with the immune system, making people with AIDS much more likely toget infections, including opportunistic infections and tumors that do not affect people with

working immune systems. This susceptibility gets worse as the disease continues.

HIV is transmitted in a number of ways including: sexual intercourse (including oral sex and

anal sex); contaminated blood transfusions and hypodermic needles; and exchange between

mother and baby during pregnancy, childbirth, and breastfeeding. It can be transmitted by anycontact of a mucous membrane or the bloodstream with a bodily fluid that has the virus in it,

such as the blood, semen, vaginal fluid, preseminal fluid, or breast milk from an infected

person.[2][3]

Although treatments for HIV/AIDS can slow the course of the disease, there is no known cure or

HIV vaccine. Antiretroviral treatment reduces both the deaths and new infections from

HIV/AIDS, but these drugs are expensive and the medications are not available in all countries.[4]

Due to the difficulty in treating HIV infection, preventing infection is a key aim in controllingthe AIDS pandemic, with health organizations promoting safe sex and needle-exchange

programmes in attempts to slow the spread of the virus. The virus and disease are often referredto together as HIV/AIDS. The disease is a major health problem in many parts of the world, and

is considered a pandemic, a disease outbreak that is not only present over a large area but is

actively spreading.[5]

In 2009, the World Health Organization (WHO) estimated that there are

33.4 million people worldwide living with HIV/AIDS, with 2.7 million new HIV infections peryear and 2.0 million annual deaths due to AIDS.

[6] As of 2010 approximately 34 million people

have HIV globally.[7]

Of these approximately 16.8 million are women and 3.4 million are less

than 15 years old.[7]

It results in about 1.8 million death from AIDS in 2010 down from 3.1million in 2001.

[7] Since AIDS was first recognized in 1981 and 2009 it has led to nearly

30 million deaths.

[8]

Genetic research indicates that HIV originated in west-central Africa during the late nineteenth

or early twentieth century.[9][10]

AIDS was first recognized by the Centers for Disease Control

and Prevention (CDC) in 1981 and its cause, HIV, identified in the early 1980s.

Signs and symptoms

The symptoms of AIDS are primarily the result of conditions that do not normally develop in

individuals with healthy immune systems. Most of these conditions are opportunistic infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of

the immune system that HIV damages.[12]

These infections affect nearly every organ system.

People with AIDS also have an increased risk of developing various cancers such as Kaposi's

sarcoma, cervical cancer and cancers of the immune system known as lymphomas. Additionally,

people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly atnight), swollen glands, chills, weakness, and weight loss.

[13][14] The specific opportunistic

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Neurological and psychiatric

HIV infection may lead to a variety of neuropsychiatric sequelae, either by infection of the now

susceptible nervous system by organisms, or as a direct consequence of the illness itself .[22]

Toxoplasmosis is a disease caused by the single-celled parasite called Toxoplasma gondii; itusually infects the brain, causing toxoplasma encephalitis, but it can also infect and cause disease

in the eyes and lungs.[23]

Cryptococcal meningitis is an infection of the meninx (the membranecovering the brain and spinal cord) by the fungus Cryptococcus neoformans. It can cause fevers,

headache, fatigue, nausea, and vomiting. Patients may also develop seizures and confusion; left

untreated, it can be lethal.

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease, in which the

gradual destruction of the myelin sheath covering the axons of nerve cells impairs the

transmission of nerve impulses. It is caused by a virus called JC virus which occurs in 70% ofthe population in latent form, causing disease only when the immune system has been severely

weakened, as is the case for AIDS patients. It progresses rapidly, usually causing death withinmonths of diagnosis.[24]

AIDS dementia complex (ADC) is a metabolic encephalopathy induced by HIV infection andfueled by immune activation of HIV infected brain macrophages and microglia. These cells are

productively infected by HIV and secrete neurotoxins of both host and viral origin.[25]

Specific

neurological impairments are manifested by cognitive, behavioral, and motor abnormalities that

occur after years of HIV infection and are associated with low CD4+ T cell levels and high

plasma viral loads.

Prevalence is 10 – 20% in Western countries[26]

but only 1 – 2% of HIV infections in India.[27][28]

This difference is possibly due to the HIV subtype in India. AIDS related mania is sometimesseen in patients with advanced HIV illness; it presents with more irritability and cognitive

impairment and less euphoria than a manic episode associated with true bipolar disorder . Unlikethe latter condition, it may have a more chronic course. This syndrome is less frequently seen

with the advent of multi-drug therapy.

