View source for Signs and symptoms of HIV/AIDS

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[[File:Early Symptoms of HIV Diagram.png|thumb|Figure 1. Early Symptoms of HIV]]
The stages of HIV infection are [[Acute (medicine)|acute infection]] (also known as primary infection), latency, and [[HIV/AIDS|AIDS]]. Acute infection lasts for several weeks and may include symptoms such as [[fever]], [[lymphadenopathy|swollen lymph node]]s, [[pharyngitis|inflammation of the throat]], [[rash]], [[myalgia|muscle pain]], [[malaise]], and mouth and esophageal sores. The latency stage involves few or no symptoms and can last anywhere from two weeks to twenty years or more, depending on the individual. AIDS, the final stage of HIV infection, is defined by low CD4+ T cell counts (fewer than 200 per [[Litre|μL]]), various [[opportunistic infection]]s, cancers, and other conditions.

==Acute infection==
[[File:Symptoms of acute HIV infection.png|thumb|Main symptoms of acute HIV infection]]

Acute HIV infection, primary HIV infection or acute [[seroconversion]] syndrome<ref name="Andrews">{{cite book |author=James, William D. |title=Andrews' Diseases of the Skin: clinical Dermatology|publisher=Saunders Elsevier |year=2006 |isbn=978-0-7216-2921-6 |last2=Berger|first2=Timothy G. }}</ref>{{rp|416}} is the first stage of [[HIV]] infection. It occurs after the incubation stage, before the latency stage, and the potential [[AIDS]] succeeding the latency stage.

During this period (usually days to weeks post-exposure) fifty to ninety percent of infected individuals develop an influenza or [[mononucleosis]]-like illness called acute HIV infection (or HIV prodrome),<ref>{{cite journal|date=1 August 1999|title=How to Recognize and Treat Acute HIV Syndrome|journal=American Family Physician|volume=60|issue=2|pages=535–542|quote=It is now known that 50 to 90 percent of patients acutely infected with HIV experience at least some symptoms of the acute retroviral syndrome.|url=http://www.aafp.org/afp/1999/0801/p535.html|access-date=30 August 2016|language=en|author=BARBARA LEE PERLMUTTER, M.D., PH.D., JORDAN B. GLASER, M.D., and SAMWEL O. OYUGI, M.D.|pmid=10465228}}</ref><ref name="Hightow-Weidman2009">{{cite journal|author=Lisa B. Hightow-Weidman |author2=Carol E. Golin |author3=Kelly Green |author4=Eva N. P. Shaw |author5=Pia D. M. MacDonald |author6=Peter A. Leone |year=2009|title=Identifying People with Acute HIV Infection: Demographic Features, Risk Factors, and Use of Health Care among Individuals with AHI in North Carolina|journal=AIDS and Behavior|volume=13|issue=6|pages=1075–1083|issn=1090-7165|doi=10.1007/s10461-008-9519-5|pmid=19127422|quote=Seventy-five percent experienced symptoms consistent with acute retroviral syndrome; although 83% sought medical care for these symptoms, only 15% were appropriately diagnosed at that initial medical visit, suggesting opportunities to diagnose these individuals earlier were missed.|language=en|pmc=2787774}}</ref> the most common symptoms of which may include [[fever]], [[lymphadenopathy]], [[pharyngitis]], [[rash]], [[myalgia]], [[malaise]], mouth and esophageal sores, and may also include, but less commonly, [[headache]], [[nausea]] and [[vomiting]], fatigue, ulcers in the mouth or on the genitals, enlarged liver/spleen, [[weight loss]], [[Candidiasis|thrush]], night sweats and diarrhea and neurological symptoms. Infected individuals may experience all, some, or none of these symptoms.<ref>{{Cite web|url = https://easystd.com/hiv-aids#what-are-the-signs-and-symptoms-of-hiv-aids-in-men-and-women|title = Early signs of HIV in men & women}}</ref> The duration of symptoms varies, averaging 28 days and usually lasting at least a week.<ref name=Kahn>{{cite journal|author1=Kahn, J. O.  |author2=Walker, B. D. | title=Acute Human Immunodeficiency Virus type 1 infection |journal=N. Engl. J. Med. | year=1998 | pages=33–39 | volume= 339| issue=1 | pmid=9647878|doi=10.1056/NEJM199807023390107}}</ref>

