JOMO KENYATTA UNIVERSITY

OF
AGRICULTURE & TECHNOLOGY
JKUAT SODeL

SCHOOL OF OPEN, DISTANCE AND eLEARNING

P.O. Box 62000, 00200
©2013

Nairobi, Kenya
E-mail: elearning@jkuat.ac.ke

SZL 2111: HIV/AIDs

JJ II LAST REVISION ON May 10, 2013

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 This presentation is intended to covered within one week.
The notes, examples and exercises should be supple-
mented with a good textbook. Most of the exercises have
solutions/answers appearing elsewhere and accessible by
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clicking the green Exercise tag. To move back to the same

page click the same tag appearing at the end of the solu-
tion/answer.
©2013

Errors and omissions in these notes are entirely the re-

sponsibility of the author who should only be contacted
through the Department of Curricula & Delivery
(SODeL) and suggested corrections may be e-mailed to
elearning@jkuat.ac.ke.
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 SZL 2111 HIV/AIDs
LESSON 5
Disease progression and symptoms

Learning outcomes
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Upon completing this topic, you should be able to understand:

ˆ Stages of HIV infection
ˆ Factors that leads to faster progression fro HIV to full
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blown AIDs
ˆ Opportunistic infections

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 SZL 2111 HIV/AIDs
5.1. Introduction
HIV infects cells of the immune system and the central nervous
system. The main cell HIV infects is T helper cell which is a
crucial part of the immune system, because it co-ordinates the
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actions of other cells of the immune system. A large reduction

in the number of T helper cells seriously weakens the immune
system.
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5.1.1. Exposure vs. Infection

When HIV+ individual encounters an uninfected person, this
does not always result in transmission of HIV to the uninfected
person. Only a fraction of the exposed people will be infected.
JJ II Different kinds of exposure between infected & uninfected indi-
J I viduals have different probabilities of leading to infection. Those
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 SZL 2111 HIV/AIDs
who are exposed & become infected do not show sign of illnesses
right away.

5.1.2. Infection vs. Disease

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Among individuals who become infected with HIV, not every-

body will develop physical symptoms. Most viral infections
don’t show physical symptoms, but most people infected with
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HIV ultimately develop some disease symptoms. These disease

symptoms are caused by damage or destruction of cells & tis-
sues in the infected person. In some cases the damage may result
from direct killing of cells by virus. In the case of AIDS, most of
physical symptoms are the indirect result of damage to the im-
JJ II mune system by HIV. Factors such as age, sex, genetic make-up,
J I nutrition, environmental factors,& encounters with other infec-
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 SZL 2111 HIV/AIDs
tious agents can influence the exact nature of the symptoms in
a particular individual.
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 SZL 2111 HIV/AIDs
5.2. Stages of HIV Infection
There are four stages of HIV infection and they include:
1. Primary H IV infection, window period & sero conversion
2. Clinically asymptomatic stage,
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3. Symptomatic HIV infection,

4. Progression from HIV to AIDS.
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5.2.1. Primary HIV infection

This is the initial stage where one obtains the virus through the
various modes of transmission. It can be divided into:
1. Window period - This stage of infection lasts for a few
JJ II weeks to about 3 months and is often accompanied by a
J I short flu-like illness or no signs. HIV cannot be detected
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 SZL 2111 HIV/AIDs
in blood screening although HIV is present in blood &
the blood in not 100% free of HIV. The virus cannot be
seen in the first 21 days. During this time a person can
still transmit the virus to another person. It is the most
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crucial stage.
2. Sero conversion - This is the development of the anti-
bodies. Immune system begins to respond to HIV by pro-
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ducing HIV antibodies and cytotoxic lymphocytes. If an

HIV antibody test is done before seroconversion is com-
plete then it may not be positive. In this stage a person
may have flu like illnesses, fever, fatigue, sore throat, joint
pains & lymphadenopathy Some will not experience any
JJ II illnesses at this stage.
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 SZL 2111 HIV/AIDs
5.2.2. Clinical asymptomatic HIV infection/ Latent phase
The presence of HIV without major symptoms. Although there
may be swollen glands. The level of HIV in the peripheral blood
drops to very low levels but people remain infectious. HIV an-
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tibodies are detectable in the blood, so antibody tests will show

a positive result. HIV is not dormant during this stage, but is
very active in the lymph nodes. Large amounts of T helper cells
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are infected and die and a large amount of virus is produced.