Tumors

Kaposi's sarcoma

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://en.wikipedia.org/wiki/Epileptic_seizurehttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Fatigue_%28medical%29http://en.wikipedia.org/wiki/Cryptococcus_neoformanshttp://en.wikipedia.org/wiki/Spinal_cordhttp://en.wikipedia.org/wiki/Meningeshttp://en.wikipedia.org/wiki/AIDS#cite_note-Luft-22http://en.wikipedia.org/wiki/Human_eyehttp://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Parasitismhttp://en.wikipedia.org/wiki/Toxoplasmosishttp://en.wikipedia.org/wiki/AIDS#cite_note-21http://en.wikipedia.org/wiki/Sequela


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An infection that often goes unrecognized in people with AIDS is Parvovirus B19. Its main

consequence is anemia, which is difficult to distinguish from the effects of antiretroviral drugs

used to treat AIDS itself .[35]

Transmission

The three main transmission routes of HIV are sexual contact, exposure to infected body fluids

or tissues, and from mother to fetus or child during the perinatal period. It is possible to find HIV

in the saliva, tears, and urine of infected individuals, but there are no recorded cases of infection

by these secretions, and the risk of infection is negligible.[47]

Sexual transmission

Average per act risk for acquisition

of HIV by exposure route to an infected source

Exposure RouteChance of

infection

Blood Transfusion 90% [48]

Childbirth (to child) 25%

Needle-sharing injection drug use 0.67%

Percutaneous needle stick 0.30%[50]

Receptive anal intercourse* 0.04 – 3.0%

Insertive anal intercourse* 0.06 – 0.056%

[51]

Receptive penile-vaginal intercourse* 0.05 – 0.30%

[51][52]

Insertive penile-vaginal intercourse*

0.01 – 0.38%[51][52]

Receptive oral intercourse*§

0 – 0.04% [51]

Insertive oral intercourse*§

0-0.005%[53]

* assuming no condom use§ source refers to oral intercourse

performed on a man

Sexual transmission occurs with the contact between sexual secretions of one person with therectal, genital or oral mucous membranes of another. Unprotected sexual acts are riskier for the

receptive partner than for the insertive partner , and the risk for transmitting HIV through

unprotected anal intercourse is greater than the risk from vaginal intercourse or oral sex.

The majority of HIV infections are acquired through unprotected sexual relations between

partners, one of whom has HIV. The primary mode of HIV infection worldwide is through

sexual contact between members of the opposite sex.[54][55][56]

However, oral sex is not entirely safe, as HIV can be transmitted through both insertive andreceptive oral sex.

[57][58] Sexual assault greatly increases the risk of HIV transmission as condoms

are rarely employed and physical trauma to the vagina or rectum occurs frequently, facilitating

the transmission of HIV.[59]

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Other sexually transmitted infections (STI) increase the risk of HIV transmission and infection,

because they cause the disruption of the normal epithelial barrier by genital ulceration and/or

microulceration; and by accumulation of pools of HIV-susceptible or HIV-infected cells(lymphocytes and macrophages) in semen and vaginal secretions. Epidemiological studies from

sub-Saharan Africa, Europe and North America suggest that genital ulcers, such as those caused

by syphilis and/or chancroid, increase the risk of becoming infected with HIV by about fourfold.There is also a significant although lesser increase in risk from STIs such as gonorrhea, chlamydia and trichomoniasis, which all cause local accumulations of lymphocytes and

macrophages.[60]

Transmission of HIV depends on the infectiousness of the index case and the susceptibility of the

uninfected partner. Infectivity seems to vary during the course of illness and is not constant

between individuals. An undetectable plasma viral load does not necessarily indicate a low viralload in the seminal liquid or genital secretions. People who have been infected with one strain of

HIV can still be infected later on in their lives by other strains.

Infection is unlikely in a single encounter. High rates of infection have been linked to a pattern ofoverlapping long-term sexual relationships. This allows the virus to quickly spread to multiple

partners who in turn infect their partners. A pattern of serial monogamy or occasional casualencounters is associated with lower rates of infection.

[61]

Blood products

CDC poster from 1989 highlighting the threat of AIDS associated with drug use

This transmission route is particularly relevant to intravenous drug users, hemophiliacs andrecipients of blood transfusions and blood products. Sharing and reusing syringes contaminatedwith HIV-infected blood represents a major risk for infection with HIV.