Because of the nonspecific nature of these symptoms, they are often not recognized as signs of HIV infection. Even if patients go to their doctors or a hospital, they will often be misdiagnosed as having one of the more common [[infectious disease]]s with the same symptoms. As a consequence, these primary symptoms are not used to diagnose HIV infection, as they do not develop in all cases and because many are caused by other more common diseases. However, recognizing the syndrome can be important because the patient is much more infectious during this period.<ref name="pmid11187417">{{cite journal  |vauthors=Daar ES, Little S, Pitt J, etal |title=Diagnosis of primary HIV-1 infection. Los Angeles County Primary HIV Infection Recruitment Network |journal=Annals of Internal Medicine |volume=134 |issue=1 |pages=25–9 |year=2001 |pmid=11187417 |doi=10.7326/0003-4819-134-1-200101020-00010|s2cid=34714025 }}</ref>

{| class="wikitable sortable"
|+ 
|-
! scope="col" style="width:10%;"| Symptoms and signs of primary HIV infections<ref name="pmid11187417"/>
! scope="col" style="width:10%;"| [[sensitivity (tests)|Sensitivity]]{{efn|name=sensitivity}}
! scope="col" style="width:10%;"| [[specificity (tests)|Specificity]]{{efn|name=specificity}}
|-
| Fever
| 88%
| 50%
|-
| Malaise
| 73%
| 42%
|-
| [[Myalgia|Muscle pain]]
| 60%
| 74%
|-
| Rash
| 58%
| 79%
|-
| Headache
| 55%
| 56%
|-
| Night sweats
| 50%
| 68%
|-
| Sore throat
| 43%
| 51%
|-
| Lymphadenopathy
| 38%
| 71%
|-
| [[Arthralgia|Joint pain]]
| 28%
| 87%
|-
| Nasal congestion
| 18%
| 62%
|}

Some of those symptoms (nasal congestion, sore throat) have a sensitivity that is less than <math>1 - \text{specificity}</math> (meaning that they are more likely without HIV than with it), and are therefore slight evidence against rather than for HIV, per [[Bayes' theorem]].

==Latency==
A strong immune defense reduces the number of viral particles in the bloodstream, marking the start of secondary or chronic HIV infection. The secondary stage of HIV infection can vary between two weeks and 10 years. During the secondary phase of infection, HIV is active within [[Lymphatic system|lymph nodes]], which typically become persistently swollen, in response to large amounts of virus that become trapped in the [[follicular dendritic cells]] (FDC) network.<ref name=burton>{{cite journal|vauthors=Burton GF, Keele BF, Estes JD, Thacker TC, Gartner S | title=Follicular dendritic cell contributions to HIV pathogenesis | journal=Semin. Immunol. | year=2002 | pages=275–284 | volume=14 | issue=4 |pmid=12163303| doi=10.1016/S1044-5323(02)00060-X| citeseerx=10.1.1.364.8696 }}</ref> The surrounding tissues that are rich in CD4<SUP>+</SUP> T cells may also become infected, and viral particles accumulate both in infected cells and as free virus. Individuals who are in this phase are still infectious. During this time, [[Helper T cell|CD4<SUP>+</SUP> CD45RO<SUP>+</SUP> T cells]] carry most of the proviral load.<ref name=clapham>{{cite journal|vauthors=Clapham PR, McKnight A | title=HIV-1 receptors and cell tropism | journal=Br. Med. Bull. |year=2001 |pages=43–59 | volume=58 | issue=4 | pmid=11714623 | doi=10.1093/bmb/58.1.43| doi-access=free }}</ref>
A small percentage of HIV-1 infected individuals retain high levels of CD4+ T-cells without antiretroviral therapy. However, most have detectable viral loads and will eventually progress to AIDS without treatment. These individuals are classified as HIV controllers or [[long-term nonprogressors]] (LTNP). People who maintain CD4+ T cell counts and also have low or clinically undetectable viral load without antiretroviral treatment are known as elite controllers or elite suppressors (ES).<ref name=Grabar>{{cite journal |author=Grabar, S., Selinger-Leneman, H., Abgrall, S., Pialoux, G., Weiss, L., Costagliola, D. |title=Prevalence and comparative characteristics of long-term nonprogressors and HIV controller patients in the French Hospital Database on HIV |journal=AIDS | year=2009 | pages=1163–1169 |volume=23 | issue=9 |pmid=19444075 |doi=10.1097/QAD.0b013e32832b44c8|s2cid=27256348 |url=https://zenodo.org/record/895972 |doi-access=free }}</ref><ref>{{Cite journal | last1 = Blankson | first1 = J. N. | title = Control of HIV-1 replication in elite suppressors | journal = Discovery Medicine | volume = 9 | issue = 46 | pages = 261–266 | year = 2010 | pmid = 20350494}}</ref>

