HIV & AIDS Complications

Opportunistic Infections

People with AIDS often become ill because of opportunistic infections. These infections are called "opportunistic" because they take hold in a person with a weakened immune system. In other words, they use the opportunity that a fragile immune system creates to trigger illness in a person. A person who has a healthy immune system might experience annoying symptoms from a cold or flu that last a few days. To a person with AIDS, these same diseaseproducing organisms can be life threatening. This is because AIDS leaves an immune system so weakened that it cannot battle and destroy the organisms that regularly invade the human body. More than 100 germs can cause opportunistic infections in people with HIV or AIDS.

In some people with AIDS, certain opportunistic infections attack the central nervous system; others affect the lungs, causing difficulty in breathing. A person living with AIDS may have breathing problems resulting from a lack of strength to cough up fluids that have collected in the back of the throat or the lungs.

The same problems can also result from a more serious obstruction or other health problems associated with AIDS. These conditions are so commonly found in people with the syndrome, and so rarely in people with intact immune systems, that they have come to be defined as symptoms of AIDS.

Cancer

A cancer develops when abnormal cells start to grow out of control in some part of the body. These cells can travel to other parts of the body as well. Unlike normal cells, which grow, divide, and die, cancer cells do not die. Cancer occurs because the genetic material (DNA) in the affected cells is damaged. Sometimes, the damaged DNA is inherited from a parent. Other times, environmental factors (such as pollution) or behaviors (such as smoking) can cause cancer. The damaged material continues to grow, taking over healthy tissue. Tumors or lesions can form and cause obstruction, pain, or both.

Certain types of cancer are more common in people with impaired immune systems. These cancers are among the AIDS-defining conditions that have been identified by the CDC:

AIDS-related Kaposi's sarcoma

This cancer develops in connective tissue such as cartilage, bone, fat, muscle, and blood vessels. Before AIDS, Kaposi's sarcoma was usually found in elderly Mediterranean and Jewish men or young African men, for whom it took a much gentler course. When it started to be diagnosed in young, homosexual men, doctors suspected that a new disease had emerged. In some ways, the sudden appearance of AIDS-related Kaposi's sarcoma helped physicians identify HIV sooner than they might have otherwise.

In people without AIDS, this form of cancer usually affects one or two areas of the body. For those with AIDS who are not taking proper medications, the condition is more extensive. Soon after AIDS develops, Kaposi's sarcoma can cause lesions (areas of abnormal tissue) to appear all over the body. Outside the body, lesions form on the skin and near the mouth. Inside, they can appear in the lungs, gastrointestinal tract, lymph nodes, liver, and spleen. When this form of cancer spreads to the lungs, it can be fatal. Usually, though, other AIDSrelated complications are more likely to cause death.

Lymphoma

One of the first symptoms that people with AIDS experience is a swelling of the glands behind the ears, in the groin, and in the armpits. Abnormal cells divide rapidly and produce tumors. These tumors can occur in the central nervous system, in the gastrointestinal tract, or throughout the lymphatic system. In people with AIDS, lymphoma can be quite an aggressive disease. The most common forms of lymphoma found in people with AIDS are non-Hodgkin's lymphoma (usually caused by cancerous white blood cells and marked by high fever, constipation, and mental confusion) and AIDSrelated primary central nervous system lymphoma (affecting the brain and spinal cord).

Invasive cervical cancer

This type of cervical cancer is called "invasive" because it invades neighboring tissues. The primary risk factor for cervical cancer is infection with the human papilloma virus, which is transmitted sexually. Cervical cancer in the early stages often does not produce symptoms. Usually, the first sign of the disease is an abnormal Pap test result, so it is crucial that women get an annual Pap smear. In HIV-infected women, invasive cervical cancer is aggressive and often deadly.

When a person with AIDS gets cancer, the disease is often far more aggressive than in an otherwise healthy person. Common cancer treatments, such as chemotherapy and radiation, can be difficult or impossible for a person with AIDS to endure. Radiation treatment is designed to destroy cancerous cells. Although the treatment is focused on the area containing cancer, sometimes radiation can destroy healthy cells. This can produce mild to severe side effects, among the most common of which are feelings of weariness, nausea and vomiting, weight loss, and itchy skin. Since these symptoms are also associated with AIDS, infected people often find radiation more difficult to deal with than other cancer patients do.

Unlike radiation, which targets the regions of the body affected by cancer, chemotherapy is a "systemic" medication. This means that the treatment affects the entire body. As with radiation, the side effects produced by chemotherapy are similar to those already suffered by people with AIDS. These side effects include nausea, vomiting, loss of appetite, diarrhea, mouth sores, and constipation. In severe cases, chronic bone marrow suppression, a side effect of chemotherapy that slows or stops blood cells from forming, can also occur.

Weight loss

As mentioned before, wasting or weight loss can occur in people who are at the end stages of the virus and not on medication. These people can lose a lot of weight for a variety of reasons. Mouth and throat sores can make eating difficult. Constant nausea, which can be brought on by medication, can prevent a person from getting proper nutrition. Chronic diarrhea can require a person to be placed on a severely restricted diet. Lack of exercise can contribute to a loss of muscle. Cancers such as AIDS-related Kaposi's sarcoma can cause substantial weight loss because they affect the gastrointestinal tract.