This period can last for many years (5 – 15 years)

• Initial Infection Symptoms include:

ˆ Mononucleosis-like illness (sore throat, swollen glands, fever)
JJ II & skin rash
J I ˆ Encephalopathy i.e. Brain infections - brain swelling &
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 SZL 2111 HIV/AIDs
inflammation of the brain lining or meninges
ˆ This causes headache, fever, brain functions impairment,
difficulty in concentration, remembering or solving prob-
lems
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ˆ Personality changes may also occur

NB: Asymptomatic period – some type of balance exist between
HIV infection & the immune system in the infected person
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5.2.3. Symptomatic HIV infection/AIDS Related Com-

plex (ARC) phase
Over time the immune system loses the struggle to contain HIV
due to the following main reasons:
JJ II 1. The lymph nodes and tissues become damaged or ’burnt-
J I out’ because of the years of activity;
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 SZL 2111 HIV/AIDs
2. HIV mutates and becomes more pathogenic, i.e. stronger
and more varied, leading to more T helper cell destruction;
3. The body fails to keep up with replacing the T helper cells
that are lost. As the immune system fails, so symptoms
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develop. Initially many of the symptoms are mild, but

as the immune system deteriorates the symptoms worsen.
When the viral load reaches a critical amounts, the im-
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mune system is suppressed to such a degree that other

infections which under normal circumstances will not be
difficult to resist gain entrance i.e. opportunistic infec-
tions. Opportunistic infections – they take advantage of
the impairment of the immune system & sometimes are
JJ II caused by organisms that don’t cause infections/ diseases
J I in man. Symptoms of HIV infection in this stage. Two or
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 SZL 2111 HIV/AIDs
more of the following signs / symptoms may occur:
ˆ Chronic fever
ˆ Lethargy (fatigue/ tiredness)
ˆ Continuous diarrhea - Eczema (allergy of the face)
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ˆ More than 10% weight loss - Psoriasis (itchy pimples)

ˆ Lymphadenopathy
ˆ Dermatitis (itchy skin)
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ˆ Night sweats
ˆ Oral candidiasis (sores in mouth)
ˆ Dementia (short term memory loss)
Incubation period - is the length in time between ini-
tial infection & becoming symptomatic. It varies between
JJ II people & depends on a length of factors
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 SZL 2111 HIV/AIDs
5.2.4. Progression of HIV to AIDS
As the immune system becomes more and more damaged the ill-
nesses that present become more and more severe leading even-
tually to an AIDS diagnosis. It’s the most advanced stage of
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HIV infection. At this time when CD4 cell count has gone down
below 200 CD4 cells/ml, HIV develops to one or more severe
opportunistic infections or cancer. The infection / cancer may
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be life threatening due to the weakened immune system.

Common symptoms in this stage/ Initial Disease Symp-
toms
An infected individual may have symptoms from more than one
of these classes;
JJ II
1. HIV wasting syndrome: - Sudden unexplained loss in body
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 SZL 2111 HIV/AIDs
weight ( >10% of total body weight), unexplained chronic
diarrhea (>1 month), Chronic weakness, unexplained pro-
longed fever usually at night that causes night sweats (>1
month) and brain damage due to high temp that causes
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fevers
2. Lymphadenopathy syndrome (LAS)/ persistent general-
ized lymphadenopathy (PGL): Lymph glands enlargement
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is persistent. They swell in groin, armpits, head & neck

but are not painful. Some infected people may experience
both LAS & Wasting Syndrome
3. Neurologic disease - direct damage of the brain by HIV or
by other agent. Damage of parts of the nervous system can
JJ II also cause different neurologic symptoms. For example:
J I (a) Dementias - Impaired mental functions, forgetfulness,
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 SZL 2111 HIV/AIDs
loss of mental functions. Difficulty reasoning & per-
forming mental tasks. Depression, social withdrawals
& personality changes. Unable to care for themselves
eventually. Coma & death may follow.
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(b) Spinal cord damage/ swelling (myelopathy) - Spinal

cord transmits nerve impulses to the muscles of the
body. Because of this, damage may result in weak-
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nesses or paralysis of voluntary muscles/ limbs.

