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Getting the Best HIV Treatment

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9 Symptoms Never to Ignore If You Have HIV

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    Understand Your Body
    Today, HIV infection is a chronic manageable condition. With the right care, it should have minimal impact on how you feel and live. If you’re doing well on HIV treatment, most illnesses and symptoms you experience in life will be unrelated to HIV infection. But people with HIV are still at higher risk of some serious health problems, especially those at more advanced stages of the disease. That’s why it’s important that you know which symptoms to take seriously. This is not a complete list, but it should help you know some of the symptoms that require immediate medical attention.
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    1. A Low CD4 Cell Count
    A low CD4 count is not a symptom, but your CD4 cell count (CD4 count) is the best measure of the health of your immune system. It is the most important test to determine your risk of complications of HIV disease. A CD4 count above 500 is considered normal, making complications unusual. Rarely, people with normal CD4 counts will develop some HIV-related cancers such as lymphoma and Kaposi sarcoma, especially if they’re not on treatment. When your CD4 count is between 200 and 500, you have mild-to-moderate immunosuppression. You may be at increased risk of some infections that can occur in HIV-negative people, such as pneumonia, herpes, tuberculosis, shingles, vaginal candidiasis, and fungal skin and nail infections. When you have a CD4 count below 200, you are considered to have AIDS. In addition to the complications already discussed, you are now at risk for certain opportunistic infections (OIs, infections that only happen to immunosuppressed people), including Pneumocystis pneumonia (PCP), oral candidiasis (“thrush”), and oral hairy leukoplakia (OHL).
  • Treating That Cough
    2. Cough and Shortness of Breath
    Anyone, whether HIV-positive or –negative, can develop bacterial pneumonia. Depending on the CD4 count, the risk may be higher with HIV infection, which is why all HIV-positive people should be vaccinated against pneumococcal pneumonia. At CD4 counts less than 200, a persistent cough (usually dry) and worsening shortness of breath with fever can be symptoms of Pneumocystis pneumonia (PCP) or other HIV-related pneumonias. People with CD4 counts less than 200 should be on PCP prophylaxis.
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    3. Headache
    Transient headaches that get better on their own or with mild pain medications are common and don’t require medical attention, but persistent headache, especially with a fever and/or stiff neck, should never been ignored. At CD4 counts below 100, headache and fever can by symptoms of cryptococcal meningitis, other forms of meningitis, or brain lesions caused by toxoplasmosis, lymphoma, or other HIV-related conditions. A simple blood test can be used to screen for cryptocococcal meningitis. Brain imaging with CT or MRI and/or a spinal tap may also be necessary to evaluate these symptoms.
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    4. Weakness, Numbness, or Seizures
    Any seizure and any new muscle weakness or numbness (especially if affecting only one side of the body) should be evaluated immediately regardless of CD4 count. These are symptoms that could indicate the presence of a brain lesion that needs to be treated immediately. Such lesions are more common in people with low CD4 counts, but stroke, another cause of seizures, weakness, or numbness, can happen in anyone, regardless of HIV status or CD4 count.
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    5. Weight Loss
    HIV-related “wasting” is now an uncommon cause of weight loss because of effective HIV therapy. If you have HIV and you’re not on treatment, any weight loss should be taken seriously, and you should start treatment right away. Unintentional weight loss can still occur for many other reasons. Common causes include depression or anxiety, hormone problems (including hyperthyroidism, adrenal insufficiency, or low testosterone levels in men), and gastrointestinal problems, including nausea, diarrhea, abdominal pain, or esophagitis causing swallowing problems.
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    6. Difficulty Swallowing
    Dysphagia (difficulty swallowing) or odynophagia (pain with swallowing) can be symptoms of esophagitis: inflammation or infection of the esophagus, the tube that connects your throat to your stomach. HIV-related esophagitis tends to occur in people with CD4 counts below 100. It can be caused by Candida (a yeast), cytomegalovirus (CMV), herpes, or aphthous ulcers. Regardless of the CD4 count, any persistent swallowing problems should be evaluated, often with an upper endoscopy, in which a flexible tube with a camera is inserted into your esophagus while you’re sedated.
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    7. Diarrhea
    Brief episodes of diarrhea, with or without nausea, are common, usually due to viral infections or eating contaminated food. You don’t need to see a doctor just because you have diarrhea, but seek medical attention if you can’t keep yourself hydrated or if your diarrhea is persistent, bloody, or if you have abdominal or rectal pain. At CD4 counts below 100, chronic diarrhea can be caused by OIs such as cryptosporidiosis, microsporidiosis, disseminated MAC, or CMV infection. Current HIV medications rarely cause diarrhea, but some can cause loose stools. Daily use of fiber supplements can make stools more solid.
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    8. Depression
    It’s normal to feel sad, discouraged, or demoralized at times, especially when adjusting to life changes such as an HIV diagnosis. True depression is never considered normal, and should always be evaluated. Depression is not just sadness. Symptoms can include prolonged feelings of hopelessness, apathy, social isolation, anxiety, insomnia or excessive sleeping, loss of sex drive, loss of appetite or excessive eating, and the inability to enjoy activities or people that you usually find enjoyable. Depression is treatable: antidepressants usually begin to work after 2 to 3 weeks. Therapy or counseling can also be useful, especially if used in conjunction with medications.
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    9. Fever
    Brief episodes of fever often occur with common viral infections (colds, flu, gastroenteritis) and do not always need to be evaluated or treated. Common respiratory infections (colds, influenza, bronchitis, sore throat, sinusitis, ear aches) are usually caused by viral infections, which don’t usually require treatment except for over-the-counter medications to manage symptoms. Fever itself is rarely dangerous; it’s part of your body’s way of fighting infection. Treat your fever only if it’s making you uncomfortable. The problem with fever is when it’s caused by a serious infection that does need to be treated. Prolonged fever should always be evaluated. Fever is more likely to be caused by serious infections as the CD4 count declines, especially below 200.
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    Prevent Symptoms and Complications
    There are many things you can do to prevent HIV-related symptoms and complications. The most important is to keep your viral load undetectable at all times with HIV therapy. Having an undetectable viral load lowers your risk of complications, even if the CD4 count remains low. Take the recommended prophylaxis (preventive measures): daily medications to prevent OIs.

    Vaccinations are also important in preventing complications of HIV infection. Recommended vaccines include the yearly flu vaccine, a series of vaccines to prevent pneumococcal pneumonia, the hepatitis A and B vaccines if you’re not already immune, the human papillomavirus (HPV) vaccine if you’re under 27 years old, and a tetanus booster every 10 years with one Tdap, which prevents tetanus, diphtheria and pertussis.  If you’re over 60 and you have a CD4 count above 200, consider the shingles vaccine.
9 Symptoms Never to Ignore If You Have HIV

About The Author

Dr. Joel Gallant, MPH, is an expert on HIV infection and AIDS with Southwest CARE Center in Santa Fe, NM.
View his Healthgrades profile >
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THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.