Psychological and emotional issues

If a person has a personal or family history of physical and mental health illnesses, these illnesses can worsen when the person develops AIDS. Some people with AIDS experience neurological changes called AIDS dementia complex. The affected person may seem sleepy, clumsy, and unable to concentrate. He or she also may have difficulty speaking, walking, or grasping objects. In addition, some people experience frequent, severe headaches; have mood swings; have a very short attention span; and have swings in their ability to function. For example, one day they may seem perfectly alert, and the next they may have poor memory—often making daily living hard. These swings also can make it difficult for some people who are living with AIDS to stick to complex treatments.

A person with AIDS often experiences periods of major depressive disorders. The related symptoms can come and go during the course of the illness. Sometimes they might seem manageable; other times they can become severe. At the earliest sign of depression, a mental health professional should be contacted. This person—a psychologist, a psychiatrist, a psychiatric nurse practitioner, a clinical social worker, or a counselor—should work with the patient's doctor to coordinate the use of medication. Coordination is particularly important because medications that treat depression and medications that treat AIDS can be harmful when used at the same time.

Some people want to use herbal remedies to treat depression or other illnesses. People being treated for AIDS, however, must consult with their primary care provider. Combining AIDS medications with herbal remedies can be dangerous. For example, St. John's wort, a popular herbal remedy used to treat depression, interferes with the vital work of protease inhibitors, medications that help prevent the virus's protease enzyme from producing infectious viral particles. A person who takes both St. John's wort and protease inhibitors could experience drug resistance to AIDS medications, which in turn can make the syndrome worse. Besides depression, other mental disorders that tend to affect people with AIDS are bipolar disorder (also called manic-depressive disorder) and anxiety disorders.

Other Problems

In addition to the symptoms that an HIV-infected person xperiences, other complications can develop over time. HIV-associated dementia: Dementia involves a loss of brain function. This could include loss of memory or unclear reasoning or thought. When someone becomes infected with HIV, the brain is one of the first organs to be damaged. This is because, within hours or days of infection, HIV travels to the brain in some of the cells that it has invaded. HIV-associated dementia is one of the most common forms of dementia worldwide. It is a degenerative condition that can slowly cause changes in behavior and personality, including a loss of coordination, memory, thinking abilities, and inhibitions.

HIV lipodystrophy syndrome

Lipodystrophy is a condition characterized by a poor or uneven distribution of fat cells. This distribution causes large amounts of fat to be stored in inappropriate places, which can lead to obesity in the lower belly and a hump on the upper back. The side effects of lipodystrophy also include diabetes and high levels of cholesterol and triglycerides.

Chronic wasting from HIV

When the power sources of cells (called mitochondria) supply less energy to tissues such as muscles and nerves, this form of weakening results. It usually causes an overall weight loss of about 10 percent, chronic diarrhea, chronic weakness, and fever.

Osteonecrosis

This condition, which results in a weakening of the bones and the death of bone tissue, is more common in people with HIV than in people without the virus. In NIH studies, osteonecrosis occurred most often in the hipbones of HIV-infected people.

Hepatitis C

In the United States, 25% of people with HIV also suffer from coinfection by another virus, called hepatitis C virus (HCV). Worldwide, this virus is found in 50% to 75% of injection-drug users infected with HIV. Being aware of this connection is important for several reasons. First, the presence of HIV infection can diminish the accuracy of HCV antibody tests. Therefore, the risk of receiving either a false-negative or a false-positive result from HCV screening antibody tests is increased in people with HIV infection.

Also, the coinfection with HIV hastens the progress of liver disease in 70% of people. In clinical studies, researchers have noted that HIV infection caused a faster progression of chronic hepatitis to cirrhosis and liver failure. In addition, hepatitis C virus may affect how well HIV can be managed and controlled in those who are infected, but more research is needed to confirm this idea. Some researchers recommend that HCV be thought of as an opportunistic infection in people with HIV because it can lead to death more rapidly due to liver disease.

Hepatitis C infection can be managed in those with HIV. Some evidence suggests that a "cocktail" of HIV medications known as HAART may alter the rapid progression of HCV. Taking HAART,may keep the HCV from progressing faster than it does for HIV-negative people. If chronic liver disease is already present, there are ways to reduce its impact. For these reasons and others, the U.S. Public Health Service recommends that all HIV-infected people be tested for the hepatitis C virus.

People with AIDS must always be aware that they are living with the disease, even though many may find that they are able to function almost normally for periods of time. For example, most people who are on medications can go to work full time, see friends, exercise, and sleep well. However, if they are not taking their medications and are exposed to an opportunistic infection, a lifethreatening illness can appear and drain them of energy and peace of mind. By managing stress, eating right, getting enough rest, staying strong, and engaging in healthpromoting behaviors (such as getting the right vitamins in their diet and exercising), people with AIDS can reduce the effects of an illness and recover faster when illness does strike.

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