(c) Peripheral nerve swelling/ damage (neuropathy) - these
nerves sense pain. When damaged can cause burning
or stinging sensations in the hands or feet or occur-
rence of numbness
JJ II NB: individual patients may experience a mixture of any
J I of these illnesses Others include: Coughs & gasping of
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 SZL 2111 HIV/AIDs
breath, Seizure- lack of coordination, Difficulty or pain
during swallowing, Psychotic symptoms - mental confusion
& forgetfulness, Loss of vision, Severe headache, Nausea,
Abdominal crump & vomiting, Extreme fatigue, Cancers-
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m of blood, and Coma. HIV+ patient can die any moment

at this stage.
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5.2.5. Other Complications in HIV Patients

This manifest when immune system is weak and they include:
a) Common brain infections - Tumors, Swelling of the brain,
Nerve damage. They can cause Headache & confusion,
Poor coordination of feet, Blindness, Enlarged lymph nodes,
JJ II Fever, sore throat, weaknesses
J I b) Common skin infections - When immune system is damaged
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 SZL 2111 HIV/AIDs
in HIV patients the skin conditions tend to persist more
& they become difficult to treat. In most cases these con-
ditions are caused by bacteria, viruses or fungi.

5.2.6. Factors that lead to faster development of HIV

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infection to full- blown AIDs

1. Age - Persons who get infected after the age of 35years
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move faster from HIV infection to full blown AIDS than

those who get infected in their mid 20s. Children who get
infected at birth die faster simply because their immune
system is not well developed at their tender age.
2. Type of HIV contracted - There are two well known
JJ II types: HIV1 and HIV2. HIV1 is harsher on people hence
J I kills faster than HIV2.
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 SZL 2111 HIV/AIDs
3. Mode of transmission - HIV got through blood transfu-
sion kills faster than one got through sexual contact. This
is because the amount of virus channeled into the blood-
stream is in large quantity.
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4. Ill - health & other types of infections - People who

are already sick & then get infected move faster than those
infected when healthy. Tropical diseases such as malaria,
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typhoid & intestinal worms makes patients to develop AIDS

faster
5. Nutritional status - Those infected & are not eating
enough of well-balanced foods are more likely to develop
AIDS faster
JJ II 6. Lifestyle - People who expose themselves to re-infection
J I with other strains of HIV or STIs / STDs and other ill-
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 SZL 2111 HIV/AIDs
nesses move faster from HIV to AIDS
7. Opportunistic infections - If they are not competently
treated, then the HIV+ person develops AIDS faster.
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 SZL 2111 HIV/AIDs
5.3. Opportunistic Infections
1. Examples of fungal infections
(a) PCP - Inflammation of the lungs caused by infection
with fungus called Pneumocystis carinii. Inflamed
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areas of lungs appear as white spots in x-rays. It’s

the leading cause of death in AIDS patients i.e. about
50% of AIDS patients will eventually develop PCP
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(b) Candida - Fungus is similar to baker’s yeast. It is

found on skin & mucosal surfaces (mouth, vagina). In
mouth they appear like white plaques that feel furry.
Antifungal e.g. mycostatin can be used. They are
difficult to completely eliminate. They can spread to
JJ II oesophagus & cause painful burning sensation when
J I eating i.e. oesophagitis. 50% of AIDS patients will
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 SZL 2111 HIV/AIDs
experience candidacies.
(c) Systemic mycosis - Soil fungus that can cause gen-
eralized infections in AIDS patients. Exist in either
mold like or yeast like form & are called dimorphic.
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There are of 3 types - Histoplasmosis, Coccidiomyco-