==AIDS==
[[File:Symptoms of AIDS.svg|thumb|250px|Main symptoms of AIDS]]
[[File:PCPxray.jpg|thumb|X-ray of [[pneumocystis pneumonia (PCP)]]. There is increased white (opacity) in the lower lungs on both sides, characteristic of PCP.]]
The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy [[immune system]]s. Most of these conditions are [[opportunistic infections]] caused by bacteria, viruses, [[fungus|fungi]], and [[parasitism|parasite]]s that are normally controlled by the elements of the immune system that HIV damages.<ref name=Holmes>{{Cite journal|vauthors=Holmes CB, Losina E, Walensky RP, Yazdanpanah Y, Freedberg KA |title= Review of human immunodeficiency virus type 1-related opportunistic infections in sub-Saharan Africa|journal=Clin. Infect. Dis.|year=2003|pages=656–662|volume=36|issue=5|pmid=12594648|doi=10.1086/367655|doi-access=free}}</ref> These infections affect nearly every [[biological system|organ system]].{{cn|date=January 2021}}

A declining [[CD4+/CD8+ ratio]] is predictive of the progression of HIV to AIDS.<ref name="pmid28182620">{{cite journal | vauthors=Bruno G, Saracino A, Monno L, Angarano G | title=The Revival of an "Old" Marker: CD4/CD8 Ratio | journal= AIDS Reviews | volume=19 | issue=2 | pages=81–88 | year=2017 | url=https://www.researchgate.net/publication/313553795  | pmid=28182620}}</ref>

People with AIDS also have an increased risk of developing various cancers such as [[Kaposi's sarcoma]], [[cervical cancer]], and cancers of the immune system known as [[lymphoma]]s. Additionally, people with AIDS often have systemic symptoms of infection like fevers, [[Night sweats|sweats]] (particularly at night), swollen glands, chills, weakness, and [[weight loss]].<ref name=Guss>{{Cite journal|author=Guss DA|title=The acquired immune deficiency syndrome: an overview for the emergency physician, Part 1|journal=J. Emerg. Med.|year=1994|pages=375–384|volume=12|issue=3|pmid=8040596|doi=10.1016/0736-4679(94)90281-X}}</ref><ref name=Guss2>{{Cite journal|author=Guss DA |title=The acquired immune deficiency syndrome: an overview for the emergency physician, Part 2|journal=J. Emerg. Med.|year=1994|pages=491–497|volume=12|issue=4|pmid= 7963396|doi=10.1016/0736-4679(94)90346-8}}</ref> The specific opportunistic infections that AIDS patients develop depend in part on the prevalence of these infections in the geographic area in which the patient lives.{{cn|date=April 2021}}

