Men's Health Education: A Complete Analysis of the Clinical Manifestations of HIV/AIDS from the Acute to the Terminal Stage

Clinical Manifestations of AIDS

1. Acute Phase: Clinical symptoms in the acute phase usually occur 2–6 months after infection. The main symptoms are fever, sore throat, rash, generalized lymphadenopathy, headache, and muscle and joint pain, similar to those of a viral flu. After approximately 3–14 days, some patients enter the asymptomatic phase, while a small number experience persistent low-grade fever, weight loss, and may also have meningitis-like symptoms such as fever, headache, vomiting, and meningeal irritation, which subside spontaneously within 2–3 weeks. A minority of patients experience chronic recurrent flare-ups.

2. Chronic Phase: This generally involves three stages: asymptomatic infection, AIDS-related syndrome, and AIDS.

① Asymptomatic Infection Phase: Also known as the incubation period, this ranges from approximately six months to 10 years, with a few individuals experiencing up to 15 years. The length of the incubation period is related to the amount and type of virus, the route of transmission, individual differences in the immune system, nutritional status, and lifestyle habits. The most important prognostic factor is the T4 lymphocyte count. Approximately 30% of those infected with the virus develop AIDS within 2-5 years. The incidence rate continues to rise over time, with some reports indicating an annual increase of about 17%. Other reports suggest that 50% of those infected develop AIDS within 10 years. Asymptomatic individuals may remain asymptomatic for a long period, even life, becoming a highly dangerous source of infection.

② AIDS-related syndrome (ARC): Early symptoms include fever, night sweats, weight loss, fatigue, and diarrhea; followed by generalized lymphadenopathy; oral and vaginal infections; recurrent polymorphic rashes, herpes, or molluscum contagiosum; unexplained bone marrow hypoplasia and anemia; leukopenia and thrombocytopenia; and various infectious diseases caused by immunodeficiency.

③ AIDS: Also known as complete AIDS. In addition to the symptoms of the ARC stage, it mainly manifests as opportunistic infections or conditional infections caused by acquired immunodeficiency, malignant tumors, and multi-system damage.

3. Various Opportunistic Infections

① Pneumocystis carinii pneumonia: Approximately 50%–60% of AIDS patients develop this disease. The onset is subacute, with fever, cough, and dyspnea appearing weeks or months before medical attention. Occasionally, chills, chest tightness, and sputum production may also occur. A small number of rapidly progressing cases present with high fever accompanied by shortness of breath, cyanosis, and even respiratory failure. Lung rales are often absent, and chest X-rays frequently show interstitial inflammation, perihilar inflammation, or alveolar inflammation. This is one of the leading causes of death in AIDS patients.

② Oropharyngeal, esophageal, and gastrointestinal candidiasis: Manifests as congestion and edema of the oropharyngeal mucosa, covered with a white fungal coating that is easily peeled off, accompanied by burning pain, salivation, and difficulty chewing and swallowing. When the lesions involve the intestines, diarrhea may occur, with stools often being green, loose, or mucous.

③ Cytomegalovirus (CMV) infection: One of the most common opportunistic viral infections in HIV/AIDS, it can cause erythema multiforme, thrombocytopenic purpura, colitis, proctitis, and persistent herpetic ulcers of the anus.

④ Tuberculosis and Mycobacterium avium infection: Tuberculosis, both intrapulmonary and extrapulmonary, is extremely common in HIV/AIDS patients, and many strains are drug-resistant, resulting in poor treatment responses. Reports indicate that the incidence of pulmonary tuberculosis can reach 77%, pleural tuberculosis 15%, intestinal tuberculosis 34%, meningeal tuberculosis 13%, tuberculous osteomyelitis 16%, hematogenous disseminated tuberculosis 16%, cutaneous tuberculosis 8%, and lymph node tuberculosis 35%–40%. Mycobacterium avium infection presents symptoms similar to tuberculosis, affecting not only the lungs but also the liver, spleen, lymph nodes, bone marrow, gastrointestinal tract, skin, and brain, resulting in corresponding symptoms. In recent years, tuberculosis has also been found to spread among hospitalized HIV-infected patients, even leading to outbreaks.