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Needle sharing is the cause of one third of all new HIV-infections in North America, China, and

Eastern Europe. This route can also affect people who give and receive tattoos and piercings.

Universal precautions are frequently not followed in both sub-Saharan Africa and much of Asia because of both a shortage of supplies and inadequate training.

The WHO estimates that approximately 2.5% of all HIV infections in sub-Saharan Africa aretransmitted through unsafe healthcare injections.[62]

Because of this, the United Nations General

Assembly has urged the nations of the world to implement precautions to prevent HIV

transmission by health workers.[63]

The risk of aquiring HIV from a blood blood transfusion is extremely low in developed countries

where improved donor selection and HIV screening is performed. However, according to theWHO, the overwhelming majority of the world's population do not have access to safe blood and

between 5% and 10% of the world's HIV infections come from transfusion of infected blood and

blood products.[64]

The risk of acquiring HIV from a needle stick from an HIV-infected person is about 0.3% (~1 in333) and the risk post mucus membrane exposure to infected blood is 0.09% (~1:1000).[50]

Perinatal transmission

The transmission of the virus from the mother to the child can occur in utero during the lastweeks of pregnancy and at childbirth. In the absence of treatment, the transmission rate betweena mother and her child during pregnancy, labor and delivery is 25%.

However, when the mother takes antiretroviral therapy and gives birth by caesarean section, therate of transmission is just 1%.

[49] The risk of infection is influenced by the viral load of the

mother at birth, with the higher the viral load, the higher the risk. Breastfeeding also increasesthe risk of transmission by about 4 %.[65]

No risk

There is no risk of acquiring HIV if exposed to feces, nasal secretions, saliva, sputum, sweat,

tears, urine, or vomit from an HIV infected person unless these are contaminated with blood.[50]

MisconceptionsMain article: Misconceptions about HIV and AIDS

There are many misconceptions about HIV and AIDS. Three of the most common are that AIDScan spread through casual contact, that sexual intercourse with a virgin will cure AIDS, and that

HIV can infect only homosexual men and drug users. Other misconceptions are that any act of

anal intercourse between two uninfected gay men can lead to HIV infection, and that open

discussion of homosexuality and HIV in schools will lead to increased rates of homosexualityand AIDS.

[66][67]

Pathophysiology

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Main article: Pathophysiology of HIV/AIDS

The pathophysiology of AIDS is complex.[68]

Ultimately, HIV causes AIDS by depleting CD4+ T

helper lymphocytes. This weakens the immune system and allows opportunistic infections. T

lymphocytes are essential to the immune response and without them, the body cannot fight

infections or kill cancerous cells. The mechanism of CD4

+

T cell depletion differs in the acuteand chronic phases.[69]

During the acute phase, HIV-induced cell lysis and killing of infected cells by cytotoxic T cells accounts for CD4

+ T cell depletion, although apoptosis may also be a factor. During the chronic

phase, the consequences of generalized immune activation coupled with the gradual loss of the

ability of the immune system to generate new T cells appear to account for the slow decline inCD4

+ T cell numbers.

Although the symptoms of immune deficiency characteristic of AIDS do not appear for yearsafter a person is infected, the bulk of CD4

+ T cell loss occurs during the first weeks of infection,

especially in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body.[70]

The reason for the preferential loss of mucosal CD4+ T cells is that a majority of

mucosal CD4+ T cells express the CCR5 coreceptor, whereas a small fraction of CD4

+ T cells in

the bloodstream do so.[71]

HIV seeks out and destroys CCR5 expressing CD4+ cells during acute infection. A vigorous

immune response eventually controls the infection and initiates the clinically latent phase.

However, CD4+ T cells in mucosal tissues remain depleted throughout the infection, although

enough remain to initially ward off life-threatening infections.

Continuous HIV replication results in a state of generalized immune activation persisting

throughout the chronic phase.

[72]

Immune activation, which is reflected by the increasedactivation state of immune cells and release of proinflammatory cytokines, results from the

activity of several HIV gene products and the immune response to ongoing HIV replication.

Another cause is the breakdown of the immune surveillance system of the mucosal barriercaused by the depletion of mucosal CD4

+ T cells during the acute phase of disease.