===Pulmonary===
[[Pneumocystis pneumonia]] (PCP) (originally known as ''Pneumocystis carinii'' pneumonia) is relatively rare in healthy, [[immunocompetence|immunocompetent]] people, but common among HIV-infected individuals.<ref>{{cite journal |last=Huang |first=L |author2=Cattamanchi, A |author3=Davis, JL |author4=den Boon, S |author5=Kovacs, J |author6=Meshnick, S |author7=Miller, RF |author8=Walzer, PD |author9=Worodria, W |author10=Masur, H |author11=International HIV-associated Opportunistic Pneumonias (IHOP) Study |author12=Lung HIV, Study |title=HIV-associated Pneumocystis pneumonia |journal=Proceedings of the American Thoracic Society |date=June 2011 |volume=8 |issue=3 |pages=294–300 |pmid=21653531 |doi=10.1513/pats.201009-062WR |pmc=3132788 }}</ref> It is caused by ''[[Pneumocystis jirovecii]]''.

Before the advent of effective diagnosis, treatment, and routine [[preventive medicine|prophylaxis]] in Western countries, it was a common immediate cause of death. In developing countries, it is still one of the first indications of AIDS in untested individuals, although it does not generally occur unless the CD4 count is less than 200 cells per μL of blood.<ref name="Feldman">{{Cite journal |author=Feldman C |title=Pneumonia associated with HIV infection |journal=Current Opinion in Infectious Diseases |year=2005 |pages=165–170 |volume=18 |issue=2 |pmid=15735422 |doi=10.1097/01.qco.0000160907.79437.5a |s2cid=31827307 }}</ref>

[[Tuberculosis]] (TB) is unique among infections associated with HIV because it is transmissible to immunocompetent people via the respiratory route, and it is not easily treatable once identified.<ref>{{Cite journal |vauthors=Kwara A, Ramachandran G, Swaminathan S |title=Dose adjustment of the non-nucleoside reverse transcriptase inhibitors during concurrent rifampicin-containing tuberculosis therapy: one size does not fit all |journal=Expert Opinion on Drug Metabolism & Toxicology |volume=6 |issue=1 |pages=55–68 |date=January 2010 |pmid=19968575 |pmc=2939445 |doi=10.1517/17425250903393752 }}</ref> [[Multiple drug resistance|Multidrug resistance]] is a serious problem. [[Tuberculosis]] with HIV co-infection (TB/HIV) is a major world health problem according to the [[World Health Organization]]: in 2007, 456,000 deaths among incident TB cases were HIV-positive, a third of all TB deaths and nearly a quarter of the estimated 2 million HIV deaths in that year.<ref>{{cite web |url=https://www.who.int/tb/publications/global_report/2009/pdf/full_report.pdf |title=Global Tuberculosis Control 2009 |access-date=November 1, 2011  |archive-url=https://web.archive.org/web/20120127022705/http://www.who.int/tb/publications/global_report/2009/pdf/full_report.pdf |archive-date=January 27, 2012 }}</ref> Even though its incidence has declined because of the use of directly observed therapy and other improved practices in Western countries, this is not the case in developing countries where HIV is most prevalent. In early-stage HIV infection (CD4 count >300 cells per μL), TB typically presents as a pulmonary disease. In advanced HIV infection, TB often presents atypically with extrapulmonary (systemic) disease a common feature. Symptoms are usually constitutional and are not localized to one particular site, often affecting [[bone marrow]], [[bone]], urinary and [[human gastrointestinal tract|gastrointestinal tract]]s, [[liver]], regional [[lymph node]]s, and the [[central nervous system]].<ref name="Decker">{{Cite journal |vauthors=Decker CF, Lazarus A |title=Tuberculosis and HIV infection. How to safely treat both disorders concurrently |journal=Postgraduate Medicine |volume=108 |issue=2 |pages=57–60, 65–8 |date=August 2000 |pmid=10951746 |url=http://www.postgradmed.com/index.php?art=pgm_08_2000%3Farticle%3D1181 |doi=10.3810/pgm.2000.08.1181 |s2cid=213057 |access-date=2012-06-07 |archive-date=2011-01-05 |archive-url=https://web.archive.org/web/20110105052504/http://www.postgradmed.com/index.php?art=pgm_08_2000%3Farticle%3D1181  }}</ref>

