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CNS involvement:
CNS involvement is frequently seen in HIV patients. They can suffer from CNS infections caused by various organisms. But majority of them develop primary HIV related neurological dysfunction which includes both progressive as well as static encephalopathy. Patients present with disturbance of motor skills, cognition, adaptive skills and behaviour. Extrapyramidal signs or cerebellar signs can be found rarely. Serial head circumference will help detect decline in growth of brain. With time they become apathetic and lose interest in surroundings. At the end, the child becomes bedridden, dull eyed and quadriparetic.

LIP (Lymphoid Interstitial Pneumonitis): Pulmonary diseases are seen in 80% of symptomatic HIV patients. Acute diseases are usually due to infections. Chronic involvement is due to either non-lymphoid or lymphoid pulmonary diseases including LIP.

The usual age of presentation of LIP is beyond 1 year of age. The progress is indolent. Patient gradually develops tachypnea, cough, wheezing, hypoxemia and later on clubbing. Fever is usually absent. It can be associated with evidence of lymphoid hyperplasia elsewhere in the body like parotid swelling, lymphadenopathy, hepatosplenomegaly etc. Later on it progresses to chronic respiratory failure, bronchiectasis, falling 02 saturation and eventually death due to super- added opportunistic infections. Mean survival after LIP is 72 months. In a few cases natural remission can occur.

Malignancies :
40% of adults and 4% of children with HIV develop malignancies like primary brain lymphoma or Kaposi's sarcoma, which present as purplish tumors on the skin or mucocutaneous junctions.

Hematological disease: HIV being a multisystem illness leads to bone marrow affection leading to anemia and other cytopenias due to multiple factors.

Anemia:
20% of asymptomatic HIV patients, 50% patients with ARC and 75% of AIDS patients develop anemia of chronic infection. Some may develop associated iron deficiency due to chronic bleeding. Some may develop megaloblastic anemia due to use of drugs like sulfonamides. Lastly some develop bone marrow suppression and anemia following infections or drugs like AZT.

Cytopenias: 13% of HIV patients develop thrombocytopenia. It can be caused by non-immune mechanisms like infections, HIV itself, drug induced bone marrow suppression or rarely malignancies. Most commonly it is caused by immune mechanisms either immune complex mediated or due to platelet autoantibodies. ITP can be the presenting feature of HIV and can remain as its sole manifestation for years.

Ophthalmic disease: Ophthalmic problems are rare in children with HIV but are often neglected. HIV itself can directly infect various parts of eye especially retina but it is usually asymptomatic. Most of the time symptomatic ophthalmic disease is caused by infections especially CMV retinitis.

Renal disease: With longer survival of HIV patients due to ARVT, more and more patients present with renal diseases which though are not a major cause of mortality, can lead to lot of morbidity. Etiologically patients can develop renal infections mainly bacterial, CMV and Candida. They can develop changes due to HIV itself. Microvascular changes are seen in some. Lastly patients can develop nephropathy following drugs like sulpha, amphotericin B, used frequently in HIV patients. 50% of HIV patients can develop pyuria, 20% develop UTI due to Pseudomonas, E. Coli or Candida, 3% develop gross hematuria, 15% develop microscopic hematuria and 80% develop various grades of proteinuria.

Cardiovascular disease: They can develop myocarditis, pericarditis, pericardial effusion or endocarditis usually seen in IV drug abusers. They can develop various types of rhythm disturbances, which can be detected on Holter monitoring. One can see infections like CMV, bacterial infection or tuberculosis affecting the heart. Rarely they can develop neoplasms like Kaposi's sarcoma or lymphoma involving heart.

Myopathy: With long term survival and wide spread use of drug like AZT, more and more HIV patients develop myopathy and neuropathy. It can be seen as an isolated problem or as part of AIDS dementia complex. Various factors have been implicated as the cause. The include HIV itself, CMV, immune mediated injury, nutritional deficiency, prolonged immobilization and lastly drugs like DDC, DDI, AZT etc. Rarely one can see pyomyositis.

HIV and Skin disorders: Almost all HIV infected children develop some or other skin disorder sometime. Skin changes seen in HIV children include various types of infections, inflammatory conditions and rarely neoplasm. Most of these are also seen in non - HIV children. In HIV children they tend to be more severe, widespread, atypical, chronic recurrent and difficult to treat.

HIV patients develop superficial or deep bacterial skin infections, fungal infections especially seborrheic dermatitis with candidiasis, onychomycosis, herpetic skin lesions, H. Zoster or recurrent and multiple molluscum contagiosum lesions. Warts due to papilloma virus can be widespread and may be flat lesions leading to confusion with other infections. Presence of condyloma should also arouse suspicion of sexual abuse.

HIV :
GI tract diseases: GI tract problems are very common in HIV patients and present as infectious or non-infectious diseases. Non-infectious diseases include malabsorption, AIDS wasting syndrome and rarely malignancies. Infections are the commonest cause of GI problem. Patient can develop acute diarrhea including dysentery, chronic nonspecific diarrhea or post- diarrhea malabsorption, infectious esophagitis and hepatobiliary infection. Diarrhea is seen in >80% of HIV infected cases and > 95% have weight loss as the disease progresses.

Also See Article On "AIDS and HIV"

Last created on 23-02-2001
Last updated on 26-05-2007