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Symptoms
It’s worth knowing the range of symptoms you might experience so that you can seek medical advice as soon as possible when you need it.
People with HIV get all the routine illnesses such as colds and flu that HIV-negative people get. So a chesty cough or diarrhoea could just be the result of the latest bug doing the rounds. But it could be something more serious, particularly if you have a low CD4 cell count. If your symptoms last for more than a few days, then you should see your doctor as quickly as possible.
What’s more, anti-HIV drugs can cause side-effects. On the whole, these are minor and go away with time, but they can be more serious, and in certain circumstances dangerous.
Being able to get medical advice in an emergency is important. So it’s worth finding out how you can get help from your clinic in an emergency or outside normal opening hours. You should also make sure that you are registered with a GP, who are the only doctors who can visit you in your home in the event of an emergency.
Doctors will always begin by asking you about your symptoms and examining you for signs of infection or allergy. They may then do a range of tests. Your doctor should explain what these tests are and why they are being undertaken.
Fevers and tiredness
These are sometimes called ‘constitutional’ symptoms because they affect the whole body. They can be the result of your body’s attempt to fight an infection, and so can be caused by many different illnesses, and can also be caused by allergic reactions to some medicines.
Taking paracemtamol can help reduce fevers, but should be used with caution by people with liver problems.
Night sweats
These are a common problem, and may be either mild and infrequent or quite severe, resulting in the need to change your bed linen or clothes.
Causes
If it is a new problem and accompanied by a fever, an acute infection is often the cause. More specific causes include tuberculosis and lymphoma. If the night sweats are intermittent and/or localised, then HIV infection is usually responsible; this is inconvenient but not a significant medical concern. Anxiety can also result in night sweats.
What to do
It is important to try to track down any infections (other than HIV itself) that could be causing the sweats, especially if they are accompanied by fever. Practical measures such as taking an aspirin or paracetamol before sleeping may be helpful. If the symptoms are severe and accompanied by other symptoms of HIV disease, then anti-HIV drug treatments may be considered.
Chest and breathing problems
Chest problems are very common and can be can caused by colds, flu, smoking, asthma, and bronchitis. However, people with HIV are particularly vulnerable to some potentially life-threatening chest infections, such as PCP pneumonia and tuberculosis. Coughs and difficulty breathing should be taken seriously, particularly if the symptoms last more than a few days. It’s also worth knowing that breathing problems can be a symptom of a severe allergic reaction to certain medicines.
Standard tests used if you have chest or breathing problems include:
- Checking your temperature. A high temperature can be a sign that you have an infection, and if your temperature goes above 102, you should see your doctor as soon as possible.
- A blood count. A blood sample is taken to see if your red blood cells, which carry oxygen, are depleted.
- A chest x-ray. This will show if there is inflammation or fluid on the lungs.
- A sputum culture. A sample of spit or phlegm is taken to see if there is any sign of infection.
In some circumstances, you may need to have a bronchoscopy. This involves passing a very small tube down with a tiny camera attached down a nostril or the throat into the lungs. A small tissue sample, called a biopsy, may also be taken. Bronchoscopies are only performed if doctors are uncertain what the cause of a chest problem is. They can be uncomfortable and if you need to have one you will normally be offered Valium.
Skin problems
Skin problems are common in people with HIV.
A common skin complaint in people with HIV is seborrhoeic dermatitis. This can cause scaly patches on the skin, and can be successfully treated with ointments.
A red rash might be the result of an allergic reaction to a medicine. If this happens to you, see your doctor as soon as possible.
Small, painful blisters around the mouth, genitals and anus can be caused by herpes simplex virus. Herpes can be controlled using aciclovir (for more information see Sex and HIV ).
Small colourless bumps on the skin with a pearly top can indicate that you have molluscum contagiosum (molluscum for short). You are particularly likely to get this if you have a low CD4 cell count, and they can spread around the body quite rapidly. They are treated by freezing them off or by surgery. If you develop them before starting anti-HIV treatment you may well find that they go away by themselves once your immune system strengthens.
Small cauliflower-like growths are probably warts. For more information see Sex and HIV .
Black, purple or dark brown spots on the skin can be a sign of the AIDS-defining cancer Kaposi’s sarcoma (KS). To have this properly diagnosed, a sample of skin from the affected area needs to be biopsied. KS has become quite rare since effective anti-HIV treatments became available, but it can still be quite serious, so if you notice any unusual marks on your skin, make sure you bring them to your doctor’s attention.
Mouth problems
Good dental hygiene including twice-daily brushing and flossing once a day will help you avoid most routine mouth problems.
However, people with HIV, particularly those with a low CD4 cell count, can be vulnerable to oral thrush, a fungal infection. Keep an eye out for white patches in the mouth. These can be painful, particularly if they are at the top of the throat, and can also cause an unpleasant taste. Oral thrush is easy to treat with a single dose of anti-fungal medication or lozenges. Once you start taking anti-HIV treatment and your immune system gets stronger, you’ll probably find that you stop getting thrush.
If the white patches in your mouth are slightly hairy, then you might have an infection called oral hairy leukoplakia. This is caused by a virus and is treated with aciclovir. Again, you’re likely to stop getting it once your immune system gets better after starting anti-HIV treatment.
Herpes blisters can affect the lips and mouth and can be treated with aciclovir. Mouth ulcers are more common in people with HIV, particularly people with lowish CD4 cell counts, but mouthwashes can help relieve the pain they cause. Mouth ulcers can also be a side-effect of some anti-HIV drugs.
Digestion problems
Pain or difficulty swallowing can be caused by oesophageal problems. The oesophagus is the tube that food passes down. Pain in the abdomen, nausea, vomiting, diarrhoea and constipation can all indicate stomach problems.
If these problems last more than a few days, or you start to lose weight, then see your doctor. Also, remember that most anti-HIV drugs can cause digestive problems, but these tend to pass with time and drugs can be taken to help control the symptoms.
Eye problems
You should have a periodic eye test, just like everybody else, to check your vision.
If you have a very low CD4 cell count, you should take problems with your vision very seriously. Blurred vision, blind spots, eye pain, or spots moving across the eye can all be symptoms of CMV (cytomegalovirus). This can be treated, but treatments work best if any eye damage is caught early.
Head problems
Everybody gets headaches from time to time. However, some anti-HIV drugs can cause problems with the head, as can certain infections, if you have a low CD4 cell count.
If you have any problems with your head lasting more than a few days, or any headaches which don’t go away with normal painkillers such as paracetamol or ibuprofen, then see your doctor.
Side-effects caused by anti-HIV drugs tend to go away after time, and if they don’t and you find that the head problems you are experiencing lower your quality of life, then speak to your doctor. It may be possible to change your medication.
Brain infections, such as toxoplasmosis and meningitis, are rare since the introduction of effective anti-HIV treatment. So too is AIDS-related dementia and lymphoma involving the brain. But if you experience symptoms of confusion, memory loss, poor concentration, speech problems or blackout tell your doctor immediately, particularly if you have a low CD4 cell count.
Depression is more common amongst people with HIV. For more information see Mental health .
Nerve problems
People with HIV can also experience problems with their peripheral nerves. This is called peripheral neuropathy, and it can be caused by HIV infection itself, or be a side-effect of drugs used to treat HIV and some other infections.
There is a lot more information on peripheral neuropathy earlier in this chapter.