sis, & Cryptococcus. They cause lung infections in
healthy patients. In AIDS patients, the brain, skin,
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bone, liver & lymphatic tissue may also be highly in-

fected.
2. Example of Bacterial infections - Components of I.S. re-
sponsible for controlling the common bacteria are less af-
fected by HIV infection, thus adult AIDS patients do not
JJ II generally suffer infections with common bacteria
J I (a) Mycobacterium - Infection with Mycobacterium avium
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 SZL 2111 HIV/AIDs
intracellular is most common in AIDS patients. It
does not cause disease in healthy people but it causes
TB-like disease in the lungs of AIDS patients. Also
causes infection of BM & presence of bacteria in blood
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at high levels. Patients will have fevers & low no. of

white blood cells. Mycobacterium tuberculosis that
causes TB is also common in AIDS patients.
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3. Example of Viral infections

(a) Cytomegalovirus (CMV) - Common virus that in-
fect people inn childhood with no symptoms but may
cause mononucleosis-like illness (sore throat, swollen
glands, fevers) in adults. Congenital infections(fetus)
JJ II can also lead to permanent brain damage. In AIDS
J I patients CMV infect retinas of the eyes causing blind-
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 SZL 2111 HIV/AIDs
ness & also adrenal glands leading to hormonal im-
balance. CMV can cause pneumonia, fevers, rash &
gastroenteritis in AIDS patients. CMV pneumonia in
patients with PCP is fatal
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(b) Varicella (shingles) - Painful rash condition that oc-

curs on human trunk. Latent varicella zoster (that
causes chicken pox in childhood) is reactivated when
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the I.S. is compromised. Antiviral drugs e.g. acy-

clovir is sometimes used to control shingles
4. Example of Protozoan infections:
(a) Cryptosporidium gastroenteritis - It is caused by pro-
tozoan called cryptosporidium. It infect lining of the
JJ II intestinal tract & causes diarrhea (gastroenteritis).
J I In normal/ healthy people diarrhea lasts a few days
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 SZL 2111 HIV/AIDs
but in AIDS patients it is prolonged & severe. That
is about 20-50 watery stools per day accompanied by
abdominal cramps & weight loss
(b) Toxoplasmosis - It is caused by Toxoplasma gondii
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that causes asymptomatic infections in healthy adults.

In AIDS patients it causes brain infections with symp-
toms similar to brain tumors (e.g. convulsions, de-
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mentias).
5. Examples of Cancers:
(a) Kaposi’s sarcoma (KS) - Are tumors of blood vessels.
In non - AIDS patients KS is seen in older men of
Jewish ancestry. Initially few tumors appear as pink,
JJ II purple or brown skin lesions located on arms or legs.
J I Eventually they spread & become widely distributed
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 SZL 2111 HIV/AIDs
in most linings of the body. They are difficult to
control if they spread to the lungs. Chemotherapy
can eradicate them.
(b) Lymphomas - Cancers derived from B cells of im-
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mune system are the common type of lymphomas in

AIDS patients. Epstein-Barr virus causes mononu-
cleosis but it can also transform normal B cell into
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cancer cell. Unusual lymphoma that spread to the

brain also occur in AIDS patients.
(c) Cervical cancers - Its common in female AIDS pa-
tients. Infections with certain strains of Human Pa-
pilloma Virus (HPV) that cause warts in the genital
JJ II tract is an underlying cause of cervical cancer. Can-
J I cer caused or induced by HPV develops faster when
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 SZL 2111 HIV/AIDs
immune system is compromised in AIDS patients.
(d) Hairy leukoplakia - Abnormal condition of the mouth
in which white plaques appear on the surface of the
tongue. This is due to abnormal growth of papillae
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cells of the tongue. They can’t be scrapped off. They

resemble cancer cells.
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 SZL 2111 HIV/AIDs
Exercise 1.  Revision Questions
The progressions of HIV to AIDs involve different stages of
clinical developments. Discuss

Example . Factors that lead to faster development of HIV
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infection to full - blown AIDS

