Infection with the human immunodeficiency virus is the starting point at the onset of the disease. After infection with the virus, a long journey begins in 5 stages. They are divided into active and passive, some of them last for weeks, while others may not be diagnosed by doctors for a long time. Let's look at these stages in more detail.
Are the stages of HIV infection always identical?
In 2001 V.I. Pokrovsky proposed the famous classification, which includes 5 stages:- First manifestations.
- Latent.
- Secondary diseases.
- Ultimate (AIDS).
As can be seen from the example, the progression of HIV infection directly depends on T-lymphocytes. The fewer there are, the faster the infection develops and the more seriously it affects the human body.
T lymphocytes play a fundamental role in the body's immunity. They are the main lymphocytes that recognize cells with foreign antigens and additionally perform the function of instantly destroying them.
The classification of the stages of HIV infection proposed by Pokrovsky very accurately describes any type of virus. Considering that one HIV cell can create up to a billion copies of itself every 24 hours, and the ability to undergo multiple mutations only adds to the complexity, one thing remains the same: HIV infection absolutely always has exactly 5 stages. Each of them is the same in its structure and effect on the human body, regardless of the strain of the virus, its mutations and other features.
The first 3 stages of HIV infection
First of all, we will consider only 3 stages of this disease, since they are quite close in their effect on the human body as a whole, and they also have low life activity limitation:Incubation stage
It reports from the moment of infection with the virus (actual or expected) until the appearance of complications characteristic of HIV infection or the production of antibodies in the body. Often, this stage lasts from 21 to 90 days.Depending on the speed of passage of the first stage, we can assume the speed of development of all subsequent ones. This is not always an indicator that HIV infection will spread quickly, but, nevertheless, a connection between these processes exists and is confirmed in medical practice.
Acute infection stage
During this process, various kinds of exacerbations, physiological changes, etc. begin to occur. This stage is divided into three forms:- 2-A, complete absence of any;
- 2-B, acute infection (difficult to diagnose symptoms, very similar to those of other types of infection);
- 2-B, acute infection in the presence of secondary diseases (fever, pharyngitis, rash, diarrhea, weight loss, thrush, etc.).
Latent
The longest stage of HIV infection. Its duration in most cases ranges from 2-3 to 20+ years.During this stage, the gradual but extremely long-term effect of the disease on the body is diagnosed. In particular, there is a decrease in the total number of CD4 lymphocytes in the blood. As for clinical manifestations, there is only one thing - enlarged lymph nodes (however, it may not exist). When comparing the minimum and maximum duration of the stage, doctors allocate 6-7 years. This is the statistical duration of the 3rd stage of the disease. After its completion, complications begin that can be treated with great difficulty and inevitably lead to the gradual death of a person - these are the final stages of the disease.
Stages 4 and 5 of HIV infection
It is not without reason that we divided the stages, because during the following changes in the patient’s body, the most life-threatening processes begin. If the first 3 stages are the time during which or acts on it and takes root, then now the virus begins to destroy literally everything around it. And this process begins from the 4th stage.Let's look at the last stages in more detail.
Secondary diseases
During these processes, the human immune system is rapidly destroyed, and the infection develops many times faster, with corresponding consequences. The following diseases appear:- permanent (oral cavity, genitals,);
- leukoplakia of the tongue;
- candidiasis of the genitals and mouth;
- rapid weight loss;
- inflammation of the respiratory tract;
- lesions of the peripheral nervous system;
- others that are life-threatening and require immediate treatment of the disease.
On average, this stage lasts no more than two years.
AIDS
The pre-mortem stage of the disease is also called terminal. Its maximum possible duration does not exceed 3 years.It makes no sense to describe the processes that occur during this stage of HIV infection. Due to the fact that their number is, to put it mildly, enormous. It would be redundant to mention them all. However, among the features of this stage, it is worth highlighting the following consequences that are characteristic of each carrier of the disease:
- the appearance of opportunistic infections;
- lesions of internal organs and corresponding systems in the body can no longer be treated, even with the most powerful drugs and any other types of therapy it is impossible to influence the spread of the disease and help the dying;
- HAART (highly active antiretroviral therapy) has no effect.
HIV infection develops in stages. The direct impact of viruses on the immune system leads to damage to various organs and systems, the development of tumor and autoimmune processes. Without highly active antiretroviral therapy, the life expectancy of patients does not exceed 10 years. The use of antiviral drugs can slow down the progression of HIV and the development of acquired immunodeficiency syndrome - AIDS.
Signs and symptoms of HIV in men and women at different stages of the disease have their own colors. They are varied and increase in severity of manifestation. The clinical classification of HIV infection proposed in 1989 by V.I. Pokrovsky, which provides for all manifestations and stages of HIV from the moment of infection to the death of the patient, has become widespread in the Russian Federation and the CIS countries.
Rice. 1. Pokrovsky Valentin Ivanovich, Russian epidemiologist, professor, doctor of medical sciences, president of the Russian Academy of Medical Sciences, director of the Central Research Institute of Epidemiology of Rospotrebnadzor.