===Gastrointestinal===
[[Esophagitis]] is an inflammation of the lining of the lower end of the [[esophagus]] (gullet or swallowing tube leading to the [[stomach]]). In HIV-infected individuals, this is normally due to fungal ([[candidiasis]]) or viral ([[Herpes simplex virus|herpes simplex-1]] or [[cytomegalovirus]]) infections. In rare cases, it could be due to [[mycobacterium|mycobacteria]].<ref name=Zaidi>{{Cite journal|vauthors=Zaidi SA, Cervia JS |title=Diagnosis and management of infectious esophagitis associated with human immunodeficiency virus infection|journal=Journal of the International Association of Physicians in AIDS Care|volume=1|issue=2|pages=53–62|year=2002 |pmid=12942677 |doi=10.1177/154510970200100204|s2cid=38823534}}</ref>

Unexplained chronic [[diarrhea]] in HIV infection is due to many possible causes, including common bacterial (''[[Salmonella]]'', ''[[Shigella]]'', ''[[Listeria]]'' or ''[[Campylobacter]]'') and parasitic infections; and uncommon opportunistic infections such as [[cryptosporidiosis]], [[microsporidiosis]], ''[[Mycobacterium avium-intracellulare infection|Mycobacterium avium]]'' complex (MAC) and viruses,<ref name="pmid11444032">{{Cite journal|author=Pollok RC |title=Viruses causing diarrhea in AIDS |journal=Novartis Foundation Symposium |volume=238 |pages=276–83; discussion 283–8 |year=2001 |pmid=11444032|doi=10.1002/0470846534.ch17|series=Novartis Foundation Symposia|isbn=978-0-470-84653-7}}</ref> [[astrovirus]], [[adenoviridae|adenovirus]], [[rotavirus]] and [[cytomegalovirus]], (the latter as a course of [[colitis]]).

In some cases, diarrhea may be a side effect of several drugs used to treat HIV, or it may simply accompany HIV infection, particularly during primary HIV infection. It may also be a side effect of [[antibacterial|antibiotic]]s used to treat bacterial causes of diarrhea (common for ''[[Clostridioides difficile infection|Clostridioides difficile]]''). In the later stages of HIV infection, diarrhea is thought to be a reflection of changes in the way the [[human gastrointestinal tract|intestinal tract]] absorbs nutrients and may be an important component of HIV-related [[wasting]].<ref name=Guerrant>{{Cite journal|vauthors=Guerrant RL, Hughes JM, Lima NL, Crane J |title=Diarrhea in developed and developing countries: magnitude, special settings, and etiologies|journal=Reviews of Infectious Diseases |volume=12 |issue=Suppl 1 |pages=S41–50 |year=1990|pmid=2406855|doi=10.1093/clinids/12.Supplement_1.S41|pmc=7792920}}</ref>

===Neurological and psychiatric===
HIV infection may lead to a variety of neuropsychiatric [[sequela]]e, either by infection of the now susceptible nervous system by organisms, or as a direct consequence of the illness itself.<ref>{{Cite journal| last1 = Gazzard| first1 = B| last2 = Balkin| first2 = A| last3 = Hill| first3 = A| title = Analysis of neuropsychiatric adverse events during clinical trials of efavirenz in antiretroviral-naive patients: a systematic review| journal = AIDS Reviews| volume = 12| issue = 2| pages = 67–75| year = 2010| pmid = 20571601}}</ref>

[[Toxoplasmosis]] is a disease caused by the single-celled [[parasitism|parasite]] ''[[Toxoplasma gondii]]''; it usually infects the brain, causing toxoplasma [[encephalitis]], but it can also infect and cause disease in the [[human eye|eye]]s and lungs.<ref name=Luft>{{Cite journal|vauthors=Luft BJ, Chua A |title=Central Nervous System Toxoplasmosis in HIV Pathogenesis, Diagnosis, and Therapy |journal=Current Infectious Disease Reports |volume=2 |issue=4 |pages=358–362 |date=August 2000 |pmid=11095878|doi=10.1007/s11908-000-0016-x|s2cid=30642847 }}</ref> Cryptococcal meningitis is an infection of the [[meninges|meninx]] (the membrane covering the brain and [[spinal cord]]) by the fungus ''[[Cryptococcus neoformans]]''. It can cause fevers, headache, [[Fatigue (medical)|fatigue]], [[nausea]], and vomiting. Patients may also develop [[epileptic seizure|seizure]]s and confusion; left untreated, it can be lethal.{{cn|date=January 2021}}