⑤ Herpes simplex virus infection: Herpes simplex commonly appears on the lips, external genitalia, and perianal area; herpes zoster often follows the distribution of the trigeminal and intercostal nerves, causing local burning and severe pain. Secondary purulent infection can occur after the blisters rupture. In addition, it can cause encephalitis, pneumonia, and hepatitis. There are reports that herpes virus infection can often exacerbate HIV replication and worsen the condition of HIV-infected individuals.

⑥ Cryptosporidium infection: This parasite lives on the brush border of the small intestinal villi and is a common cause of persistent, severe diarrhea in AIDS patients. It leads to malabsorption of exogenous nutrients and loss of endogenous nutrients. Symptoms include watery stools, 6–25 times/day, spasmodic abdominal pain, nausea, vomiting, abdominal distension, occasional fever, and leukocytosis. Severe cases can lead to water and electrolyte imbalance and even shock. There are also reports of Cryptosporidium causing cholecystitis, cholangitis, colitis, and pancreatitis, as well as esophageal and gastric lesions. Cryptosporidium oocysts can be found in stool using the sucrose flotation method.

⑦ Amoebic and Giardia lamblia enteropathy: More than 10 years before the AIDS epidemic, a high rate of parasitic infection was found in homosexual men, and it was once named homosexual bowel syndrome. It is one of the common causes of diarrhea in AIDS patients. Giardia lamblia parasitize the upper small intestine, typically presenting with watery stools, foul odor, and abdominal distension, occasionally accompanied by fever, nausea, vomiting, and bloody stools.

⑧ Epstein-Barr virus (EBV) infection: Most data suggest that oral hairy leukoplakia is related to EBV infection. It manifests as raised, rough-surfaced hairy white patches several millimeters above the mucosa or tongue surface on the sides, surface, or buccal mucosa, which are difficult to peel off. EBV-DNA can be detected in the specimen using Southern blotting. In addition, AIDS-related lymphomas are also believed to be associated with EBV infection.

⑨ Toxoplasmosis: The pathogen is Toxoplasma gondii. 80% of immunocompetent individuals are asymptomatic, while a few experience fatigue, muscle pain, occasional fever, and lymphadenopathy. In AIDS patients, toxoplasmosis can manifest as toxoplasmic encephalitis or toxoplasmic brain abscess, leading to hemiparesis, ataxia, and epileptic-like seizures. It can also present as confusion and lethargy. 50% of patients may experience fever and increased intracranial pressure.

⑩ Papillomavirus (PLV) infection: Can cause common warts and condyloma acuminata. Common warts present as multiple linear or flat warts; condyloma acuminata manifests as painful and itchy growths on the external genitalia and perianal area. In addition, progressive multifocal leukoencephalopathy (PML) presents as fatigue, dysarthria, facial paralysis, and visual impairment. However, cerebrospinal fluid may be normal, electroencephalography (EEG) shows focal abnormalities, and CT scans show multiple low-density lesions in the white matter. The diagnosis can be confirmed by the discovery of papillary polymorphonuclear vesicular viral inclusions in biopsy or pathological examination. Differential diagnosis should exclude granulomatous disease, astrocytoma, and primary brain lymphoma.

⑪ Cryptococcal meningitis: Common, recurrent, presenting with headache, vomiting, altered consciousness, and positive meningeal signs. Cerebrospinal fluid pressure is high, protein and white blood cell counts are mildly to moderately increased, while glucose and chloride levels are decreased. Cryptococcus can be detected by direct smear staining with Indian ink.

⑫ Hepatitis virus infection: The hepatitis virus infection rate among AIDS patients is as high as 76%–95%, including hepatitis A, B, C, D, and E viruses. Hepatitis B and hepatitis C have the worst prognosis.

⑬ Reports indicate that some HIV-infected men are infected with invasive Haemophilus influenzae and Nocardia.

4. Malignant tumors: Kaposi's sarcoma and non-Hodgkin's lymphoma are the most common, followed by chronic lymphocytic leukemia, oropharyngeal tumors, lung cancer, and liver cancer.