Incubation period of HIV infection
The incubation period of HIV infection is determined by the period from the moment of infection to clinical manifestations and/or the appearance of antibodies in the blood serum. HIV can remain in an “inactive” state (state of inactive replication) from 2 weeks to 3-5 years or more, while the patient’s general condition does not noticeably worsen, but antibodies to HIV antigens are already appearing in the blood serum. This stage is called the latent phase or the “carrier” period. When immunodeficiency viruses enter the human body, they begin to reproduce themselves immediately. But clinical manifestations of the disease appear only when weakened immunity ceases to properly protect the patient’s body from infections.
It is impossible to say exactly how long it takes for HIV infection to appear. The duration of the incubation period is influenced by the route and nature of infection, the infectious dose, the age of the patient, his immune status and many other factors. When transfusion of infected blood occurs, the latent period is shorter than during sexual transmission.
The period from the moment of infection to the appearance of antibodies to HIV in the blood (seroconversion period, window period) ranges from 2 weeks to 1 year (up to 6 months in weakened people). During this period, the patient still does not have antibodies and, thinking that he is not infected with HIV, continues to infect others.
Examination of contact persons with HIV-infected patients allows diagnosing the disease at the “carrier” stage.
Rice. 2. Oral candidiasis and herpes rashes are indicators of a malfunction of the immune system and can be early manifestations of HIV infection.
Signs and symptoms of HIV in men and women in stage IIA (acute febrile)
After the incubation period, the stage of primary manifestations of HIV infection develops. It is caused by the direct interaction of the patient’s body with the immunodeficiency virus and is divided into:
- IIA - acute febrile stage of HIV.
- IIB - asymptomatic stage of HIV.
- IIB - stage of persistent generalized lymphadenopathy.
The duration of stage IIA (acute febrile) HIV in men and women ranges from 2 to 4 weeks (usually 7 to 10 days). It is associated with a massive release of HIV into the systemic bloodstream and the spread of viruses throughout the body. Changes in the patient’s body during this period are nonspecific and are so diverse and multiple that they create certain difficulties when a doctor diagnoses HIV infection during this period. Despite this, the acute febrile phase passes on its own even without specific treatment and passes into the next stage of HIV - asymptomatic. Primary infection in some patients is asymptomatic, while in other patients the most severe clinical picture of the disease quickly develops.
Mononucleosis-like syndrome in HIV
In 50 - 90% of cases of HIV patients in the early stages of the disease in men and women, mononucleosis-like syndrome (acute retroviral syndrome) develops. This condition develops as a result of the patient’s active immune response to HIV infection.
Mononucleosis-like syndrome occurs with fever, pharyngitis, rash, headaches, muscle and joint pain, diarrhea and lymphadenopathy, the spleen and liver are enlarged. Meningitis, encephalopathy and neuropathy develop less frequently.
In some cases, acute retroviral syndrome has manifestations of certain opportunistic infections that develop against the background of deep depression of cellular and humoral immunity. Cases of the development of oral candidiasis and candidal esophagitis, Pneumocystis pneumonia, cytomegalovirus colitis, tuberculosis and cerebral toxoplasmosis are recorded.
In men and women with mononucleosis-like syndrome, the progression of HIV infection and the transition to the AIDS stage occurs more quickly, and an unfavorable outcome is observed in the next 2 to 3 years.
In the blood there is a decrease in CD4 lymphocytes and platelets, an increase in the level of CD8 lymphocytes and transaminases. A high viral load is detected. The process is completed within 1 to 6 weeks even without treatment. In severe cases, patients are hospitalized.
Rice. 3. Feeling tired, malaise, headaches, muscle and joint pain, fever, diarrhea, severe night sweats are symptoms of HIV in the early stages.
Intoxication syndrome in HIV
In the acute febrile stage, 96% of patients have an increase in body temperature. Fever reaches 38 0 C and lasts 1 - 3 weeks and often. Half of all patients develop headaches, muscle and joint pain, fatigue, malaise, and severe night sweats.
Fever and malaise are the most common symptoms of HIV during the febrile period, and weight loss is the most specific.
Enlarged lymph nodes in HIV
74% of men and women have enlarged lymph nodes. For HIV infection in the febrile stage, a gradual increase in the posterior cervical and occipital, then submandibular, supraclavicular, axillary, ulnar and inguinal lymph nodes is especially characteristic. They have a dough-like consistency, reach 3 cm in diameter, are mobile, and not fused to the surrounding tissues. After 4 weeks, the lymph nodes return to normal size, but in some cases the process transforms into persistent generalized lymphadenopathy. Enlarged lymph nodes in the acute stage occur against the background of elevated body temperature, weakness, sweating, and fatigue.
Rice. 4. Enlarged lymph nodes are the first signs of HIV infection in men and women.
HIV rash
In 70% of cases, a rash appears in men and women in the early acute period of the disease. More often, an erythematous rash (areas of redness of varying sizes) and a maculopapular rash (areas of compaction) are recorded. Features of the rash in HIV infection: the rash is profuse, often purple in color, symmetrical, localized on the torso, its individual elements can also be located on the neck and face, does not peel off, does not bother the patient, is similar to rashes caused by measles, rubella, syphilis, etc. The rash disappears within 2 - 3 weeks.
