The Final Phases of HIV/Aids
It is not possible to say exactly what symptoms and diseases will be associated with HIV-infection in a specific person. Because of the unique way in which HIV attacks and disarms the immune system, all kinds of bacteria, fungi, protozoa, viruses and cancers are able to invade the body. That is the reason why we talk about Aids as a syndrome - a collection of many illnesses and infections.

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HIV-infection can, however, theoretically be divided into the following phases or stages:

1. The primary HIV infection phase (or acute sero-conversion illness)
2. The asymptomatic latent phase
3. The minor symptomatic phase
4. The major symptomatic phase and opportunistic diseases
5. AIDS-defining conditions: the severe symptomatic phase generally known as full-blown Aids

From Phase 4 - The major symptomatic phase of HIV infection and opportunistic diseases - symptoms and opportunistic diseases begin to appear as the immune system continues to deteriorate. At this point, the CD4 cell count becomes very low while the viral load becomes very high.

The following symptoms are usually an indication of advanced immune deficiency:

• Oral and vaginal thrush infections which are very persistent and recurrent (Candida)
• Recurrent herpes infections such as cold sores (herpes simplex)
• Recurrent herpes zoster (or shingles)
• Bacterial skin infections and skin rashes
• Fever for more than a month
• Night sweats
• Persistent diarrhoea for more than a month
• Weight loss (more than 10 percent of the usual body weight)
• Generalised lymphadenopathy (or, in some cases, the shrinking of previously enlarged lymph nodes)
• Abdominal discomfort, headaches
• Oral hairy leucoplakia (thickened white patches on the side of the tongue)
• Persistent cough and reactivation of tuberculosis
• Opportunistic diseases of various kinds

Phase 5: The severe symptomatic phase (Full-blown Aids)
Only when patients enter the last phase of HIV infection can they be said to have full-blown Aids. It usually takes about 18 months for the major symptomatic phase to develop into Aids.

In the final stage of Aids, the symptoms of HIV disease become more acute, patients become infected by relatively rare and unusual organisms that do not respond to antibiotics, the immune system deteriorates, and more persistent and untreatable opportunistic conditions and cancers begin to manifest.

While people with Aids (the last phase of HIV disease) usually die within two years, anti-retroviral therapy and the prevention and treatment of opportunistic infections may prolong this period.

The Aids patient in the final phase is usually plagued by many of the following problems:

• The Aids patient is usually very thin and emaciated due to continuous diarrhoea, nausea and vomiting (which may last for weeks or even for months).
• Conditions in the mouth (such as thrush and sores) may become so painful that the patient is no longer able to eat.
• Women suffer from persistent, recurrent vaginal infections and cervical cancer.
• Persistent generalised lymphadenopathy (PGL) is present - lymph nodes are larger than one centimetre in diameter, in two or more sites other than the groin area for a period of at least three months.
• Severe skin infections, warts and ringworm.
• Respiratory infections, persistent cough, chest pain and fever.
• Pneumonia, especially pneumocystis carinii pneumonia (PCP).
• Severe herpes zoster (or shingles).
• Nervous system problems - often complain of pains, numbness or “pins and needles” in the hands and feet.
• Neurological abnormalities with symptoms such as memory loss, poor concentration, tremor, headache, confusion, loss of vision and seizures. Aids patients may develop infections in the central nervous system or the brain.
• Kaposi’s sarcoma, or a rare form of skin cancer (painless reddish-brown or bluish-purple swelling on the skin and mucous membranes such as in the mouth). Kaposi’s sarcoma can also occur in the lungs and gastro-intestinal tract. It reacts well to chemotherapy or to alpha-interferon, but it can develop invasive open lesions and cause death if not promptly treated. Kaposi’s sarcoma is less common in black Africans.
• Lymphoma or cancer of the lymph nodes.
• Tuberculosis is a very serious opportunistic infection which affects people with Aids. According to a UNAIDS Report (2000, c), up to 50 percent of HIV-infected individuals in Africa have active tuberculosis.
• Other sexually transmitted diseases.

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