NATURAL HISTORY AND AIDS

NATURAL HISTORY AND AIDS

NATURAL HISTORY AND AIDS

Physical examination may show no abnormality, but about one-third of patientshave persistent generalized lymphadenopathy (PGL). Thisis defined as lymph nodes of 1 cm or more in diameter intwo or more non-contiguous extrainguinal sites, whichcannot be explained by any other infection or condition.The commonest sites of lymphadenopathy are the cervicaland axillary lymph nodes; it is unusual in the hilar lymphnodes. Biopsy usually shows a benign profuse follicularhyperplasia.At some time after the initial infection non-specific constitutionalsymptoms develop. These may be intermittentor persistent, and include fevers, night sweats, diarrhoeaand weight loss. Patients may also be affected by several'minor' opportunistic infections or conditions that tendto affect the mucous membranes and skin, such as oralcandidiasis, oral hairy leukoplakia, herpes zoster, recurrent oral or anogenital herpes simplex,and other skin conditions such as seborrhoeic dermatitis,folliculitis, impetigo and tinea infections. This collectionof symptoms and signs, which are often a prodrome tothe development of major opportunistic infections ortumours, is referred to as symptomatic non-AIDS.Without treatment with antiretroviral therapy, about75% of HIV-infected people developed symptomatic disease (either AIDS or non-AIDS) and 45-50% developAIDS in 9-10 years from primary infection. Retrospectivetesting of stored blood samples from early prospectivecohort studies have shown that levels of plasma viral load,combined with the absolute CD4 count, are highly predictiveof the risk of clinical progression. Infectedpersons with low plasma viral load levels following primaryinfection, presumably reflecting a better-preserved specificimmune response to HIV, have a much lower risk of clinicalprogression than those with substantially higher plasmaviral load.

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