manifestations of HIV

manifestations of HIV

HIV infection begins with the injection of the virus directly into the blood stream by the exposure of broken skin or mucous membrane to HIV-contaminated fluids, or by perinatal transmission from an infected mother to an infant.

The first thing that starts developing is a flu-like illness with swollen glands in the neck and armpits. The average period from infection with HIV to the development of AIDS is estimated to be more than eight years.

HIV disease progresses from a variable symptom-free period to the AIDS symptoms stage when the immune system starts to break down and the patient is unable to fight infections and presents with glands in the armpit and neck which remain swollen for more than three months, a simple boil or warts which may spread all over the body, patient may feel tired all the time, have high temperatures, drenching night sweats, lose more than 10 per cent of their body weight and have diarrhoea lasting more than a month.

Infection of a special type of white blood cells in the blood called CD4 lymphocytes and macrophages leads to failing resistance and susceptibility to infections and malignancies characteristic of AIDS.

In addition, direct effects of HIV, particularly on the CNS, can cause encephalitis, HIV encephalopathy and AIDS dementia complex. Eye disorders are common in HIV and occur in approximately 75 per cent of HIV patients during the course of this disease. They include various opportunistic infections (of the retina, cornea and ocular adnexa) and tumours (including the eyelids, conjunctiva and orbital structures).

The most common eye problem of HIV-infected patients is, in fact, visual field defects (can see only half the page), floaters or flashing lights due to abnormalities of the small vessels of the retina called HIV retinopathy which does not progress.

In HIV-infected adults there is dry eye problem which can cause intermittent eye pain, blurred vision that clears with blinking and worsens with extended reading and computer use. In a child infected with HIV often the only symptom is that he or she cries without tears. This condition, called keratoconjunctivitis sicca, is due to the damage to lacrimal gland and is treated with artificial tears.

The HIV-infected patient may complain of eye pain, decreased vision, irritation and difficulty to open eyes in bright light when they have corneal infections due to virus (most commonly herpes), bacteria and fungus (most frequently by candida) which have to be treated with medical therapy.

When a HIV-infected patient complains of diminished vision with the loss of peripheral vision (“looks like I am in a tunnel”) he/she may have retinitis due to Toxoplasma (in patients with CD4 counts of <100cells/microlitre)>

The HIV-infected patient may develop deep purple-red nodules on the eyelid skin or a bright red lesion in the conjunctiva like a subconjunctival haemorrhage, both being a common presentation of Kaposi’s sarcoma. The lesion has to be treated with excision, radiation or medical therapy.

The HIV-infected patient may develop viral warts to nerve palsies of the eye, but most HIV-infected persons can expect to be asymptomatic for three to five years after infection. When T4 cell counts fall below 200 cells/mm3 prophylaxis is advised. Combination pharmacotherapy — highly active antiretroviral therapy (HAART) for HIV-infected individuals — has resulted in a dramatic improvement in function by reducing the rate of newly diagnosed (from 6.1 per cent to1.2 per cent) and relapses (from 36 per cent to 17 per cent) of CMV retinitis and has reduced the rate of progression to AIDS or death by 86 per cent. All HIV-infected patients should have regular ophthalmic care because many illnesses may first manifest in the eye and in some cases the ophthalmologist may be the first to suspect HIV infection or to diagnose AIDS. this is very dangrous