Caution: Acute HIV infection may sometimes present as a serious and often fatal disease
Diagnosed with appendicitis and undergoing an exploratory operation had AIDS-related herpes throughout her digestive tract and spawned a colectomy! ...
A Swiss study of people who were diagnosed during the primary infection syndrome HIVfound that a quarter of them had or developed a wide range of early symptoms of primary HIVTypical " Primary HIV infection; many of them serious and some who arrived pôr em risco a life dos pacientes.
Gastrointestinal and neurological symptoms were particularly common in the manifestations of the early syndrome of HIV infection. However, although these symptoms are often erroneously interpreted at first, they were at least in this study at least significantly useful for early diagnosis of HIV infection.
The study on HIV infection
O Study on Primary Infection HIV Zurick is an observational study that since January of 2002 has observed documented symptoms and laboratory test results in any patient who is diagnosed with early syndrome of HIV infection. This is defined as:
Acute HIV infection.
- The presence of symptoms suggestive of HIV infection, HIV-negative or testing of HIV-positive antibodies with a p24 antigen and / or HIV-positive RNA (viral load) indeterminate.
- In the absence of symptoms suggesting HIV infection, someone with a documented HIV-positive antibody test on the last 90 days, once a known date of exposure.
Acute HIV infection:
- Symptoms suggestive of HIV infection and HIV-positive antibody test but with a negative HIV assay
- No symptoms, someone with a documented test of anti-HIV antibodies in the last 90-180 days since known the date of exposure to the virus.
The study was partially prospective, that is, although most people were diagnosed with HIV because they had symptoms, the patients were followed up for a period of six months and any manifestation that gave rise to the thought of being a case of acute infection with the actual presence of HIV infection were observed, assisted and cataloged.
There is no broad consensus on how to define "Typical acute HIV disease"And therefore the researchers in this study had to use their own definitions, taken from a search in the preexisting medical literature.
They collected the seventeen symptoms and the two laboratory abnormalities most commonly found in the acute HIV infection and the most commonly reported symptom is fever, with one or more concurrent events in the 18 group of events and other conditions mentioned above or two or more of these conditions in the absence of fever.
In addition to fever, the five main typical symptoms of acute HIV infection used for this study were elevated liver enzymes, malaise and fatigue, pharyngitis (sore throat), rash, and swollen lymph nodes. Weight loss with no apparent cause, headaches, muscle and joint pain and low platelet count were the "top five" in other studies.
Early Atypical HIV Infections were then classified as:
- An opportunistic disease defining AIDS. (Translator's note: tuberculosis for example, or recurrent vaginal candidiasis, in a typically female example).
- A symptom or group of symptoms not present in the "typical" list.
- Other signs, such as unusual laboratory abnormalities. (At some stage in my life my triglyceride count was above 3.300 and 200 is already considered excessively high)
If patients had any of these signs, they were classified as "atypical," even if these events were accompanied by other symptoms that belonged to the list mentioned at the beginning of the text.
Results - asymptomatic patients
Of the 290 patients, 202 (70%) had typical symptoms of HIV infection and 74 patients (25%) had atypical symptoms; only 14 individuals (5%), seven in the acute category and seven in the recent category had no symptoms of primary HIV infection.
This is not surprising since the most common reason for the study was the presentation of people with suggestive symptoms.
It is important to keep this factor in mind because it [the factor] is less than usual to estimate the proportion of people who do not show any symptoms of infection, which, depending on a between ten and sixty percent of the form and definition of acute HIV disease that is carefully elaborated as is seen.
This means that atypical and severe infectious courses have emerged many times in the presentations of primary HIV infection documented in this study are less common than the 30% prevalence found here; they can actually occur in anything between 2% and 15% of acute HIV infections.
The people most likely to be asymptomatic were women, young people, and who had been infected with HIV strains resistant to various antiretroviral drugs (Translator's note: It seems clear that people making use of medication in one way or another, have left "leak" strains relatively suppressed which when released from drug pressure evolved into more resistant forms of HIV. I ask everyone to make no mistake and if anyone tries to maintain a relationship, sex or shag and even quickie without a condom, throw holy water on it!). They also had an average viral load in the first test of approximately 130.000 copies of RNA per ml, whereas symptomatic patients (typical or not) had an average viral load of 4 or 5 million copies / ml.
Outcomes - atypical symptoms
Most people (83) with symptoms were acute category and of these, 69 (28,5) were classified as atypical. 17 of the recent category, 40 symptoms were classified as atypical.
People with atypical symptoms were more likely to have HIV subtype "non-B, straight and not be in any STDs monitoring (STDs). This is interesting because most acute HIV infection studies were performed in people with HIV subtype B, and because some subtypes, such as D, and LA, seem more virulent than subtype B.
People with atypical symptoms were much more likely to be hospitalized because of these strains: 43% with atypical symptoms versus 11% with typical values.
There was a long list of atypical diseases linked to HIV infection. The most common causes were intestinal or neurological; more specifically linked to the central nervous system. However, the symptoms also involved ophthalmological, pulmonary, renal and other complications related to genitalia and skin problems.
There were constitutional symptoms such as severe weight loss and blood abnormalities such as pancytopenia (Note from the translator: It is advisable to read the Wikipedia article that deals with this health problem, since this is serious and given the context of this article, it is not necessary to import the text here.
