Symptoms

50 percent to 90 percent of people experience symptoms within the first few weeks of contracting HIV infection, usually experiencing a flu-like illness with many of the following symptoms: fever, sore throat, rash, nausea and vomiting, diarrhoea, fatigue, swollen lymph nodes, muscle aches, headaches and joint pain. However, at this stage most patients and physicians dismiss the illness as a routine cold or flu. In a small number of cases, this early stage of infection may progress to meningitis (inflammation of membranes covering the brain) or other severe flu-like symptoms necessitating hospitalisation.

As the destruction of CD4 cells causes them to drop below normal, the patient may begin to develop swollen lymph nodes and abnormalities of the skin, such as seborrheic dermatitis (dandruff), new or worsening psoriasis and minor infections. Ulcers around the mouth can also develop.

Over the next few years, as the CD4 level continues to drop, the frequency of skin problems and mouth ulcers increases, and recurrent herpes and varicella-zoster infections (shingles) can occur. In addition, many patients develop diarrhoea, fever, unexplained weight loss, joint and muscle pain and fatigue. Tuberculosis is one of the most common AIDS-related infections in the developing world.

It is impossible to predict when someone will develop AIDS. The CD4 count is however a useful guide. As the number of CD4 cells diminish then it is more likely that people will develop the signs of AIDS. In an HIV-infected person, some signs that AIDS has developed are:

• The CD4 count has decreased to 200 cells or below.
• An opportunistic infection has developed, causing certain types of pneumonia, diarrhoea, eye infections or meningitis. Some of the germs that can cause these opportunistic infections include Candida fungus, cryptococcosis, cytomegalovirus, herpes simplex virus, Mycobacterium avium complex, Pneumocystis carinii and others.
• A tumour has developed, including cervical cancer, Kaposi's sarcoma (a cancer causing round reddish spots in the skin and mouth), non-Hodgkin's lymphoma (certain types) or brain lymphoma.
• An AIDS-related brain illness has developed, including HIV encephalopathy (AIDS dementia) or progressive multifocal leukoencephalopathy caused by the JC virus.
• There is severe body wasting (HIV wasting syndrome).
• There is an AIDS-related lung illness, such as pulmonary lymphoid hyperplasia or lymphoid interstitial pneumonia (usually seen only in children).