[73]

This results in the systemic exposure of the immune system to microbial components of the gut’snormal flora, which in a healthy person is kept in check by the mucosal immune system. The

activation and proliferation of T cells that results from immune activation provides fresh targets

for HIV infection. However, direct killing by HIV alone cannot account for the observed

depletion of CD4+ T cells since only 0.01 – 0.10% of CD4

+ T cells in the blood are infected.

A major cause of CD4+ T cell loss appears to result from their heightened susceptibility to

apoptosis when the immune system remains activated. Although new T cells are continuously produced by the thymus to replace the ones lost, the regenerative capacity of the thymus is

slowly destroyed by direct infection of its thymocytes by HIV. Eventually, the minimal number

of CD4+ T cells necessary to maintain a sufficient immune response is lost, leading to AIDS.

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Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is

a disease of the human immune system caused by the human immunodeficiency virus (HIV).[1]

The illness interferes with the immune system, making people with AIDS much more likely toget infections, including opportunistic infections and tumors that do not affect people with

working immune systems. This susceptibility gets worse as the disease continues.

HIV is transmitted in a number of ways including: sexual intercourse (including oral sex and

anal sex); contaminated blood transfusions and hypodermic needles; and exchange between

mother and baby during pregnancy, childbirth, and breastfeeding. It can be transmitted by anycontact of a mucous membrane or the bloodstream with a bodily fluid that has the virus in it,

such as the blood, semen, vaginal fluid, preseminal fluid, or breast milk from an infected

person.[2][3]

Although treatments for HIV/AIDS can slow the course of the disease, there is no known cure or

HIV vaccine. Antiretroviral treatment reduces both the deaths and new infections from

HIV/AIDS, but these drugs are expensive and the medications are not available in all countries.[4]

Due to the difficulty in treating HIV infection, preventing infection is a key aim in controllingthe AIDS pandemic, with health organizations promoting safe sex and needle-exchange

programmes in attempts to slow the spread of the virus. The virus and disease are often referredto together as HIV/AIDS. The disease is a major health problem in many parts of the world, and

is considered a pandemic, a disease outbreak that is not only present over a large area but is

actively spreading.[5]

In 2009, the World Health Organization (WHO) estimated that there are

33.4 million people worldwide living with HIV/AIDS, with 2.7 million new HIV infections peryear and 2.0 million annual deaths due to AIDS.

[6] As of 2010 approximately 34 million people

have HIV globally.[7]

Of these approximately 16.8 million are women and 3.4 million are less

than 15 years old.[7]

It results in about 1.8 million death from AIDS in 2010 down from 3.1million in 2001.

[7] Since AIDS was first recognized in 1981 and 2009 it has led to nearly

30 million deaths.[8]

Genetic research indicates that HIV originated in west-central Africa during the late nineteenth

or early twentieth century.[9][10]

AIDS was first recognized by the Centers for Disease Control

and Prevention (CDC) in 1981 and its cause, HIV, identified in the early 1980s.

Signs and symptoms

The symptoms of AIDS are primarily the result of conditions that do not normally develop in

individuals with healthy immune systems. Most of these conditions are opportunistic infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of

the immune system that HIV damages.[12]

These infections affect nearly every organ system.

People with AIDS also have an increased risk of developing various cancers such as Kaposi's

sarcoma, cervical cancer and cancers of the immune system known as lymphomas. Additionally,

people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly atnight), swollen glands, chills, weakness, and weight loss.