AIDS and the defining conditions of AIDS were seen in 23% of people with atypical presentation. The disease AIDS-defining disease was accentuated by oral candidiasis or esophageal candidiasis, seen in 14% of atypical presentations. Most other AIDS-defining diseases consisted of intestinal or hepatic infections, usually cytomegalovirus (CMV) infections, a virus of the herpes virus family; there was also a single severe case of another strain of herpes virus in an inflammation initially diagnosed as Lyme disease, and a profound drop in platelet counts, which was accompanied by a generalized HSV (herpes). Two of the cases of gastroesophageal reflux by candida, and also involved neurological symptoms.
A patient with severe diarrhea and wasting syndrome (weight loss without an apparent cause) without generating other HIV-related syndromes.
The next most common symptom of the group of non-AIDS-defining diseases, such as gastrointestinal symptoms, was seen in 14% of atypical presentations. Half of these consisted of tonsillitis. Three gastrointestinal cases leading to surgeries: one involved a patient with severe gastrointestinal bleeding, an anal abscess and an inflammation of the gallbladder in a patient in whom an HIV viral load of 100 million (!!!!!!!!!) copies / ml.
One patient had acute bacterial pneumonia, arthritis and acute renal failure: the other was originally diagnosed with appendicitis and underwent an exploratory operation; and had an AIDS-related herpes throughout her digestive tract which led to a colectomy (partial removal of the colon).
Central nervous system symptoms were observed in 12% of the atypical presentations. These ranged from transient facial paralysis in three patients, prolonged vertigo in one patient, and three patients who had acute psychiatric episodes (two of them were in the acute phase of recent infection). Two patients had severe cerebral inflammation (encephalitis) and meningitis; one had to be treated in the Intensive Care Unit.
Other associated symptoms were cutaneous symptoms (9%), including dermatitis and cellulitis (soft tissue infection); the lungs (6%, including three cases of pneumonia, in addition to the above case); (6%, including three cases of pancytopenia) and urogenital symptoms (3%, including two other patients with renal insufficiency, in addition to the above).
Although some patients became critically ill, no one analyzed in the study evolved to death (death).
The mean CD4 count in all atypical (including asymptomatic) presentations was 421 cells / mm3. In most cases of atypical disease, CD4 counts were recorded above 350 cells / mm3 and in a number of cases, including some of the most severe, up to 500 cells / mm3. Exactly 50% of patients had a viral load in the representation of more than 100.000 copies / ml.
Although 38 of patients with atypical symptoms were correctly diagnosed with acute HIV infection, the remainder received a wide range of diagnoses prior to being tested for HIV (my primary syndrome was extremely violent and I wandered hospital in the city of São Paulo always receiving the same diagnosis: influenza. When I was treated by a doctor with capital letters I received the true diagnosis: Viral Meningitis.
These include: 17% with other viral diseases, such as "kiss disease", infectious mononucleosis (Epstein-Barr virus); 6% with bacterial infections such as streptococcus; 3% (ten patients) with syphilis; gastroenteritis of unknown cause, and only diagnoses of a variety of diseases such as infective endocarditis, Lyme disease, appendicitis, diverticulitis and lymphoma. Twelve percent of the patients were diagnosed by the anti-HIV test with no other diagnoses recorded.
Overall, however, the misdiagnoses in this study do not appear to have delayed the diagnosis of HIV seropositivity in these patients. The mean time of seropositive diagnosis for HIV, after the first presentation, was 29 days in people with typical symptoms and 32 days with atypical symptoms.
People who were being assisted in an outpatient clinic for STDs were diagnosed from relatively "early" (21 days after the date of presentation) than people who were attending hospital on an outpatient basis for other diseases (32 days) and others ( 33 days).
[Translator saddened Note: The highlighted section above contains two phonemes: A & E and GP are unintelligible to me and I put the paragraph in which they are contained in English below. If any soul to go through here know define the expressions I'll thank from the bottom of my heart. Here goes:
People Attending an STI clinic Were diagnosed Earlier (21 days after presentation) than people Attending hospital A & E (32 days) or GPs (33 days)].
The researchers note that there is only one individual symptom in the list of typical symptoms of HIV that is not presented as "very often" or "almost common" in patients who end up being diagnosed as HIV-negative to HIV.
It is the combination of symptoms that account together with the probability of recent exposure to HIV, and this study extends our knowledge of how this may present.
This study is a reminder that HIV can be present in a wide variety of different forms and can cause a large and serious acute illness, stressing the importance of testing after any suspected or post-exposure prophylaxis (PEP) exposure after a very recent.
Posted in: 27 2015 May
Translated from the original in English Acute HIV infection may present in many ways - sometimes as a serious illness by Cláudio Santos de Souza in 29 May 2015. (I do translation work for fair prices. Hire me and help me to pay the operating costs of this site)
Note the Soropositivo.Org Editor. The text forces me to rain on wet: If you think you may have had contact with HIV in less than 72 hours as to hospital and look for PEP and, unfortunately, this time window has already been closed, seek urgently make the diagnosis for HIV as early as possible, given the fact that, raining in the wet again, ignoring a problem does not solve it and, on the contrary, in spite of not having had any of those in the study, you can not be so so lucky, and say, "go to death." (...)