Sometimes patients develop small hemorrhages in the skin or mucous membranes up to 3 cm in diameter (ecchymoses); with minor injuries, hematomas may appear.
In the acute stage of HIV, a vesiculopapular rash often appears, characteristic of herpes infection and.
Rice. 5. A rash with HIV infection on the body is the first sign of the disease.
Rice. 6. HIV rash on the torso and arms.
Neurological disorders in HIV
Neurological disorders in the acute stage of HIV are observed in 12% of cases. Lymphocytic meningitis, encephalopathy and myelopathy develop.
Rice. 7. A severe form of herpetic lesions of the mucous membrane of the lips, oral cavity and eyes is the first sign of HIV infection.
Gastrointestinal symptoms
During the acute period, every third man and woman develops diarrhea, in 27% of cases nausea and vomiting are noted, abdominal pain often appears, and body weight decreases.
Laboratory diagnosis of HIV in the acute febrile stage
Viral replication in the acute stage is most active, however, the number of CD4 + lymphocytes always remains more than 500 per 1 μl and only with a sharp suppression of the immune system does the indicator drop to the level of development of opportunistic infections.
The CD4/CD8 ratio is less than 1. The higher the viral load, the more infectious the patient is during this period.
Antibodies to HIV and the maximum concentration of viruses in the stage of primary manifestations are detected at the end of the acute febrile stage. In 96% of men and women they appear by the end of the third month from the moment of infection, in the remaining patients - after 6 months. The test for the detection of antibodies to HIV in the acute febrile stage is repeated after a few weeks, since it is the timely administration of antiretroviral therapy during this period that is most beneficial for the patient.
Antibodies to HIV p24 proteins are detected; antibodies produced by the patient’s body are detected using ELISA and immunoblotting. Viral load (detection of RNA viruses) is determined using PCR.
High levels of antibodies and low levels of viral load occur during asymptomatic HIV infection in the acute period and indicate control of the patient’s immune system over the level of viruses in the blood.
During the clinically pronounced period, the viral load is quite high, but with the appearance of specific antibodies it drops, and the symptoms of HIV infection weaken and then disappear completely even without treatment.
Rice. 8. Severe form of candidiasis (thrush) of the oral cavity in an HIV patient.
The older the patient is, the faster HIV infection progresses to the AIDS stage.
Signs and symptoms of HIV in men and women in stage IIB (asymptomatic)
At the end of the acute stage of HIV infection, a certain balance is established in the patient’s body, when the patient’s immune system restrains the reproduction of viruses for many months (usually 1 - 2 months) and even years (up to 5 - 10 years). On average, the asymptomatic stage of HIV lasts 6 months. During this period, the patient feels well and leads his usual lifestyle, but at the same time, he is a source of HIV (asymptomatic carrier of the virus). Highly active antiretroviral therapy prolongs this stage for many decades, during which the patient leads a normal life. In addition, the likelihood of infecting others is significantly reduced.
The number of lymphocytes in the blood is within normal limits. The results of ELISA and immunoblotting studies are positive.
Signs and symptoms of HIV in men and women in stage IIB (persistent generalized lymphadenopathy)
Generalized lymphadenopathy is the only sign of HIV infection during this period. Lymph nodes appear in 2 or more anatomically unrelated places (except for the groin areas), at least 1 cm in diameter, persisting for at least 3 months in the absence of a causative disease. The most commonly enlarged posterior cervical, cervical, supraclavicular, axillary and ulnar lymph nodes. Lymph nodes sometimes increase, sometimes decrease, but persist constantly, soft, painless, mobile. Generalized lymphadenopathy should be differentiated from bacterial infections (syphilis and brucellosis), viral (infectious mononucleosis and rubella), protozoal (toxoplasmosis), tumors (leukemia and lymphoma) and sarcoidosis.
The causes of skin damage during this period are seborrhea, psoriasis, ichthyosis, eosinophilic folliculitis, and widespread scabies.
Damage to the oral mucosa in the form of leukoplakia indicates the progression of HIV infection. Lesions of the skin and mucous membranes are recorded.
The level of CD4 lymphocytes gradually decreases, but remains more than 500 in 1 μl, the total number of lymphocytes is above 50% of the age norm.
During this period, patients feel satisfactory. Labor and sexual activity were preserved in both men and women. The disease is detected accidentally during a medical examination.
The duration of this stage ranges from 6 months to 5 years. At the end of it, the development of asthenic syndrome is noted, the liver and spleen enlarge, and body temperature rises. Patients are worried about frequent ARVI, otitis, pneumonia and bronchitis. Frequent diarrhea leads to weight loss, fungal, viral and bacterial infections develop.
Rice. 9. The photo shows signs of HIV infection in women: recurrent herpes of the skin of the face (photo on the left) and the mucous membranes of the lips in a girl (photo on the right).
Rice. 10. Symptoms of HIV infection - leukoplakia of the tongue. The disease may undergo cancerous degeneration.
Rice. 11. Seborrheic dermatitis (photo on the left) and eosinophilic folliculitis (photo on the right) are manifestations of skin lesions in stage 2 of HIV infection.