[[Progressive multifocal leukoencephalopathy]] (PML) is a [[demyelinating disease]], in which the gradual destruction of the [[myelin]] sheath covering the [[axon]]s of nerve cells impairs the transmission of nerve impulses. It is caused by a virus called [[JC virus]] which occurs in 70% of the population in [[Virus latency|latent]] form, causing disease only when the immune system has been severely weakened, as is the case for AIDS patients. It progresses rapidly, usually causing death within months of diagnosis.<ref name=Sadler>{{Cite journal|vauthors=Sadler M, Nelson MR |title=Progressive multifocal leukoencephalopathy in HIV|journal=International Journal of STD & AIDS |volume=8 |issue=6 |pages=351–7 |date=June 1997|pmid=9179644 |doi=10.1258/0956462971920181}}</ref>

[[HIV-associated dementia]] (HAD) is a metabolic [[encephalopathy]] induced by HIV infection and fueled by immune activation of HIV-infected brain [[macrophage]]s and [[microglia]]. These cells are productively infected by HIV and secrete [[neurotoxin]]s of both host and viral origin.<ref name=Gray>{{Cite journal|vauthors=Gray F, Adle-Biassette H, Chretien F, Lorin de la Grandmaison G, Force G, Keohane C |title=Neuropathology and neurodegeneration in human immunodeficiency virus infection. Pathogenesis of HIV-induced lesions of the brain, correlations with HIV-associated disorders and modifications according to treatments |journal=Clinical Neuropathology |volume=20 |issue=4 |pages=146–55 |year=2001|pmid=11495003}}</ref> Specific neurological impairments are manifested by cognitive, behavioral, and motor abnormalities that occur after years of HIV infection and are associated with low CD4<SUP>+</SUP> T cell levels and high plasma viral loads.{{cn|date=April 2021}}

Prevalence is 10–20% in Western countries<ref name=Grant>{{Cite book|vauthors=Grant I, Sacktor H, McArthur J|year=2005|title=The Neurology of AIDS|chapter=HIV neurocognitive disorders|chapter-url=http://www.hnrc.ucsd.edu/publications_pdf/2005grant1.pdf|editor1-link=Howard E. Gendelman|editor1=H.E. Gendelman|editor2=I. Grant|editor3=I. Everall|editor4=S. A. Lipton|editor5=S. Swindells.|edition=2nd|pages=357–373|publisher=Oxford University Press|location=London, UK|isbn=978-0-19-852610-0|access-date=2012-06-07|archive-date=2009-09-23|archive-url=https://web.archive.org/web/20090923072326/http://www.hnrc.ucsd.edu/publications_pdf/2005grant1.pdf}}</ref> but only 1–2% of HIV infections in India.<ref name=Satischandra>{{Cite journal|author=Satishchandra P |title=Profile of neurologic disorders associated with HIV/AIDS from Bangalore, south India (1989–96)|journal=The Indian Journal of Medical Research |volume=111|pages=14–23 |date=January 2000 |pmid=10793489|name-list-style=vanc|author2=Nalini A|author3=Gourie-Devi M|display-authors=3|last4=Khanna|first4=N|last5=Santosh|first5=V|last6=Ravi|first6=V|last7=Desai|first7=A|last8=Chandramuki|first8=A|last9=Jayakumar|first9=PN}}</ref><ref name=Wadia>{{Cite journal|author=Wadia RS |title=Neurological manifestations of HIV disease|journal=The Journal of the Association of Physicians of India| volume=49|pages=343–8 |date=March 2001|pmid=11291974|name-list-style=vanc|author2=Pujari SN|author3=Kothari S|display-authors=3|last4=Udhar|first4=M|last5= Kulkarni|first5=S|last6=Bhagat|first6=S|last7=Nanivadekar|first7=A}}</ref> This difference is possibly due to the HIV subtype in India. AIDS-related mania is sometimes seen in patients with advanced HIV illness; it presents with more irritability and cognitive impairment and less euphoria than a [[mania|manic episode]] associated with true [[bipolar disorder]]. Unlike the latter condition, it may have a more chronic course. This syndrome is less frequently seen with the advent of multi-drug therapy.{{cn|date=January 2021}}