[13][14] The specific opportunistic

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iki/AIDS#cite_note-TotalDeath2010-7http://en.wikipedia.org/wiki/AIDS#cite_note-TotalDeath2010-7http://en.wikipedia.org/wiki/Molecular_phylogeneticshttp://en.wikipedia.org/wiki/Molecular_phylogeneticshttp://en.wikipedia.org/wiki/AIDS#cite_note-Gao-8http://en.wikipedia.org/wiki/AIDS#cite_note-Gao-8http://en.wikipedia.org/wiki/AIDS#cite_note-Gao-8http://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Preventionhttp://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Preventionhttp://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Preventionhttp://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Preventionhttp://en.wikipedia.org/wiki/Immune_systemhttp://en.wikipedia.org/wiki/Immune_systemhttp://en.wikipedia.org/wiki/Immune_systemhttp://en.wikipedia.org/wiki/Opportunistic_infectionshttp://en.wikipedia.org/wiki/Opportunistic_infectionshttp://en.wikipedia.org/wiki/Opportunistic_infectionshttp://en.wikipedia.org/wiki/Fungushttp://en.wikipedia.org/wiki/Fungushttp://en.wikipedia.org/wiki/Fungushttp://en.wikipedia.org/wiki/Parasitismhttp://en.wikipedia.org/wiki/Parasitismhttp://en.wikipedia.org/wiki/Parasitismhttp://en.wikipedia.org/wiki/AIDS#cite_note-Holmes-11http://en.wikipedia.org/wiki/AIDS#cite_note-Holmes-11http://en.wikipedia.org/wiki/AIDS#cite_note-Holmes-11http://en.wikipedia.org/wiki/Biological_systemhttp://en.wikipedia.org/wiki/Biological_systemhttp://en.wikipedia.org/wiki/Biological_systemhttp://en.wikipedia.org/wiki/Kaposi%27s_sarcomahttp://en.wikipedia.org/wiki/Kaposi%27s_sarcomahttp://en.wikipedia.org/wiki/Kaposi%27s_sarcomahttp://en.wikipedia.org/wiki/Kaposi%27s_sarcomahttp://en.wikipedia.org/wiki/Cervical_cancerhttp://en.wikipedia.org/wiki/Cervical_cancerhttp://en.wikipedia.org/wiki/Cervical_cancerhttp://en.wikipedia.org/wiki/Lymphomahttp://en.wikipedia.org/wiki/Lymphomahttp://en.wikipedia.org/wiki/Lymphomahttp://en.wikipedia.org/wiki/Night_sweatshttp://en.wikipedia.org/wiki/Night_sweatshttp://en.wikipedia.org/wiki/Night_sweatshttp://en.wikipedia.org/wiki/Weight_losshttp://en.wikipedia.org/wiki/Weight_losshttp://en.wikipedia.org/wiki/AIDS#cite_note-Guss-12http://en.wikipedia.org/wiki/AIDS#cite_note-Guss-12http://en.wikipedia.org/wiki/AIDS#cite_note-Guss-12http://en.wikipedia.org/wiki/AIDS#cite_note-Guss-12http://en.wikipedia.org/wiki/AIDS#cite_note-Guss-12http://en.wikipedia.org/wiki/Weight_losshttp://en.wikipedia.org/wiki/Night_sweatshttp://en.wikipedia.org/wiki/Lymphomahttp://en.wikipedia.org/wiki/Cervical_cancerhttp://en.wikipedia.org/wiki/Kaposi%27s_sarcomahttp://en.wikipedia.org/wiki/Kaposi%27s_sarcomahttp://en.wikipedia.org/wiki/Biological_systemhttp://en.wikipedia.org/wiki/AIDS#cite_note-Holmes-11http://en.wikipedia.org/wiki/Parasitismhttp://en.wikipedia.org/wiki/Fungushttp://en.wikipedia.org/wiki/Opportunistic_infectionshttp://en.wikipedia.org/wiki/Immune_systemhttp://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Preventionhttp://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Preventionhttp://en.wikipedia.org/wiki/AIDS#cite_note-Gao-8http://en.wikipedia.org/wiki/AIDS#cite_note-Gao-8http://en.wikipedia.org/wiki/Molecular_phylogeneticshttp://en.wikipedia.org/wiki/AIDS#cite_note-TotalDeath2010-7http://en.wikipedia.org/wiki/AIDS#cite_note-UN2011Ten-6http://en.wikipedia.org/wiki/AIDS#cite_note-UN2011Ten-6http://en.wikipedia.org/wiki/AIDS#cite_note-UN2011Ten-6http://en.wikipedia.org/wiki/AIDS#cite_note-WHO2009-5http://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/AIDS#cite_note-Kallings-4http://en.wikipedia.org/wiki/Pandemichttp://en.wikipedia.org/wiki/Needle-exchange_programmehttp://en.wikipedia.org/wiki/Needle-exchange_programmehttp://en.wikipedia.org/wiki/Safe_sexhttp://en.wikipedia.org/wiki/AIDS_pandemichttp://en.wikipedia.org/wiki/AIDS#cite_note-Palella-3http://en.wikipedia.org/wiki/Pharmaceutical_drughttp://en.wikipedia.org/wiki/Morbidityhttp://en.wikipedia.org/wiki/Mortality_ratehttp://en.wikipedia.org/wiki/Antiretroviral_drughttp://en.wikipedia.org/wiki/HIV_vaccinehttp://en.wikipedia.org/wiki/AIDS#cite_note-CDCtransmission-1http://en.wikipedia.org/wiki/AIDS#cite_note-CDCtransmission-1http://en.wikipedia.org/wiki/Human_breast_milkhttp://en.wikipedia.org/wiki/Pre-ejaculatehttp://en.wikipedia.org/wiki/Vaginal_lubricationhttp://en.wikipedia.org/wiki/Semenhttp://en.wikipedia.org/wiki/Body_fluidhttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Breastfeedinghttp://en.wikipedia.org/wiki/Hypodermic_needlehttp://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/Anal_sexhttp://en.wikipedia.org/wiki/Oral_sexhttp://en.wikipedia.org/wiki/Sexual_intercoursehttp://en.wikipedia.org/wiki/Transmission_%28medicine%29http://en.wikipedia.org/wiki/Tumorshttp://en.wikipedia.org/wiki/Opportunistic_infectionhttp://en.wikipedia.org/wiki/AIDS#cite_note-pmid11396444-0http://en.wikipedia.org/wiki/HIVhttp://en.wikipedia.org/wiki/Immune_systemhttp://en.wikipedia.org/wiki/Disease