① Kaposi's sarcoma associated with AIDS is seen in about one-third of patients. It is characterized by multiple vascular nodules on the skin, appearing as raised, purplish-red and purplish-blue maculopapules, also known as diffuse infiltrative and hemorrhagic plaques; some are spongy and firm. Lesions initially appear on the extremities, subsequently affecting the head, neck, trunk, and external genitalia, ranging from several to hundreds. Approximately 10% of Kaposi's sarcoma patients have no skin lesions, only fever, weight loss, anemia, and hepatosplenomegaly and lymphadenopathy. In advanced stages, it can affect all organs and systems of the body.

② Non-Hodgkin's lymphoma occurs in 95% of extralymphatic tissues, primarily affecting the bone marrow (53%), liver (43%), central nervous system (35%), and digestive tract (22%). AIDS-related lymphomas often originate in the brain, with nonspecific symptoms and frequent progressive deterioration. Cerebrospinal fluid is normal, and serum CMV antibodies are positive. CT scans show homogeneous contrast-enhanced lesions around the ventricles; pathological examination reveals large tumor cells infiltrating the parenchyma, perivascular spaces, and pia mater. Primary bone marrow involvement in non-Hodgkin's lymphoma mainly presents with fever, anemia, bleeding tendency, infectious syndromes, and abnormal blood and bone marrow morphology. Gastrointestinal lymphomas present with abdominal distension, abdominal pain, abdominal mass, abnormal bowel movements, and gastrointestinal bleeding. The median survival for lymphoma patients is reported to be 7 months, with those achieving complete remission through chemotherapy surviving up to 20 months.

③ Gliomas are malignant transformations of astrocytes caused by HIV infection, and may also be related to papillomavirus infection, potentially leading to frontal syndrome.

④ Other tumors present with corresponding clinical manifestations.

5. Multi-organ and multi-system damage, its occurrence is related to the following factors:
① Direct damage from HIV, such as HIV meningitis, HIV myocarditis, and HIV-related nephropathy.

② Opportunistic infections affecting various organs and systems: related to deficiencies in immune surveillance, decreased killing activity of natural killer cells and cytotoxic cells, and reduced levels of certain lymphokines such as interleukin-2.

③ Multiple malignant lesions affecting multiple organs and systems: HIV is a lentivirus that can cause chromosomal aberrations and unlimited proliferation of cells, leading to anaplasia and carcinogenesis; a decrease in the number and function of T cells reduces the body's tumor surveillance function, making it unable to recognize and kill nascent tumor cells; after the T cell's inhibitory function on B cells is reduced, B cell function is relatively hyperactive, and when stimulated by antigens, it can produce blocking factors, which can block the binding sites on the surface of tumor cells, preventing several immune cells from playing a tumor-killing role.

④ Immunopathological damage caused by abnormalities in cellular and humoral immunity: Clinically, the multi-system damage in AIDS closely resembles certain connective tissue diseases. Some cases showed obvious hematological changes, such as pancytopenia, even before the diagnostic criteria for AIDS were established. Therefore, some scholars have proposed that AIDS is an autoimmune disease caused by HIV infection. Laboratory data also indicate that AIDS patients exhibit hyperimmune globulinemia, polyclonal activation, formation of circulating immune complexes, and production of autoantibodies, such as antinuclear antibodies, anti-erythrocyte, anti-leukocyte, and anti-platelet antibodies, anti-lymphocyte antibodies, and a positive Coombs test. Autopsies have also confirmed severe thymic destruction in AIDS patients. In some cases, the combined use of immunosuppressants such as cyclosporine A, low-dose cyclophosphamide, or prednisone, while receiving antiviral and anti-opportunistic infection treatment, can alleviate symptoms. This demonstrates the role of immunopathological damage in the multi-organ, multi-system pathogenesis of AIDS. Of course, some scholars also believe that while autoimmune mechanisms can explain some clinical and hematological features of AIDS, there is currently insufficient evidence to definitively or refute its classification as an autoimmune disease. In particular, AIDS patients show a progressive decrease in T4 cells, while the number of this cell population is often increased in individuals with autoimmune diseases.