Stage of secondary diseases of HIV infection
Signs and symptoms of HIV infection in men and women in stage IIIA
Stage IIIA of HIV infection is a transition period from persistent generalized lymphadenopathy to the AIDS-associated complex, which is a clinical manifestation of HIV-induced secondary immunodeficiency.
Rice. 12. Shingles is most severe in adults with severe suppression of the immune system, which is observed, among other things, in AIDS.
Signs and symptoms of HIV infection in stage IIIB
This stage of HIV infection is characterized in men and women by severe symptoms of impaired cellular immunity, and the clinical manifestations are nothing more than the AIDS-associated complex, when the patient develops infections and tumors that are not found in the AIDS stage.
- During this period, there is a decrease in the CD4/CD8 ratio and the blast transformation reaction rate; the level of CD4 lymphocytes is recorded in the range from 200 to 500 per 1 μl. In a general blood test, leukopenia, anemia, and thrombocytopenia increase; an increase in circulating immune complexes is noted in the blood plasma.
- The clinical picture is characterized by prolonged (more than 1 month) fever, persistent diarrhea, profuse night sweats, severe symptoms of intoxication, and weight loss of more than 10%. Lymphadenopathy becomes generalized. Symptoms of damage to internal organs and the peripheral nervous system appear.
- Diseases such as viral (hepatitis C, common), fungal diseases (oral and vaginal candidiasis), persistent and long-lasting bacterial infections of the bronchi and lungs, protozoal lesions (without dissemination) of internal organs, in a localized form, are detected. Skin lesions are more widespread, severe and longer lasting.
Rice. 13. Bacillary angiomatosis in HIV patients. The causative agent of the disease is a bacterium of the genus Bartonella.
Rice. 14. Signs of HIV in men in the later stages: damage to the rectum and soft tissues (photo on the left), genital warts (photo on the right).
Signs and symptoms of HIV infection in stage IIIB (AIDS stage)
Stage IIIB of HIV infection represents a detailed picture of AIDS, characterized by profound suppression of the immune system and the development of opportunistic diseases that occur in severe form, threatening the patient’s life.
Rice. 15. A comprehensive picture of AIDS. The photo shows patients with neoplasms in the form of Kaposi's sarcoma (photo on the left) and lymphoma (photo on the right).
Rice. 16. Signs of HIV infection in women in the later stages of HIV. The photo shows invasive cervical cancer.
The more severe the symptoms of HIV in the early stages and the longer they appear in the patient, the faster AIDS develops. Some men and women experience a mild (asymptomatic) course of HIV infection, which is a good prognostic sign.
Terminal stage of HIV infection
The transition to the terminal stage of AIDS in men and women occurs when the level of CD4 lymphocytes decreases to 50 or below per 1 μl. During this period, an uncontrollable course of the disease is observed and an unfavorable outcome is expected in the near future. The patient is exhausted, depressed and loses faith in recovery.
The lower the level of CD4 lymphocytes, the more severe the manifestations of infections and the shorter the duration of the terminal stage of HIV infection.
Signs and symptoms of end-stage HIV infection
- The patient develops atypical mycobacteriosis, CMV (cytomegalovirus) retinitis, cryptococcal meningitis, widespread aspergillosis, disseminated histoplasmosis, coccidioidomycosis and bartonnellosis, and leukoencephalitis progresses.
- Symptoms of diseases overlap each other. The patient's body quickly becomes exhausted. Due to constant fever, severe symptoms of intoxication and cachexia, the patient is constantly in bed. Diarrhea and loss of appetite leads to weight loss. Dementia develops.
- Viremia increases, CD4 lymphocyte counts reach critically minimal values.
Rice. 17. Terminal stage of the disease. Complete loss of the patient's faith in recovery. In the photo on the left is a patient with AIDS with severe somatic pathology, in the photo on the right is a patient with a common form of Kaposi's sarcoma.
HIV prognosis
The duration of HIV infection is on average 10 - 15 years. The development of the disease is influenced by the level of viral load and the number of CD4 lymphocytes in the blood at the beginning of treatment, the availability of medical care, the patient’s adherence to treatment, etc.
Factors for the progression of HIV infection:
- It is believed that when the level of CD4 lymphocytes decreases to 7% during the first year of the disease, the risk of HIV infection progressing to the AIDS stage increases by 35 times.
- Rapid progression of the disease is observed with transfusion of infected blood.
- Development of drug resistance of antiviral drugs.
- The transition of HIV infection to the AIDS stage is reduced in mature and elderly people.
- The combination of HIV infection with other viral diseases has a negative effect on the duration of the disease.
- Poor nutrition.
- Genetic predisposition.
Factors that slow down the transition of HIV infection to the AIDS stage:
- Timely initiation of highly active antiretroviral therapy (HAART). In the absence of HAART, the patient's death occurs within 1 year from the date of diagnosis of AIDS. It is believed that in regions where HAART is available, the life expectancy of HIV-infected people reaches 20 years.
- No side effects from taking antiretroviral drugs.
- Adequate treatment of concomitant diseases.
- Adequate food.
- Rejection of bad habits.