Solution: Age - Persons who get infected after the age of 35years
move faster from HIV infection to full blown AIDS than those
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who get infected in their mid 20s. Children who get infected
at birth die faster simply because their immune system is not
well developed at their tender age. Type of HIV contracted -
There are two well known types: HIV1 and HIV2. HIV1 is
harsher on people hence kills faster than HIV2. Mode of trans-
JJ II mission - HIV got through blood transfusion kills faster than
J I one got through sexual contact. This is because the amount of
J DocDoc I
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 SZL 2111 HIV/AIDs
virus channeled into the bloodstream is in large quantity. Ill
- health & other types of infections - People who are already
sick & then get infected move faster than those infected when
healthy - Tropical diseases such as malaria, typhoid & intestinal
JKUAT SODeL

worms makes patients to develop AIDS faster Nutritional status

- Those infected & are not eating enough of will balanced foods
are more likely to develop AIDS faster. Lifestyle - People who
©2013

expose themselves to re-infection with other strains of HIV or

STIs/STDs and other illnesses move faster from HIV to AIDS.
Opportunistic infections - If they are not competently treated,
then the HIV+ person develops AIDS faster. 

JJ II
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 SZL 2111 HIV/AIDs
References and Additional Reading Materials
1. Maranga R. O, Muya S. M and Ogila K. O (2008) Funda-
mentals of HIV/AIDS Education. Signon Publishers.
2. Barry D. S. (1999) AIDS and HIV in Perspectives. CPU.
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ISBN-13: 9780521627665
3. Ellison G. Parker M., Camphpbell C (2003) Learning from
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HIV and AIDS. Cambridge CPU.ISBN-13: 9780521709286.

4. Shavitri Ramaiah (2008) HIV/AIDS; Health solutions. Ster-
ling Publishers Ltd. ISBN-9788120733305.

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 SZL 2111 HIV/AIDs
Solutions to Exercises
Exercise 1. Primary HIV infection - This is the initial stage
where one obtains the virus through the various modes of trans-
mission. Window period - This stage of infection lasts for a few
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weeks to about 3 months and is often accompanied by a short

flu-like illness or no signs. HIV cannot be detected in blood
screening although HIV is present in blood & the blood in not
©2013

100% free of HIV. During this time a person can still transmit
the virus to another person. It’s the most crucial stage. Sero
conversion - This is the development of the anti-bodies. Immune
system begins to respond to HIV by producing HIV antibodies
and cytotoxic lymphocytes. If an HIV antibody test is done
JJ II before seroconversion is complete then it may not be positive.
J I In this stage a person may have flu like illnesses, fever, fatigue,
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 SZL 2111 HIV/AIDs
sore throat, joint pains & lymphadenopathy. Some will not ex-
perience any illnesses at this stage. Clinical asymptomatic HIV
infection/ Latent phase - The presence of HIV without major
symptoms. Although there may be swollen glands. The level of
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HIV in the peripheral blood drops to very low levels but peo-
ple remain infectious and HIV antibodies are detectable in the
blood, so antibody tests will show a positive result. HIV is
©2013

not dormant during this stage, but is very active in the lymph
nodes. Large amounts of T helper cells are infected and die and
a large amount of virus is produced. This period can last for
many years (5 – 15 years). Symptomatic HIV infection/AIDS
Related Complex (ARC) phase - Over time the immune system
JJ II loses the struggle to contain HIV due to the following main rea-
J I sons: The lymph nodes and tissues become damaged or ’burnt
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 SZL 2111 HIV/AIDs
out’ because of the years of activity; HIV mutates and becomes
more pathogenic, i.e. stronger and more varied, leading to more
T helper cell destruction; The body fails to keep up with replac-
ing the T helper cells that are lost. It varies between people &
JKUAT SODeL

depends on a length of factors. Progression of HIV to AIDS -

As the immune system becomes more and more damaged the ill-
nesses that present become more and more severe leading even-
©2013

tually to an AIDS diagnosis. It’s the most advanced stage of

HIV infection. At this time when CD4 cell count has gone down
below 200CD4 cells/ml, HIV develops to one or more severe op-
portunistic infections or cancer.
Exercise 1
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