HIV/AIDS Stages and Common Opportunistic Infections

Having recurrent pneumocystis pneumonia in the past 9 months has triggered me to research more and talk about the HIV stages and most common infection that I might be at risk for. This has helped me seek medical help early enough when the symptoms started. The symptoms of HIV vary depending on the stage of the infection. In people who begin HIV treatment soon after diagnosis and take treatment consistently every day, HIV is unlikely to progress or become symptomatic. People who do not take HIV treatment will eventually experience disease progression and worsening symptoms. This is because HIV infection attacks the body’s immune system, making it ineffective.

Learning the stages of HIV infection can help you understand what to expect and learn how to take care of yourself.

What Are Early Signs of HIV Infection?
Some people don’t notice any symptoms in the weeks or months after being infected with HIV. Others notice swollen lymph nodes or a period of flu-like symptoms during the first stage of HIV.

Stage 1: Acute HIV Infection
Also known as the primary or acute phase of HIV, the acute (severe) stage begins within two to four weeks immediately after infection. Soon after a person is infected, their body shows a normal immune response to the virus. As the immune system tries to fight HIV, it produces HIV antibodies . During the acute phase, the virus rapidly makes a copy of itself, and people are highly contagious.

Some people don’t notice symptoms of HIV during the acute phase. Others experience flu-like symptoms such as swollen lymph nodes, headache, sore throat, fever, rash, muscle and joint aches, upset stomach, and sores in the mouth. These symptoms may start between two and eight weeks after infection and may last for a week or two.

Stage 2: Chronic or Latent HIV Infection
The chronic (ongoing) phase of HIV is also referred to as the clinical latent or asymptomatic stage. It lasts for approximately 10 to 15 years in most people who don’t take HIV treatment. In some people, the chronic period is much shorter, and HIV progresses more quickly to the next stage.

In people who consistently take HIV medicines (antiretroviral therapy) every day, the chronic stage can be prolonged by many decades, or even forever. These medications work to reduce a person’s viral load, or how many HIV particles are in the body. Maintaining a low viral load helps prevent disease progression and lower the risk of transmitting the virus to sexual partners.

Some people notice persistently swollen lymph nodes or may experience fatigue, loose stools or diarrhea, weight loss, shingles infections, or bouts of pneumonia during chronic HIV infection.

If a person has a tuberculosis germ in their body, it may become active. If a person has human papillomavirus (HPV) or herpes simplex infection in their body, they may experience outbreaks of these diseases.

Some people may notice white marks in their mouth called oral candidiasis, or thrush. HIV continues to reproduce in the body, and it is possible to infect others. In those who are taking HIV treatment, it may be difficult to separate HIV symptoms from the side effects of medication.

Stage 3: AIDS
At the end of the chronic stage, levels of HIV within the body begin to rise dramatically, and numbers of specific white blood cells, known as CD4 T cells, drop as the virus destroys them. AIDS is diagnosed when CD4 cell counts drop below 200 cells per cubic millimetre or when certain infections or types of cancer develop. People with AIDS who do not receive treatment often die within approximately three years, although this number varies.

Symptoms of AIDS may occur on their own or may be related to other underlying health issues associated with AIDS. These include:
- Extreme fatigue
- Rapid weight loss
- Night sweats or recurrent fevers
- Prolonged diarrhea (lasts more than one week)
- Pneumonia
- Swelling of the lymph nodes in the neck, armpits, or groin
- Discolored spots on the skin, eyelids, nose, and mouth
- Depression, memory loss, or other cognitive issues
- Opportunistic Infections

During this final stage of HIV, a person’s immune system has become ineffective. This leaves the body unprotected against every sort of infection. People with AIDS can become seriously ill or even die from bacteria, viruses, or fungi that would be not typically infect people who are not living with HIV. This type of infection is known as an opportunistic infection.

Types of Opportunistic Infections are as followed:

Pneumocystis Pneumonia (PCP, also called PJP) is believed to be caused by a common fungus. In people with AIDS, PCP causes fever, chest pain, trouble breathing, and fatigue. There are other varieties of pneumonia common in people with AIDS but unusual in healthy people.

Cytomegalovirus (CMV), a virus related to herpes, infects most people but does not cause illness except in those with compromised immune systems. In people with AIDS, CMV can infect the eyes — causing blindness — or attack the lungs, heart, brain, or gastrointestinal system.

Mycobacterium Avium Complex is a group of common bacteria that causes abdominal pain, fever, night sweats, weight loss, anemia, and fatigue in those with AIDS.

Tuberculosis (TB) is a leading cause of death in people with AIDS. TB most commonly affects the lungs, causing chest pain, coughing up sputum or blood, weight loss, fever, and fatigue. People living with HIV are at higher risk for TB to involve other parts of the body as well.

Candidiasis, also known as a yeast infection or thrush, is most commonly caused by the fungus Candida albicans. Although minor yeast infections can be a nuisance even in healthy people, candidiasis can affect immunocompromised people more severely, such as those with AIDS. Candidiasis can cause:

Difficulty swallowing
A bad taste in the mouth (can be metallic)
White patches on the inner cheeks and tongue, known as thrush
Cracks and sores in the corners of the mouth
Burning, itching, and thick white discharge from the vagina
Chest pain when it affects the esophagus
Pneumonia in the lungs
Toxoplasmosis
Toxoplasmosis is an infection by the microorganism Toxoplasma gondii, which can be found in cat or bird feces and undercooked meat. Toxoplasmosis is harmless in healthy people, but in people with AIDS, the infection can cause symptoms including headache, fever, confusion, seizures, and coma.

AIDS-Related Cancers are typical in people with AIDS because their compromised immune systems enable cancer to develop and grow quickly.

Kaposi Sarcoma, a type of cancer that is related to a common herpes virus, Kaposi Sarcoma causes darkened purple or brown spots on the skin. If Kaposi Sarcoma spreads to the lungs or intestines, the lesions can be quite painful and cause severe swelling and may cause death.

Non-Hodgkin Lymphoma (NHL) can develop in people with or without HIV, but certain types of NHL are more common in people who are HIV positive. Primary central nervous system (CNS) lymphoma begins in the brain or spinal cord. Symptoms of CNS lymphoma include confusion, memory problems, seizures, and paralysis of the facial muscles.

Invasive Cervical Cancer and Anal Cancer. Cervical cancer is caused by the human papillomavirus. Women with HIV are more likely to develop abnormal cervical cells that can lead to cancer and have a higher risk of those abnormal cells progressing to invasive cervical cancer. Treatments for invasive cervical cancer do not work as well in women with HIV as they do in women who are HIV negative. Symptoms of cervical cancer include abnormal vaginal bleeding, pelvic pain, unusual discharge, and painful urination.

To read more about opportunistic infections, read our blog post.