After the immunodeficiency virus enters the human blood, the disease goes through several stages until the infection finally destroys the natural defenses and the body becomes defenseless against the attack of various diseases. HIV itself is not fatal, but what it does to the human body is dangerous.
Few patients survive to stage 4b, which occurs approximately fifteen years after contracting HIV infection. During this period, the patient develops infectious or oncological diseases that lead to death. The human body is no longer able to resist viruses. The majority of patients die from deterioration of nerve cells and brain diseases.
How much a person is given after infection depends on many factors; the disease does not always develop gradually. Passing one stage after another, it is possible to observe both the rapidly developing disease and the stages of its spontaneous remission and retreat. Determining the stages of development of immunodeficiency is based on determining the titer of HIV or the amount of antibodies to the virus, but in the last stages of the disease the method is less accurate.
The first stage of the development of the disease is direct infection with the virus and its active reproduction. In the second stage, HIV begins to gain a foothold in the blood, causing symptoms similar to those of a cold. The total duration of development is up to 24 months.
At the third stage, the body is still able to withstand the attacks of the virus (the lymph nodes are affected). The duration of the stage is determined by the individual resistance of the body and can last from 24 months to 20 years (it all depends on how quickly the virus deals with CD4 lymphocytes).
When the disease reaches the fourth stage, a person’s immunity is so destroyed that it can no longer stop the development of the virus - and loses the fight for life. The minimum level of CD4 cells, macrophages and other defense cells is determined in human blood. The human body gradually loses the battle to HIV and the virus completely occupies the body, provoking the development of neoplasms and severe infections.
It is at the fourth stage that the body becomes defenseless against infection, which a normal person can quickly and easily cope with.
These diseases are called opportunistic (from the Latin benefit, opportunity) infections or HIV-related diseases, that is, those that take advantage of the state of practical absence of immunity. For the development of one of these pathologies, the presence of HIV is necessary; some, combined with immunodeficiency, take on an unusually severe form.
Pre-AIDS according to the classification accepted in Russia, which was developed by V.I. Pokrovsky, has three stages of gradual development:
- 4A with determination of the level of CD4 lymphocytes up to 500 per cubic meter. mm;
- 4B with a gradual drop in CD4 level to 200 per cubic meter. mm;
- 4B, characterized by a drop in CD4 count to less than 200 per cubic meter. mm.
If in phase 4A concomitant infections are treatable, but require a longer time, then in stage 4B they are practically incurable. The stage is determined based on symptoms of concomitant diseases and an analytical study of the number of CD4 cells in the blood.
In some cases, remission of pre-AIDS is observed, but it is not possible to determine whether the cause is a spontaneous process or highly active antiretroviral therapy.
Stage 4 Pre-AIDS
Stage 4 Pre-AIDS shows a critically low level of body defense and the maximum load of HIV on the immune system. A person practically loses the ability to resist the disease, but the use of HAART and treatment of concomitant diseases in many cases makes it possible to stop the development of pathology.
The onset of stage 4B indicates that the virus has found a way to cope with the drugs that block it, and the transition to the next phase becomes faster. Changing the medicine used allows you to stop the development of the virus and bypass its protection.
HIV infection can stop, and stage 4B will not occur. The stopped development of the virus shows that a balance has been achieved between the state of the body and the course of the pathogen. This “falling asleep” of the virus also occurs at stage 4B - this means that with sufficient medical support, the patient can live indefinitely.
Symptoms
Many people experience chest pain, severe coughing, accompanied by bloody sputum.
Signs:
- Pain in the head area;
- Severe dizziness;
- Nausea that occurs immediately after eating;
- Increased sweating;
- Anxiety and suspiciousness;
- Sleep problems.
The patient's skin condition also worsens. Quite often, a person develops ulcers on the palms and in the armpits. The wounds bleed and pus accumulates in them. This phenomenon is temporary, the ulcers usually disappear after the initiation of appropriate therapy. The patient may have a sharp rise in body temperature and develop bronchitis or flu. The danger of the situation is that influenza, which develops at stage 4B of HIV infection, can be fatal.
A patient suffering from HIV infection often experiences anemia. With this disease, the level of hemoglobin in the blood decreases and the risk of heart failure increases. The patient complains of loss of appetite and weight loss.
Regular consumption of alcoholic beverages, smoking and drug addiction doubles the aggressiveness of the human immunodeficiency virus. At this stage, additional infection of a person with sexually transmitted diseases, hepatitis C, which accelerates the destruction of the body and the patient’s refusal of a rational way of life: an established daily routine, diet, feasible physical activity, has an extremely negative impact.
Late treatment, non-compliance with doctor’s prescriptions, or refusal to treat HIV and related infections accelerates the transition of the disease to the terminal stage. At this stage of the disease, patients are extremely exhausted, they have no appetite, there is constant fatigue, and patients spend almost all their time in bed.
The accompanying pathology in this phase of the lesion is Pneumocystis pneumonia (characteristic only for this stage of HIV and is considered one of its symptoms). The patient suffers from the herpes virus, which causes permanent ulcers and lesions on the mucous membranes.