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infections that AIDS patients develop depend in part on the prevalence of these infections in the

geographic area in which the patient lives.

Pulmonary

Pneumocystis pneumonia (PCP) (originally known as Pneumocystis carinii pneumonia) isrelatively rare in healthy, immunocompetent people, but common among HIV-infected

individuals. It is caused by Pneumocystis jirovecii.

Before the advent of effective diagnosis, treatment and routine prophylaxis in Western countries,

it was a common immediate cause of death. In developing countries, it is still one of the firstindications of AIDS in untested individuals, although it does not generally occur unless the CD4

count is less than 200 cells per µL of blood.[15]

Tuberculosis (TB) is unique among infections associated with HIV because it is transmissible to

immunocompetent people via the respiratory route, and is not easily treatable once identified.[16]

Multidrug resistance is a serious problem. Tuberculosis with HIV co-infection (TB/HIV) is amajor world health problem according to the World Health Organization: in 2007, 456,000

deaths among incident TB cases were HIV-positive, a third of all TB deaths and nearly a quarter

of the estimated 2 million HIV deaths in that year .[17]

Even though its incidence has declined because of the use of directly observed therapy and other improved practices in Western

countries, this is not the case in developing countries where HIV is most prevalent. In early-stage

HIV infection (CD4 count >300 cells per µL), TB typically presents as a pulmonary disease. In

advanced HIV infection, TB often presents atypically with extrapulmonary (systemic) disease acommon feature. Symptoms are usually constitutional and are not localized to one particular site,

often affecting bone marrow, bone, urinary and gastrointestinal tracts, liver , regional lymph

nodes, and the central nervous system.[18]

Gastrointestinal

Esophagitis is an inflammation of the lining of the lower end of the esophagus (gullet orswallowing tube leading to the stomach). In HIV-infected individuals, this is normally due tofungal (candidiasis) or viral (herpes simplex-1 or cytomegalovirus) infections. In rare cases, it

could be due to mycobacteria.[19]

Unexplained chronic diarrhea in HIV infection is due to many possible causes, including

common bacterial (Salmonella, Shigella, Listeria or Campylobacter ) and parasitic infections; and

uncommon opportunistic infections such as cryptosporidiosis, microsporidiosis, Mycobacterium

avium complex (MAC) and viruses,

[20]

astrovirus, adenovirus, rotavirus and cytomegalovirus, (the latter as a course of colitis).

In some cases, diarrhea may be a side effect of several drugs used to treat HIV, or it may simplyaccompany HIV infection, particularly during primary HIV infection. It may also be a side effect

of antibiotics used to treat bacterial causes of diarrhea (common for Clostridium difficile). In the

later stages of HIV infection, diarrhea is thought to be a reflection of changes in the way theintestinal tract absorbs nutrients, and may be an important component of HIV-related wasting.

