AIDS (HIV): Complications

The following are the most important diseases or complications that may be contributed to by AIDS:

Respiratory system (J00-J99)

  • Recurrent pneumonia (pneumonia; usually community-acquired pneumonia (CAP)); most common pathogens (in descending order): Pneumococcus, Pneumocystis jiroveci (formerly Pneumocystis carinii pneumonia (PCP); at 50%, the most common initial manifestation of AIDS disease), respiratory viruses, Haemophilus influenza, Staphylococcus aureusClinical presentation of Pneumocystis jirovecii pneumonia: Develops insidiously and presents with dry irritable cough, subfebrile temperatures, and increasing exertional dyspnea (occurrence of shortness of breath (dyspnea) with normal physical exertion). Note: Low CD4 cell counts are associated with increased mortality (death rate).

Eyes and eye appendages (H00-H59).

Skin and subcutaneous (L00-L99).

  • Eosinophilic pustular folliculitis (EPF; synonyms: eosinophilic pustulosis; eosinophilic pustular folliculitis; Ofuji syndrome) – Clinical presentation: Pustular dermatosis (blood eosinophilia/increased number of eosinophilic granulocytes) with intraepidermal eosinophilic pustules (pustules) associated with severe pruritus; no other systemic involvement; localization: face, here v. especially forehead area (infantile form), trunk and extremities (adult form); differential diagnoses: drug-induced sterile pustular skin changes (eg, EGFR (“epidermal growth factor receptor”) inhibitors), infectious folliculitis by microbes; for the manifestation of the disease seems to be relevant immunosuppression.
  • Psoriasis (psoriasis) – may be more pronounced and more resistant to therapy under HIV infection than without HIV infection.
  • Seborrheic eczema – co-caused by the yeast Malassezia furfur (formerly Pityrosporon ovale); however, this is a special form of eczema; clinical picture: redness and greasy scaling in the nasolabial area (nasal lip area).

Infectious and parasitic diseases (A00-B99).

  • Candidiasis of the deep respiratory tract – fungal infection of the lungs or bronchi.
  • Chronic intestinal isosporasis – chronic intestinal inflammation caused by a parasite.
  • Chronic intestinal cryptosporidiosis – intestinal infection caused by parasites of the genus Cryptosporidium.
  • CMV infection – infection with cytomegalovirus.
  • Coccidioidomycosis – respiratory disease caused by a particular type of fungus.
  • Herpes simplex infections (HSV infections) – development of acute retinal necrosis (ARN; inflammation of retina (retina) and retinal pigment epithelium with significant visual loss), esophagitis (esophagitis), tracheobronchitis (inflammation of the trachea and bronchial mucosa), HSV pneumonia (HSV pneumonia), and colitis (intestinal inflammation).
  • Herpes zoster infections (shingles) – repeatedly occurring with lowered CD4 cell counts.
  • Histoplasmosis – systemic infectious disease with the fungus Histoplasma capsulatum.
  • Human herpes virus type 8 (HHV-8) – see below neoplasms – tumor diseases (C00-D48)/Kaposi sarcoma.
  • Cryptococcosis – respiratory disease with the fungus Cryptococcus neoformans.
  • Methicillin-resistant Staphylococcus aureus (MRSA) infections.
  • Mycoses (fungal diseases
  • Esophageal candidiasis/soor esophagitis – fungal infection of the esophagus.
  • Pneumocystis jiroveci pneumonia (old name: Pneumocystis carinii pneumonia); most common opportunistic infection of AIDS disease/the most common initial manifestation with about 50%.
  • Progressive multifocal leukoencephalopathy (PML) – disease of the brain caused by the JC virus (belongs together with the SV-40 and BK virus in the family Polyomaviridae and therein to the genus of polyomaviruses), which can lead to many different symptoms such as aphasia (loss of normal speech) or hemianopsia (visual field defects).
  • Recurrent salmonella sepsis.
  • Toxoplasmosis (infectious disease) of the central nervous system (CNS; cerebral toxoplasmosis) – most common opportunistic infection in HIV sufferers; symptomatology: symptoms are often nonspecific with headache, impaired consciousness, and focal deficits (localized change in the brain leading to dysfunction in another part of the body)
  • Tuberculosis (consumption) – HIV/TB co-infection (double infection); WHO: risk of co-infection with tuberculosis is 26-31 times higher in HIV patients than in people who are not infected with HIV; vulnerable population includes prison inmates.

