The Human Immunodeficiency Virus (HIV) may present itself in many different ways over the course of the illness. As the body's defense system becomes less effective, early signs of immune deficiency become apparent. These tend to show up mostly in the skin, mouth and gastrointestinal tract. They are often common illnesses in the general population, but are exaggerated and harder to treat in the HIV patient.
1. Warts may be caused by the molluscum contagiosum or human papilloma viruses. These can occur anywhere on the skin, but are often found in the genital region. Freezing (cryotherapy), burning (diathermy) or surgical excision may be used to remove the warts, although the underlying virus will remain present. In HIV patients around 50% of warts will recur even after repeated treatment. The presence of warts increases the risk of developing some cancers. Regular Pap smear tests and anal examinations are essential.
2. Herpes infection may cause Herpes simplex (oral herpes, cold sores), Herpes Type 2 (genital herpes) or herpes zoster (shingles). The virus may be more severe and harder to treat in the HIV patient. Anti-viral medications are necessary with double doses often required. Extreme caution must be taken to prevent others from coming into contact with the ulcers as the HIV virus can be spread through a herpes lesion.
3. Folliculitis (ingrown or inflamed hair follicles) appears on the back and chest or sometimes on the face and limbs. It is often triggered by staphylococcus bacteria on the skin, or may occur without any apparent cause. Antibacterial body wash, steroid creams, antibiotics or ultraviolet light may be used for treatment.
4. Drug-induced rash. HIV patients are 10 times more likely than the general population to react to antiviral or antibiotic medications (usually sulfonamides). The skin rash can range from mild to severe and may be sensitive to light. Oral antihistamines or adjustment of medications may help reduce the rash.
1. Candida albicans is a minor but very common fungal infection in HIV patients. It causes white plaques on the tongue, cheeks and palate and sometimes ulceration. Oral anti-fungal lozenges or mouthwashes are usually effective.
2. Oral hairy leukoplakia is the appearance of thick white patches on the tongue. It is painless and usually requires no treatment although it must be carefully watched as there is a high risk of malignancy.
3. Gingivitis (gum disease) can be severe in HIV patients and lead to rapid loss of teeth. Regular visits to a dentist specialising in HIV are essential, along with twice daily brushing (soft brush), antiseptic non-alcoholic mouthwashes and flossing.
4. Xerostomia (dry mouth) is caused by the HIV virus and some medications that attack the salivary glands. The lack of saliva can lead quickly to tooth decay. Regular brushing and artificial saliva mouthwashes will help keep the mouth moist.
1. Oesophagitis is caused by the spread of candida from the mouth and occurs in around 30% of patients. Antifungal medications will help.
2. Diarrhoea is a chronic symptom for about 90% of patients. Infections and medications can trigger the problem, which becomes more frequent as the disease progresses. A high-calorie intake is necessary to maintain adequate nutrition.
Remember: Patients with HIV must be under the constant care of a team of Health Professionals specialising in this condition, such as a Doctor, Dentist, Pharmacist, Sexual Health Nurse and Dietitian. Health problems that are mild in the general population can be more severe and harder to treat in the HIV patient.