The intestines experience attacks from protozoan microorganisms (protozoa), diseases from which are considered characteristics of the onset of stage 4B.
Often there is total damage by the tuberculosis bacillus to the bones, membranes of the brain, intestines, and skin of the human body; characterized by infection with mycobacteria (protozoa, similar to the tuberculosis bacillus), which attack the skin, digestive system, lungs, and central nervous system. Mycobacteria normally very rarely infect humans, although the causative agent of leprosy belongs to this group.
Cryptococcal meningitis, which is typical for HIV-infected people, also does not occur in healthy people (the causative agent is the yeast fungus cryptococcus, which lives in the soil). Characteristic of the last stage of HIV are a variety of malignant neoplasms that occur anywhere in the body, as well as heart and kidney failure.
Characteristic of stage 4B of HIV is damage to the central nervous system, classified as HIV (AIDS) dementia. It manifests itself in a decrease in intellectual abilities, memory and personality disorders, and coordination problems.
Accompanying disorders are depression and anxiety, psychosis, insomnia, and leaving home. The patient is constantly in a state of deep depression caused by the presence of a complex of diseases and suffering.
Against the background of emotional depression, pathologies of the central nervous system and heart rapidly develop. At this stage of HIV, patients refuse the help of a psychologist, although professional consultations and the patient’s desire to fight for life often significantly improve the condition.
Pregnancy at stage 4B
Pregnancy does not accelerate the development of immunodeficiency, but you should not have a child at stage 4B of HIV infection. The probability of infection of the baby in the womb is quite high. In addition, the virus may develop resistance to drugs.
During pregnancy, a woman’s body is especially vulnerable; her immune system is aimed, first of all, at protecting the unborn child from contracting HIV infection. At the initial stage, the patient can become a mother only if there are no other contraindications to bearing a baby.
Pre-AIDS therapy
Medicine does not know a medicine that could completely stop the infection of the human immunodeficiency virus, but modern methods of treating HIV make it possible to block the replication process of the pathogen and prolong the life of patients. The effectiveness of the drugs is very high - if you follow the doctor’s prescriptions and take the medicine correctly, the process of growth of CD4 leukocytes and massive suppression of HIV is possible.
Treatment is aimed at suppressing HIV and preventing the development of concomitant infections, long-term preservation of the patient’s acceptable condition, psychological and emotional supervision and support for patients.
The doctor, using HAART and symptomatic treatment, tries to ensure that the stage of secondary diseases does not progress to AIDS. At stage 4B, the last stage of HIV, HAART is always prescribed.
HAART is carried out:
- HIV transcriptase inhibitors (nucleoside) Didanosine, Lamivudine, Abacovir, Stavudine;
- Non-nucleoside inhibitors Nevirapine, Delavirdine;
- Inhibitor of viral fragments Saquinavir, Indinavir, Ritonavir.
The drugs are prescribed to the patient in combination, periodically changing combinations.
If a patient has HIV dementia, therapy with Zidovudine and Didanosine is prescribed simultaneously, a course of treatment of at least 4 months. When mental disorders manifest themselves, appropriate drug treatment is used.
HIV-related infections are treated with symptomatic therapy: antibiotics, antiviral and antimycotic agents. Complex treatment includes general health-improving medications (vitamins and supplements), and physiotherapy is used whenever possible.
Is the forecast optimistic?
The prognosis for AIDS is not very optimistic. The average life expectancy of a patient is 1-3 years.
The rate of transition of HIV infection to the stage of acquired immunodeficiency syndrome is influenced by the following factors:
- State of human health;
- Bad habits. The body of people who regularly consume alcoholic beverages and psychotropic substances is noticeably weakened. In this case, the likelihood of developing AIDS increases significantly;
- Infection with various infectious diseases. Diseases transmitted through intimate intimacy place additional stress on the body;
- Lifestyle of an HIV-positive person. If you refuse a strict diet, heavy physical work, or failure to comply with basic hygiene standards, the risk of adverse consequences of HIV infection increases;
- Compliance with medical orders. If antiviral therapy is not started in a timely manner, the patient's life expectancy is significantly reduced.
Modern medications can stop the development of the disease at stage 4B. Therefore, there is no need to despair and give up!
I want to know how AIDS is divided into stages of the disease, I’m interested in 4, and in general how long do people live with AIDS and I got the best answer
Answer from White lily[guru]
According to the classification proposed by V.I. Pokrovsky in 2001, HIV infection in the body goes through 5 stages:
Incubation stage (stage 1): from the moment of infection until clinical manifestations of acute infection and/or antibody production (on average from 3 weeks to 3 months).
Stage of primary manifestations (stage 2):
2 "A" - asymptomatic, when there are no clinical manifestations of HIV infection or opportunistic diseases, and the response to the introduction of HIV is the production of antibodies.
2 "B" - acute HIV infection without secondary diseases (various clinical manifestations, most of them similar to the symptoms of other infections).
2 "B" - acute HIV infection with secondary diseases (against the background of a temporary decrease in CD4 lymphocytes, secondary diseases develop - tonsillitis, bacterial pneumonia, candidiasis, herpes - as a rule, they are treatable). The duration of clinical manifestations of acute HIV infection is usually 2 - 3 weeks.