[21]

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ushttp://en.wikipedia.org/wiki/Cytomegalovirushttp://en.wikipedia.org/wiki/Cytomegalovirushttp://en.wikipedia.org/wiki/Colitishttp://en.wikipedia.org/wiki/Colitishttp://en.wikipedia.org/wiki/Colitishttp://en.wikipedia.org/wiki/Antibacterialhttp://en.wikipedia.org/wiki/Antibacterialhttp://en.wikipedia.org/wiki/Antibacterialhttp://en.wikipedia.org/wiki/Clostridium_difficilehttp://en.wikipedia.org/wiki/Clostridium_difficilehttp://en.wikipedia.org/wiki/Clostridium_difficilehttp://en.wikipedia.org/wiki/Human_gastrointestinal_tracthttp://en.wikipedia.org/wiki/Human_gastrointestinal_tracthttp://en.wikipedia.org/wiki/Wastinghttp://en.wikipedia.org/wiki/Wastinghttp://en.wikipedia.org/wiki/AIDS#cite_note-Guerrant-20http://en.wikipedia.org/wiki/AIDS#cite_note-Guerrant-20http://en.wikipedia.org/wiki/AIDS#cite_note-Guerrant-20http://en.wikipedia.org/wiki/AIDS#cite_note-Guerrant-20http://en.wikipedia.org/wiki/Wastinghttp://en.wikipedia.org/wiki/Human_gastrointestinal_tracthttp://en.wikipedia.org/wiki/Clostridium_difficilehttp://en.wikipedia.org/wiki/Antibacterialhttp://en.wikipedia.org/wiki/Colitishttp://en.wikipedia.org/wiki/Cytomegalovirushttp://en.wikipedia.org/wiki/Rotavirushttp://en.wikipedia.org/wiki/Adenoviridaehttp://en.wikipedia.org/wiki/Astrovirushttp://en.wikipedia.org/wiki/AIDS#cite_note-pmid11444032-19http://en.wikipedia.org/wiki/Mycobacterium_avium-intracellulare_infectionhttp://en.wikipedia.org/wiki/Mycobacterium_avium-intracellulare_infectionhttp://en.wikipedia.org/wiki/Microsporidiosishttp://en.wikipedia.org/wiki/Cryptosporidiosishttp://en.wikipedia.org/wiki/Campylobacterhttp://en.wikipedia.org/wiki/Listeriahttp://en.wikipedia.org/wiki/Shigellahttp://en.wikipedia.org/wiki/Salmonellahttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/AIDS#cite_note-Zaidi-18http://en.wikipedia.org/wiki/Mycobacteriumhttp://en.wikipedia.org/wiki/Cytomegalovirushttp://en.wikipedia.org/wiki/Herpes_simplex_virushttp://en.wikipedia.org/wiki/Candidiasishttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Esophagushttp://en.wikipedia.org/wiki/Esophagitishttp://en.wikipedia.org/wiki/AIDS#cite_note-Decker-17http://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Human_gastrointestinal_tracthttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/AIDS#cite_note-16http://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/Tuberculosishttp://en.wikipedia.org/wiki/Multiple_drug_resistancehttp://en.wikipedia.org/wiki/AIDS#cite_note-15http://en.wikipedia.org/wiki/Tuberculosishttp://en.wikipedia.org/wiki/AIDS#cite_note-Feldman-14http://en.wikipedia.org/wiki/Preventive_medicinehttp://en.wikipedia.org/wiki/Pneumocystis_pneumonia_%28PCP%29http://en.wikipedia.org/wiki/Immunocompetencehttp://en.wikipedia.org/wiki/Pneumocystis_pneumonia_%28PCP%29


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Neurological and psychiatric

HIV infection may lead to a variety of neuropsychiatric sequelae, either by infection of the now

susceptible nervous system by organisms, or as a direct consequence of the illness itself .[22]

Toxoplasmosis is a disease caused by the single-celled parasite called Toxoplasma gondii; itusually infects the brain, causing toxoplasma encephalitis, but it can also infect and cause disease

in the eyes and lungs.[23]

Cryptococcal meningitis is an infection of the meninx (the membranecovering the brain and spinal cord) by the fungus Cryptococcus neoformans. It can cause fevers,

headache, fatigue, nausea, and vomiting. Patients may also develop seizures and confusion; left

untreated, it can be lethal.

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease, in which the

gradual destruction of the myelin sheath covering the axons of nerve cells impairs the

transmission of nerve impulses. It is caused by a virus called JC virus which occurs in 70% ofthe population in latent form, causing disease only when the immune system has been severely

weakened, as is the case for AIDS patients. It progresses rapidly, usually causing death withinmonths of diagnosis.[24]

AIDS dementia complex (ADC) is a metabolic encephalopathy induced by HIV infection andfueled by immune activation of HIV infected brain macrophages and microglia. These cells are

productively infected by HIV and secrete neurotoxins of both host and viral origin.[25]

Specific

neurological impairments are manifested by cognitive, behavioral, and motor abnormalities that

occur after years of HIV infection and are associated with low CD4+ T cell levels and high

plasma viral loads.

