ABC of AIDS. Range and natural history of infection.

Abstract

Infection with the human immunodeficency virus (HIV) can produce a very varied clinical picture ranging from an acute seroconversion illness to full blown AIDS many years later. Infection may be asymptomatic or symptomatic. Acute infection following 1st exposure to the virus is usually asymptomatic and may occur up to 6 weeks after the contact. When symptoms do occur they are often nonspecific. A glandular fever-like illness has been described at the time of the acute seroconversion. The patient suffers from fever malaise lethargy myalgia arthralgia lymphadenopathy and sore throat. A positive test to HIV indicates only that a person has been exposed to the virus and not that he or she has gained any natural immunity. Chronic infection may also be asymptomatic. The clinical features described consist of cytopenias minor opportunistic infections and skin conditions lymphadenopathy and the AIDS related complex. The lymphadenopathy seen in chronic infection has been termed the persistent generalized lymphadenopathy syndrome (PGL). Several series of patients with persistent generalized lymphadenopathy have been studied prospectively for a number of years. The proportion with the syndrome who progress to AIDS varies from 10 to 30% but the proportion increases the longer the patients are followed up. The 2 main clinical manifestations of AIDS are tumours and a series of opportunistic infections. Kaposis sarcoma is the commonest original tumour described. Most patients in the US and the UK present originally with Pneumocystis carinii pneumonia followed by other opportunistic infections and Kaposis sarcoma. The many opportunistic infections associated with AIDS affect virtually any body system. The median survival of patients after diagnosis of AIDS varies with the presenting manifestation.