Latent stage (stage 3): Slow progression of immunodeficiency. The only clinical manifestation is enlarged lymph nodes, which may be absent. The duration of the latent stage is from 2 - 3 to 20 or more years, on average 6 - 7 years. There is a gradual decrease in the level of CD4 lymphocytes.
Stage of secondary diseases (stage 4): HIV replication continues, leading to the death of CD4 lymphocytes and the development of secondary (opportunistic) diseases, infectious and/or oncological, against the background of immunodeficiency. Symptoms at this stage are reversible, that is, they can go away on their own or as a result of treatment. Depending on the severity of secondary diseases, the following stages are distinguished.
4 "A" - it is characterized by bacterial, fungal and viral lesions of the mucous membranes and skin, inflammatory diseases of the upper respiratory tract.
4 "B" - more severe and long-lasting skin lesions, Kaposi's sarcoma, weight loss, damage to the peripheral nervous system and internal organs.
4 "B" - severe, life-threatening opportunistic diseases.
Terminal stage (stage 5): Damage to organs and systems is irreversible. Even adequately administered antiviral therapy and treatment of opportunistic diseases are not effective, and the patient dies within a few months.
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In 2001, under the leadership of Academician of the Russian Academy of Medical Sciences V.I. Pokrovsky, a new edition of the domestic clinical classification of HIV infection was implemented.Clinical classification of HIV infection:Stage 1– “incubation stage” – the period from the moment of infection until the appearance of the body’s reaction in the form of clinical manifestations of acute infection and/or the production of antibodies. Its duration usually ranges from 3 weeks to 3 months, but in isolated cases it can last up to a year. During this period, HIV actively multiplies, but there are no clinical manifestations of the disease and antibodies to HIV have not yet been detected. Consequently, the diagnosis of HIV infection at this stage cannot be established using traditional laboratory methods. It can only be suspected on the basis of epidemiological data and confirmed during laboratory testing by the detection of human immunodeficiency virus, its antigens, and nucleic acids in the patient’s serum.
Stage 2– “stage of primary manifestations”, is associated with the manifestation of the body’s primary response to the introduction and replication of HIV in the form of clinical manifestations and/or the production of antibodies. The stage of primary manifestations of HIV infection can have several course options:
2A – “asymptomatic”, characterized by the absence of any clinical manifestations of HIV infection. The body's response to the introduction of HIV is manifested only by the production of antibodies.
2B – “acute infection without secondary diseases”, manifested by a variety of clinical symptoms. The most commonly recorded symptoms are fever, rashes on the skin and mucous membranes (urticarial, papular, petechial), enlarged lymph nodes, and pharyngitis. An enlarged liver, spleen, and diarrhea may occur.
Sometimes aseptic meningitis develops, manifested by meningeal syndrome. In this case, lumbar puncture usually results in unchanged cerebrospinal fluid flowing out under increased pressure, and occasionally there is slight lymphocytosis in it. Similar clinical symptoms can be observed in many infectious diseases, especially in so-called childhood infections.
Sometimes this variant of the course is called mononucleosis-like or rubella-like syndrome. In the blood of patients during this period, wide-plasma lymphocytes - mononuclear cells - can be detected, which further enhances the similarity of this variant of the course of HIV infection with infectious mononucleosis.
Vivid mononucleosis-like or rubella-like symptoms are observed in 15-30% of patients. The rest have 1-2 of the above symptoms in any combination. Some patients may experience lesions of an autoimmune nature. With this course of the stage of primary manifestations, a transient decrease in the level of CD4 lymphocytes is often observed.
2B – “acute infection with secondary diseases”, characterized by a significant decrease in the level of CD4 lymphocytes. As a result, against the background of immunodeficiency, secondary diseases of various etiologies appear (candidiasis, herpetic infection, etc.). Their manifestations, as a rule, are mild, short-term, respond well to therapy, but can be severe (candidal esophagitis, Pneumocystis pneumonia) and in rare cases, even death is possible.
In general, the stage of primary manifestations, which occurs in the form of acute infection (2B and 2C), is recorded in 50-90% of patients with HIV infection. The onset of the stage of primary manifestations, which occurs in the form of an acute infection, is usually noted in the first 3 months after infection. It can precede seroconversion, that is, the appearance of antibodies to HIV. Therefore, at the first clinical symptoms, antibodies to HIV proteins and glycoproteins may not be detected in the patient’s serum.
The duration of clinical manifestations in the second stage can vary from several days to several months, but they are usually recorded within 2-3 weeks. Clinical symptoms of the stage of primary manifestations of HIV infection can recur.
In general, the duration of the stage of primary manifestations of HIV infection is one year from the onset of symptoms of acute infection or seroconversion. In prognostic terms, the asymptomatic course of the stage of primary manifestations of HIV infection is more favorable. The more severe and longer (more than 14 days) this stage proceeded, the greater the likelihood of rapid progression of HIV infection.
The stage of primary manifestations of HIV infection in the vast majority of patients becomes subclinical, but in some patients it can immediately pass into the stage of secondary diseases.