Prevalence is 10 – 20% in Western countries[26]

but only 1 – 2% of HIV infections in India.[27][28]

This difference is possibly due to the HIV subtype in India. AIDS related mania is sometimesseen in patients with advanced HIV illness; it presents with more irritability and cognitive

impairment and less euphoria than a manic episode associated with true bipolar disorder . Unlikethe latter condition, it may have a more chronic course. This syndrome is less frequently seen

with the advent of multi-drug therapy.

Tumors

Kaposi's sarcoma

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://en.wikipedia.org/wiki/Epileptic_seizurehttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Fatigue_%28medical%29http://en.wikipedia.org/wiki/Cryptococcus_neoformanshttp://en.wikipedia.org/wiki/Spinal_cordhttp://en.wikipedia.org/wiki/Meningeshttp://en.wikipedia.org/wiki/AIDS#cite_note-Luft-22http://en.wikipedia.org/wiki/Human_eyehttp://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Parasitismhttp://en.wikipedia.org/wiki/Toxoplasmosishttp://en.wikipedia.org/wiki/AIDS#cite_note-21http://en.wikipedia.org/wiki/Sequela


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People with HIV infections have substantially increased incidence of several cancers. This is

primarily due to co-infection with an oncogenic DNA virus, especially Epstein-Barr virus

(EBV), Kaposi's sarcoma-associated herpesvirus (KSHV) (also known as human herpesvirus-8[HHV-8]), and human papillomavirus (HPV).

[29][30]

Kaposi's sarcoma (KS) is the most common tumor in HIV-infected patients. The appearance ofthis tumor in young homosexual men in 1981 was one of the first signals of the AIDS epidemic.

Caused by a gammaherpes virus called Kaposi's sarcoma-associated herpes virus (KSHV), it

often appears as purplish nodules on the skin, but can affect other organs, especially the mouth,gastrointestinal tract, and lungs. High-grade B cell lymphomas such as Burkitt's lymphoma,

Burkitt's-like lymphoma, diffuse large B-cell lymphoma (DLBCL), and primary central nervous

system lymphoma present more often in HIV-infected patients. These particular cancers often

foreshadow a poor prognosis. Epstein-Barr virus (EBV) or KSHV cause many of theselymphomas. In HIV-infected patients, lymphoma often arises in extranodal sites such as the

gastrointestinal tract.[31]

When they occur in an HIV-infected patient, KS and aggressive B cell

lymphomas confer a diagnosis of AIDS.

Invasive cervical cancer in HIV-infected women is also considered AIDS-defining, it is caused

by human papillomavirus (HPV).[32]

In addition to the AIDS-defining tumors listed above, HIV-infected patients are at increased risk

of certain other tumors, notably Hodgkin's disease, anal and rectal carcinomas, hepatocellularcarcinomas, head and neck cancers, and lung cancer. Some of these are causes by viruses, such

as Hodgkin's disease (EBV), anal/rectal cancers (HPV), head and neck cancers (HPV), and

hepatocellular carcinoma (hepatitis B or C). Other contributing factors include exposure to

carcinogens (cigarette smoke for lung cancer), or living for years with subtle immune defects.

Interestingly, the incidence of many common tumors, such as breast cancer or colon cancer , doesnot increase in HIV-infected patients. In areas where HAART is extensively used to treat AIDS,the incidence of many AIDS-related malignancies has decreased, but at the same time malignant

cancers overall have become the most common cause of death of HIV-infected patients.[33]

In

recent years, an increasing proportion of these deaths have been from non-AIDS-definingcancers.

Other infections

People with AIDS often develop opportunistic infections that present with non-specific

symptoms, especially low-grade fevers and weight loss. These include opportunistic infection

with Mycobacterium avium-intracellulare and cytomegalovirus (CMV). CMV can cause colitis,as described above, and CMV retinitis can cause blindness.

Penicilliosis due to Penicillium marneffei is now the third most common opportunistic infection

(after extrapulmonary tuberculosis and cryptococcosis) in HIV-positive individuals within theendemic area of Southeast Asia.

[34]

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edia.org/wiki/

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