===Tumors===
[[File:Kaposi's Sarcoma.jpg|thumb|[[Kaposi's sarcoma]] ]]

People with HIV infections have substantially increased incidence of several cancers. This is primarily due to co-infection with an [[oncogene|oncogenic]] [[DNA virus]], especially [[Epstein-Barr virus]] (EBV), [[Kaposi's sarcoma-associated herpesvirus]] (KSHV) (also known as human herpesvirus-8 [HHV-8]), and [[papillomaviridae|human papillomavirus]] (HPV).<ref name="Boshoff2002">{{Cite journal|vauthors=Boshoff C, Weiss R |title=AIDS-related malignancies | journal=Nature Reviews Cancer | year=2002 | pages=373–382 | volume=2 | issue=5 |pmid=12044013 | doi=10.1038/nrc797 |s2cid=13513517 }}</ref><ref name="Yarchoan2005">{{Cite journal|vauthors=Yarchoan R, Tosato G, Little RF | title=Therapy insight: AIDS-related malignancies – the influence of antiviral therapy on pathogenesis and management | journal=Nat. Clin. Pract. Oncol. | year=2005 | pages=406–415 | volume=2 |issue=8 | pmid=16130937 | doi=10.1038/ncponc0253 | s2cid=23476060 | url=https://zenodo.org/record/1233371 }}</ref>

Kaposi's sarcoma (KS) is the most common tumor in HIV-infected patients. The appearance of this tumor in young [[homosexual men]] in 1981 was one of the first signals of the AIDS epidemic. Caused by a [[Gammaherpesvirinae|gammaherpes]] virus called [[Kaposi's sarcoma-associated herpes virus]] (KSHV), it often appears as purplish [[Nodule (medicine)|nodules]] on the skin, but can affect other organs, especially the mouth, gastrointestinal tract, and lungs. High-grade [[B cell]] [[lymphoma]]s such as [[Burkitt's lymphoma]], Burkitt's-like lymphoma, diffuse large B-cell lymphoma (DLBCL), and [[primary central nervous system lymphoma]] present more often in HIV-infected patients. These particular cancers often foreshadow a poor prognosis. [[Epstein-Barr virus]] (EBV) or KSHV cause many of these lymphomas. In HIV-infected patients, lymphoma often arises in extranodal sites such as the gastrointestinal tract.<ref>{{Cite journal|vauthors=Ho-Yen C, Chang F|title=Gastrointestinal Malignancies in HIV/AIDS |journal=The AIDS Reader |volume=18 |issue=6|date=June 1, 2008 |url=http://www.consultantlive.com/aids/article/1145619/1359079}}</ref> When they occur in an HIV-infected patient, KS and aggressive B cell lymphomas confer a diagnosis of AIDS.{{cn|date=May 2021}}

Invasive [[cervical cancer]] in HIV-infected women is also considered AIDS-defining; it is caused by [[human papillomavirus]] (HPV).<ref>{{Cite journal|author=Palefsky J |title=Human papillomavirus infection in HIV-infected persons |journal=Top HIV Med |volume=15 |issue=4 |pages=130–3 |year=2007 |pmid=17720998 }}</ref>