Stage 3– “subclinical stage” is characterized by a slow increase in immunodeficiency, which is associated with compensation of the immune response due to modification and excessive reproduction of CD4 cells. The rate of HIV reproduction during this period, compared to the stage of primary manifestations, slows down.
The main clinical manifestation of the subclinical stage is persistent generalized lymphadenopathy (PGL). It is characterized by an enlargement of at least two lymph nodes, in at least two unrelated groups (not counting the inguinal ones), in adults to a size in diameter of more than 1 cm, in children - more than 0.5 cm, persisting for at least 3 years. -x months. Upon examination, usually the lymph nodes are elastic, painless, not fused with the surrounding tissue, and the skin over them is not changed.
Enlarged lymph nodes at this stage may not meet the criteria for PGL or may not be registered at all. On the other hand, such changes in the lymph nodes can be observed in later stages of HIV infection; in some cases, they occur throughout the entire disease, but in the subclinical stage, enlarged lymph nodes are the only clinical manifestation.
The duration of the subclinical stage ranges from 2-3 to 20 or more years, but on average it lasts 6-7 years. The rate of decrease in the level of CD4 lymphocytes during this period averages 0.05-0.07x10 9 /l per year.
Stage 4– “stage of secondary diseases”, is associated with depletion of the CD4 cell population due to ongoing HIV replication. As a result, against the background of significant immunodeficiency, infectious and/or oncological secondary diseases develop. Their presence determines the clinical picture of the stage of secondary diseases.
Depending on the severity of secondary diseases, stages 4A, 4B, 4B are distinguished:
4A usually develops 6-10 years after infection. It is characterized by bacterial, fungal and viral lesions of the mucous membranes and skin, and inflammatory diseases of the upper respiratory tract. Typically, stage 4A develops in patients with a CD4 lymphocyte count of 0.5-0.35x10 9 /L (in healthy individuals, the CD4 lymphocyte count ranges from 0.6-1.9x10 9 /L).
4B most often occurs 7-10 years after infection. Skin lesions during this period are deeper in nature and tend to be protracted. Damage to internal organs begins to develop. Weight loss, fever, localized Kaposi's sarcoma, and damage to the peripheral nervous system may occur. Typically, stage 4B develops in patients with a CD4 lymphocyte count of 0.35-0.2x10 9 /L.
4B is predominantly detected 10-12 years after infection. It is characterized by the development of severe, life-threatening secondary diseases, their generalized nature, and damage to the central nervous system. Typically, stage 4B occurs when the CD4 count is less than 0.2x10 9 /L. Despite the fact that the transition of HIV infection to the stage of secondary diseases is a manifestation of the depletion of the protective reserves of the body of an infected person, this process is reversible (at least for some time). Spontaneously or as a result of therapy, the clinical manifestations of secondary diseases may disappear. Therefore, in the stage of secondary diseases, phases of progression (in the absence of antiretroviral therapy or against the background of antiretroviral therapy) and remission (spontaneous, after previously conducted antiretroviral therapy or against the background of antiretroviral therapy) are distinguished.
Stage 5– “terminal stage”, manifested by the irreversible course of secondary diseases. Even adequately administered antiretroviral therapy and treatment of secondary diseases are ineffective. As a result, the patient dies within a few months. At this stage, the CD4 cell count is usually below 0.05x10 9 /L.
It should be noted that the clinical course of HIV infection is highly variable. The given data on the duration of individual stages of the disease are averaged and may have significant fluctuations. The sequence of progression of HIV infection through all stages of the disease is not required. For example, the latent stage can, when a patient develops Pneumocystis pneumonia, go directly to stage 4B, bypassing stages 4A and 4B. There are cases when the latent stage directly passed into the terminal stage.
The duration of HIV infection varies widely. The average duration of the disease from the moment of HIV infection to the development of the final stage of HIV infection (AIDS itself) ranges from 5-8 to 10-12 years, although some patients live 15 years or more.
The fastest progression of the disease from the moment of infection to death is described, which was 28 weeks.
The duration of the disease depends on the type of virus and the individual characteristics of the human body (the body’s susceptibility to the virus, the presence of concomitant diseases, habitual intoxications, etc.). Thus, when infected with HIV type 2, the disease progresses somewhat more slowly. The older you are when you become infected with HIV, the faster the disease usually progresses.
Intravenous administration of psychoactive substances is often accompanied by the development of severe bacterial infections (abscesses, cellulitis, pneumonia, endocarditis, sepsis, tuberculosis, etc.), which can also occur with normal CD4 lymphocyte counts. At the same time, the presence of these lesions contributes to a more rapid progression of HIV infection.
The use of modern antiretroviral therapy regimens can significantly increase the duration and improve the quality of life of patients with HIV infection.
Belyaeva Valentina Vladimirovna,
Pokrovsky Vadim Valentinovich,
Professor, Academician of the Russian Academy of Medical Sciences, Head of the Russian Federal Scientific and Methodological Center for the Prevention and Control of AIDS
Kravchenko Alexey Viktorovich,
Doctor of Medical Sciences, leading researcher at the Russian Federal Scientific and Methodological Center for the Prevention and Control of AIDS
