AIDS Watch: Vital Signs
How to know when HIV becomes AIDS.
By Kelly McCann
When it comes to living with HIV disease, regular medical monitoring is absolutely essential to ensure continued good health. There are a couple of important blood tests that need to be run every few months, and through such testing, the doctor derives knowledge about the health of the patient’s immune system, the numbers of virus in the patient’s body, and, thus, the effectiveness of treatment in fighting viral replication.
Moreover, certain tests, along with clinical monitoring, are used to determine when a person’s HIV infection has progressed to AIDS. In particular, the CD4 T-lymphocyte count (commonly referred to as T cell count) is very important to HIV taxonomy. CD4 cells are a type of white blood cells that play an important part in helping the body fight infections. Since these are the same cells that are infected and destroyed by HIV, T cell counts can provide information about the status of the immune system.
In 1993, the CDC revised the classification system for HIV infection to emphasize the importance of CD4 cell counts in the categorization of HIV disease. At that time, the CDC also expanded the definition of AIDS. In order to receive a diagnosis of AIDS, a person must be infected with HIV, and they must also have:
• A CD4 cell count of less than 200 per micro- liter (one millionth of a liter) of blood, or
• A CD4 cell percentage of less than 14 percent, or
• Diagnosis with an AIDS-indicator illness.
Twenty-six medical conditions are considered to be AIDS indicator illnesses in people living with HIV:
1. Candidiasis (fungal or yeast infection) of bronchi, trachea, or lungs can lead to pneumonia.
2. Candidiasis (fungal or yeast infection) of the esophagus that can cause pain and difficulty swallowing.
3. Invasive Cervical Cancer in women
4. Coccidioidomycosis (disseminated or extrapulmonary) is a fungal infection that usually presents as an influenza-like illness with fever, cough, headaches, rash, body aches. It can also present as acute or even chronic pneumonia.
5. Cryptococcosis (extrapulmonary) is a serious and potentially fatal fungal disease. According to the CDC, most U.S. patients with this illness are HIV-infected and have meningitis.
6. Cryptosporidiosis (chronic intestinal) is a diarrheal illness caused by a parasitic protozoan. In persons with HIV, “Crypto” can cause nausea, vomiting, watery diarrhea, and accompanying weight loss.
7. Cytomegalovirus disease (other than liver, spleen, or nodes) is caused by a virus belonging to the Herpes family. Like other Herpes viruses, it can remain dormant in the body for a long period of time. Reactivation of the virus in the body is usually an indicator of an impaired immune system. This illness is a major cause of disease and death in immuno-compromised persons, commonly causing pneumonia and gastrointestinal disease.
8. Cytomegalovirus (CMV) retinitis (with loss of vision) refers to the infection of the retina, another common manifestation of the disease.
9. Encephalopathy (HIV related) involves lesions in the brain or general degeneration of brain matter and can be characterized by cognitive and/or motor dysfunction.
10. Herpes simplex with chronic ulcers (more than one month’s duration) or bronchitis, pneumonitis, or esophagitis.
11. Histoplasmosis (disseminated or extrapulmonary) is a somewhat common fungal infection among persons with HIV infection. It usually involves the lungs and causes respiratory or flu-like symptoms but it can affect other organs of the body and lead to serious health problems, even death, if left untreated.
12. Isosporiasis (chronic intestinal) is caused by a protozoan parasite. The illness is characterized by abdominal cramps, severe diarrhea, and weight loss.
13. Kaposi’s Sarcoma is a commonly diagnosed cancer among HIV-positive persons. KS usually appears as painless purplish spots or lesions on the skin or inside the mouth, caused by an overgrowth of blood vessels. KS can also occur in the intestines, lymph nodes, or lungs.
14. Burkitt’s Lymphoma. (Lymphoma refers to cancer of the lymphoid or lymphatic tissues. Different types have varying prognoses, but all forms constitute serious disease.)
15. Immunoblastic Lymphoma.
16. Primary Lymphoma of the brain.
17. Mycobacterium avium complex (disseminated or extrapulmonary) is an illness characterized by night sweats, weight loss, abdominal pain, fatigue, diarrhea, and anemia.
18. Mycobacterium (other species, disseminated or extrapulmonary).
19. Toxoplasmosis of the brain is an infection that is caused by a protozoan parasite carried by birds, cats, and other animals, and found in the soil. If it infects the brain, it causes encephalitis (inflammation).
20. Mycobacterium Tuberculosis (pulmonary). (Tuberculosis [TB] is an airborne bacterial infection that initially infects the lungs. In most people, the disease never becomes a problem. However, if the body’s immune system is impaired, say by HIV disease, TB can spread throughout the lungs and other organs.)
21. Mycobacterium Tuberculosis (extrapulmonary).
22. Pneumocystis carinii pneumonia (PCP) is a serious illness commonly seen in HIV-infected persons. Symptoms include fever, cough, and trouble breathing. It can be fatal if left untreated.
23. Pneumonia (recurrent) involves diagnosis with two or more episodes of pneumonia within one year.
24. Progressive multifocal leukoencephalopathy is a rare nervous system disorder, most commonly seen in immuno-compromised individuals. Caused by a virus, this disease leads to the destruction of nerve cells and is accompanied by vision loss, speech disturbances, mental decline, paralysis, and, eventually, coma.
25. Salmonella septicemia (recurrent) is a disease caused by the presence of harmful bacteria in the blood.
26. Wasting syndrome is the involuntary loss of more than 10 percent of body weight plus chronic diarrhea or chronic weakness and fever.
While the list of AIDS-indicating illnesses is long and scary, be aware that most of these illnesses can be treated successfully and some can even be prevented with prophylactic medications. But remember, everything begins with regular medical monitoring.
Kelly A. McCann is the chief executive officer of AIDS Foundation Houston. To learn more about HIV disease classification or AIDS-indicating illnesses, contact AFH at 713/623-6796.