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[[Category:HIV/AIDS]]
[[Category:HIV/AIDS]]
{{Viral diseases}}
{{STD/STI}}
{{Link FA|he}}
{{Link FA|vi}}
[[af:Vigs]]
[[als:AIDS]]
[[am:ኤድስ]]
[[an:SIDA]]
[[ar:متلازمة العوز المناعي المكتسب]]
[[ast:SIDA]]
[[az:QİÇS]]
[[bat-smg:AIDS]]
[[be-x-old:СНІД]]
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[[eu:Hartutako Immuno Eskasiaren Sindromea]]
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[[fr:Syndrome d'immunodéficience acquise]]
[[fur:AIDS]]
[[ga:SEIF]]
[[gd:AIDS]]
[[gl:SIDA]]
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[[hr:Sindrom stečene imunodeficijencije]]
[[ht:Sida]]
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[[id:AIDS]]
[[is:Alnæmi]]
[[it:AIDS]]
[[ja:後天性免疫不全症候群]]
[[ka:შიდსი]]
[[ki:AIDS]]
[[km:ជំងឺអេដស៍]]
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[[pt:Síndrome da imunodeficiência adquirida]]
[[qu:Unquy hark'aypa chaskisqa waqlliynin]]
[[ro:SIDA]]
[[ru:Синдром приобретённого иммунного дефицита]]
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[[yi:עידס]]
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[[zh:艾滋病]]
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[[zh-yue:愛滋病]]


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Revision as of 17:38, 5 March 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The pathophysiology of AIDS is complex, as is the case with all syndromes.[1]

Pathophysiology

The major pulmonary illnesses

Pneumocystis jiroveci pneumonia

Pneumocystis jiroveci is present in this lung impression smear, using Giemsa stain

Pneumocystis jiroveci pneumonia (originally known as Pneumocystis carinii pneumonia, often abbreviated PCP) is relatively rare in normal, immunocompetent people but common among HIV-infected individuals. Before the advent of effective treatment and diagnosis in Western countries it was a common immediate cause of death. In developing countries, it is still one of the first indications of AIDS in untested individuals, although it does not generally occur unless the CD4 count is less than 200 per µl (Feldman, 2005).

Tuberculosis

Scanning electron micrograph (SEM) of a number of Gram-positive Mycobacterium tuberculosis bacteria

Among infections associated with HIV, Tuberculosis (TB) is unique in that it may be transmitted to immunocompetent persons via the respiratory route, is easily treatable once identified, may occur in early-stage HIV disease, and is preventable with drug therapy. However, multi-drug resistance is a potentially serious problem. 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 may present atypically and extrapulmonary TB is common infecting bone marrow, bone, urinary and gastrointestinal tracts, liver, regional lymph nodes, and the central nervous system (Decker and Lazarus, 2000).

The major gastro-intestinal illnesses

Esophagitis

Esophagitis is an inflammation of the lining of the lower end of the esophagus (gullet or swallowing tube leading to the stomach). In HIV infected individuals, this could be due to fungus (candidiasis), virus (herpes simplex-1 or cytomegalovirus). In rare cases, it could be due to mycobacteria (Zaidi and Cervia, 2002).

Unexplained chronic diarrhea

In HIV infection, there are many possible causes of diarrhea, including common bacterial (Salmonella, Shigella, Listeria, Campylobacter, or Escherichia coli) and parasitic infections, and uncommon opportunistic infections such as cryptosporidiosis, microsporidiosis, Mycobacterium avium complex (MAC) and cytomegalovirus (CMV) colitis. Diarrhea may follow a course of antibiotics (common for Clostridium difficile). It may also be a side effect of several drugs used to treat HIV, or it may simply accompany HIV infection, particularly during primary HIV infection. In the later stages of HIV infection, diarrhea is thought to be a reflection of changes in the way the intestinal tract absorbs nutrients, and may be an important component of HIV-related wasting (Guerrant et al., 1990).

The major neurological illnesses

Toxoplasmosis

Toxoplasmosis of heart in AIDS

Toxoplasmosis is a disease caused by the single-celled parasite called Toxoplasma gondii. T. gondii usually infects the brain causing toxoplasma encephalitis. It can also infect and cause disease in the eyes and lungs (Luft and Chua, 2000).

Progressive multifocal leukoencephalopathy

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease, in which the myelin sheath covering the axons of nerve cells is gradually destroyed, impairing the transmission of nerve impulses. It is caused by a virus called JC virus which occurs in 70% of the population in latent form, causing disease only when the immune system has been severly weakened, as is the case for AIDS patients. It progresses rapidly, usually causing death within months of diagnosis (Sadler and Nelson, 1997).

HIV-associated dementia

HIV-1 associated dementia (HAD) is a metabolic encephalopathy induced by HIV infection and fueled by immune activation of brain macrophages and microglia (Gray et al., 2001). These cells are actively infected with HIV and secrete neurotoxins of both host and viral origin. Specific neurologic impairments are manifested by cognitive, behavioral, and motor abnormalities that occur after years of HIV infection and is associated with low CD4+ T cell levels and high plasma viral loads. Prevalence is between 15-30% in Western countries (Heaton et al., 1995; White et al., 1995) and has only been seen in 1-2% of India based infections (Satischandra et al., 2000; Wadia et al., 2001).

HIV-associated malignancies

Patients with HIV infection are susceptible to a number of malignancies (Yarchoan et al., 2005). The most common is Kaposi's sarcoma, and the appearance of this tumor in young gay men in New York in 1981 was one of the first signals of the AIDS epidemic. In addition, patients with HIV infection have a higher incidence of certain high grade B cell lymphomas, especially Burkitt-like and large cell lymphomas. These tumors, as well as aggressive cervical cancer in women, confer a diagnosis of AIDS in patients with HIV infection.

The major dermatological illnesses

Kaposi's sarcoma lesion commonly found in patients with stage IV AIDS

AIDS-associated Kaposi sarcoma or KS-AIDS presents with cutaneous lesions that begin as one or several red to purple-red macules, rapidly progressing to papules, nodules, and plaques, with a predilection for the head, neck, trunk, and mucous membranes.

Intraoral Kaposi’s sarcoma lesion with an overlying candidiasis infection
















See Also

References

  1. Guss DA (1994). "The acquired immune deficiency syndrome: an overview for the emergency physician, Part 1". J Emerg Med. 12 (3): 375–84. PMID 8040596.


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