In addition to the AIDS-defining tumors listed above, HIV-infected patients are at increased risk of certain other tumors, notably [[Hodgkin's disease]], [[Anal cancer|anal]] and [[colorectal cancer|rectal carcinoma]]s, [[hepatocellular carcinoma]]s, [[head and neck cancer]]s, and lung cancer. Some of these are caused by viruses, such as Hodgkin's disease (EBV), anal/rectal cancers (HPV), head and neck cancers (HPV), and hepatocellular carcinoma ([[hepatitis B]] or [[hepatitis C|C]]). Other contributing factors include exposure to carcinogens (cigarette smoke for lung cancer), or living for years with subtle immune defects.{{cn|date=January 2021}}

The incidence of many common tumors, such as [[breast cancer]] or [[colorectal cancer|colon cancer]], does not increase in HIV-infected patients. In areas where [[Antiretroviral drug|HAART]] is extensively used to treat AIDS, the incidence of many AIDS-related malignancies has decreased, but at the same time malignant cancers overall have become the most common cause of death of HIV-infected patients.<ref name=Bonnet>{{Cite journal| author=Bonnet F | title=Malignancy-related causes of death in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy | journal=Cancer |year=2004 | pages=317–324 | volume=101 | issue=2 | pmid=15241829 | doi=10.1002/cncr.20354|name-list-style=vanc|author2=Lewden C| author3=May T| display-authors=3| last4=Heripret| first4=Laurence| last5=Jougla|first5=Eric| last6=Bevilacqua| first6=Sibylle| last7=Costagliola| first7=Dominique| last8=Salmon|first8=Dominique| last9=Chêne | first9=Geneviève| s2cid=79554735 | doi-access=free}}</ref> In recent years, an increasing proportion of these deaths have been from non-AIDS-defining cancers.{{citation needed|date=November 2014}}

In line with the treatment of cancer, chemotherapy has shown promise in increasing the number of uninfected T-cells and diminishing the viral load.<ref>Karrakchou, J., Rachik, M., & Gourari, S. (2006). Optimal control and infectiology: Application to an HIV/AIDS model. Applied Mathematics and Computation, 177(2), 807–818. doi: 10.1016/j.amc.2005.11.092</ref>

=== Other infections ===
People with AIDS often develop opportunistic infections that present with [[non-specific symptom]]s, especially [[fever|low-grade fever]]s and weight loss. These include opportunistic infection with ''[[Mycobacterium avium-intracellulare infection|Mycobacterium avium-intracellulare]]'' and [[cytomegalovirus]] (CMV). CMV can cause colitis, as described above, and [[Cytomegalovirus retinitis|CMV retinitis]] can cause blindness.{{cn|date=January 2021}}

[[Talaromycosis]] due to ''[[Talaromyces marneffei]]'' is now the third most common opportunistic infection (after extrapulmonary tuberculosis and [[cryptococcosis]]) in HIV-positive individuals within the endemic area of Southeast Asia.<ref name=Skoulidis>{{cite journal|last=Skoulidis|first=F|author2=Morgan, MS |author3=MacLeod, KM |title=Penicillium marneffei: a pathogen on our doorstep?|journal=Journal of the Royal Society of Medicine|date=August 2004|volume=97|issue=8|pages=394–6|pmid=15286196|doi=10.1177/014107680409700811|pmc=1079563}}</ref>

An infection that often goes unrecognized in people with AIDS is [[Parvovirus B19]]. Its main consequence is [[anemia]], which is difficult to distinguish from the effects of antiretroviral drugs used to treat AIDS itself.<ref>{{Cite journal|author1=Silvero AM |author2=Acevedo-Gadea CR |author3=Pantanowitz L "" |title=Unsuspected Parvovirus B19 Infection in a Person With AIDS|journal=The AIDS Reader|volume=19 |issue=6 |date=June 4, 2009|url=http://www.consultantlive.com/aids/article/1145619/1419436}}</ref>

==References==
{{reflist|2}}

==Notes==
{{notes
|notes =

{{efn
|name=sensitivity
|Presence of symptoms as a predictor of acute HIV infection.
}}

{{efn
|name=specificity
|Absence of symptom as a predictor of no acute HIV infection.
}}

}}

{{HIV and AIDS |state=autocollapse}}

{{DEFAULTSORT:Signs and symptoms of HIV AIDS}}
[[Category:HIV/AIDS]]