What to Do When You Feel Sick
This chapter, which discusses the medical complications of HIV infection, is most relevant to people with advanced disease, that is, with a CD4 count of less than 200. Included here are the symptoms for which people should see a physician, the most likely diagnosis of those symptoms, the tests that establish the diagnosis, and the best treatment.
The chapter is organized by anatomy: lungs, skin, mouth, digestive system,| Table 5. Prognosis by CD4 Cell Count and Viral Load (without Treatment): Probability of an AIDS Complication | ||||
| Probability of AIDS without Treatment in | ||||
| 3 Years | 6 Years | 9 Years | ||
| CD4 Count | Viral Load | (%) | (%) | (%) |
| over 500 | under 2,000 | 1 | 5 | 11 |
| 2,000-40,000 | 5 | 20 | 41 | |
| 40,000-120,000 | 10 | 35 | 60 | |
| over 120,000 | 33 | 67 | 76 | |
| 350-500 | 2,000-40,000 | 6 | 30 | 53 |
| 40,000-120,000 | 15 | 57 | 79 | |
| over 120,000 | 48 | 78 | 94 | |
| under 350 | 2,000-40,000 | 4 | 30 | 42 |
| 40,000-120,000 | 40 | 73 | 86 | |
| over 120,000 | 73 | 93 | 96 | |
Source: Adapted from J.
Mellors et al., Annals of Internal Medicine 126 (1997): 946. To simplify presentation, numbers have been rounded off and aggregated. Viral load levels are for the HIV RNA PCR (Roche) assay.
gynecological problems, eyes, and head and nerves, and concludes with a segment on the constitutional symptoms—like fever and fatigue—that affect the whole body. So, for example, someone worried about a red rash would look up skin problems, find the symptom of red rash, and read which diagnoses are possible.
Our intent is not to provide a substitute for medical care, in part because diagnostic tests and treatments are subject to rapidly changing guidelines, and some of this information can quickly become antiquated.
HIV, in those who are untreated or who fail therapy, affects the body in two different ways. The first way it affects the body is directly, causing an early mononucleosis-like disease or a late dementia called HIV- associated dementia. These are complications caused by the virus directly. The second way HIV affects the body is indirectly, specifically by reducing the number of CD4 cells (see chapter 3). Most of the symptoms that people with HIV infection have are a result of complications that would not happen with the usual number of CD4 cells. As noted previously, the usual CD4 cell count is about 1,000; a person with HIV infection loses, on average, about 30-80 CD4s each year, so that after seven or eight years the count is down to 200-300. Different people lose CD4 cells at different rates, but the CD4 count at which complications occur is less than 200, and often substantially lower.
Some complications, however, do not depend quite so much on CD4 cell counts. Those include Kaposi’s sarcoma, lymphomas, bacterial pneumonias (but not pneumocystis pneumonia), Candida vaginitis, salmonellosis, herpes zoster or shingles, and tuberculosis.
Most of the common and serious complications occur when the CD4 count is below 200 per milliliter, and many people have few medical problems until the CD4 count is consistently below 50. These include pneumocystis pneumonia, disseminated (widespread) cytomegalovirus infection, disseminated (widespread) Mycobacterium avium complex infection, cryptosporidiosis, toxoplasmosis, cryptococcal meningitis, and HIV-associated dementia.
We should emphasize that when HAART arrests the growth of HIV, it also halts all HIV-related complications, both direct and indirect. Since 1996, when HAART was introduced, nearly all the complications discussed in this chapter have decreased, most by 50 to 80 percent, and some have nearly disappeared.