Circulatory system (I00-I99)

  • Subclinical coronary sclerosis/calcification of the coronary arteries without clinical symptoms (in young HIV patients) → increased incidence of cardiovascular disease and events more common at younger ages than in the general population; partly due to lifestyle differences (smoking, drug use)

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

  • Chronic parotitis (parotid gland inflammation/indicator disease for HIV).
  • Oral hairy leukoplakia (OHL) – clinical presentation: asymptomatic whitish “hairy” deposits on the lateral margins of the tongue that cannot be wiped off (unlike oral candidiasis/fungal infection); causative disease is chronic Eppstein-Barr virus (EBV) replication [advanced HIV infection/indicator disease for HIV].
  • Oral ulceration (ulceration of the mouth) caused by cytomegalovirus (CMV).
  • Sialadenitis (inflammation of the salivary glands).

Musculoskeletal system and connective tissue (M00-M99).

  • Osteoporosis (bone loss) (about 15% of cases due to chronic inflammation and antiretroviral therapy).

Neoplasms – tumor diseases (C00-D48).

  • Anal carcinoma/anal cancer – often arising from precursors within a few months; often associated with human papillomavirus/HPV and men who have sex with men (MSM); another risk factor is smoking; precursor of anal carcinoma: anal (and penile) intraepithelial neoplasia (AIN/PIN).
  • Bronchial carcinoma (lung cancer) – occurs two to eight times more frequently in HIV patients than in uninfected individuals
  • Burkitt’s lymphoma – malignant (malignant) lymphoma, the formation of which is associated with the Epstein-Barr virus and is counted among the B-cell non-Hodgkin’s lymphomas.
  • Cervical carcinoma (cervical cancer).
  • Cholangiocellular carcinoma (CCC; bile duct carcinoma).
  • Neck-head carcinoma
  • Hepatocellular carcinoma (HCG; hepatocellular carcinoma).
  • Gastrointestinal carcinoma (tumors of the gastrointestinal tract; esophageal and gastric tumors; colorectal carcinoma).
  • Hodgkin’s lymphoma – malignant neoplasm (malignant neoplasm) of the lymphatic system with possible involvement of other organs (25-fold increased risk).
  • Kaposi’s sarcoma (KS; pronounced [ˈkɒpoʃi] – “Kaposchi”) – a tumor disease occurring mainly in connection with AIDS, the cause of which is most likely due to human herpes virus type 8 (HHV-8) in conjunction with cofactors (immunosuppression, environmental factors and oxidative and nitrosative stress). The disease is manifested by the appearance of brown-red to purplish spots from which plaque-like and nodular tumors develop. In case of truncal infestation usually exanthematous spread of skin lesions (about 70% of cases). Furthermore, infestation of lymph nodes, more rarely gastrointestinal tract (gastrointestinal tract), liver, lungs or heart are affected. Men are more frequently affected than women. In the AIDS-associated form, brown-bluish spots multifocally appear mostly also on the skin of legs and arms. Therapy of cutaneous Kaposi’s sarcoma (KS): antiretroviral therapy (ART); KS lesions regressed completely in 64 of the 68 patients treated exclusively with antiretroviral therapy; recurrence-free rate was 82% five years after initial KS diagnosis (data from the Competence Network HIV/AIDS)).
  • Non-Hodgkin’s lymphoma – malignant (malignant) disease originating from lymphoid tissue.
  • Primary CNS lymphoma
  • Thyroid tumors

Ears – mastoid process (H60-H95)

  • Hearing loss – increase in hearing threshold in the range of high and low frequencies; independent of the stage of immunodeficiency, duration and compliance with therapy.

Psyche – nervous system (F00-F99; G00-G99).

  • Neuro-AIDS
    • Dementia – HIV-associated dementia (HAD).
    • Encephalopathy (degenerative changes of the brain).
    • Paralysis
    • Neurocognitive disorders (HIV-associated neurocognitive disorders, HAND) (approximately 50% of HIV patients).
      • According to a cohort study, viral DNA was detectable in cells of the cerebrospinal fluid in 1 in 2 patients after nearly 9 years of therapy, which was associated with worse neurocognitive test scores.
    • Speech disorders

Genitourinary system (N00-N99)

  • Anogenital ulceration (ulceration of the anus and genital area) caused by cytomegalovirus (CMV).
  • HIV-associated immune mediated kidney disease (HIVIMKD) – persistent HIV infection may be associated with renal immunologic complications; causative is an antibody response to HIV epitopes; gammopathy (alteration of plasma proteins) with resulting alpha-2 microglobulinuria is observed.
  • HIV-associated nephropathy (HIVAN) – renal involvement in HIV infection due to HIV-associated chronic inflammation (inflammation) and direct infection by HIV; predisposed to this disease are patients with high viral load and reduced CD-4 cell counts; clinical picture: rapid renal function loss.

Further

  • Wasting syndrome – HIV-associated involuntary weight loss and decline in performance.