AIDS: Clinical Manifestations


Human immunodeficiency virus (HIV) affects the host's immune system over time. As a result, HIV‐infected people can experience a wide range of clinical manifestations, especially if the infection is not treated with combination antiretroviral therapy (cART). In advanced stages of the disease, patients eventually risk severe illnesses. More than 20 conditions, including opportunistic infections and malignancies, have been classified as acquired immune deficiency syndrome (AIDS)‐defining illnesses. With the success of cART producing long‐term viral suppression and immune reconstitution, the major clinical complications of chronic infection now are serious non‐AIDS‐related events. This term refers to an increasing rate of cardiovascular, liver and renal diseases as well as neoplasms occurring in long‐term treated patients with longer life expectancies. However, there are still significant differences in access to and availability of antiretroviral therapy throughout the world which leads to contrasting patterns in the spectrum of AIDS‐defining illnesses in resource‐limited settings and developed countries.

Key Concepts:

  • AIDS arise from a compromised immune system and the resulting loss of host defences and immune surveillance mechanisms.

  • The spectrum of AIDS‐defining illnesses varies in developed and resource‐limited settings.

  • Pneumocystis jiroveci pneumonia is the most common AIDS‐related illness in developed countries.

  • Tuberculosis is the most common AIDS‐related illness in developing countries.

  • Many AIDS‐related infections represent recrudescence of latent infection rather than de novo acquisition.

  • Antiretroviral therapy has had a significant impact on the spectrum of ADIs.

  • AIDS‐related malignancies occur at increased rates in chronically infected patients and these tend to have a viral associated aetiology.

  • Effective antiretroviral therapy has resulted in prolonged suppression of viral replication, sustained immune reconstitution and very substantial reductions in AIDS‐related morbidity and mortality.

  • Owing to increases in life expectancy resulting from effective antiretroviral therapy serious non‐AIDS‐related illnesses have become more important in clinical management.

Keywords: HIV; AIDS; clinical spectrum; opportunistic infections; SNAEs; cancer

Figure 1.

CD4 range and AIDS clinical spectrum. List is indicative, not exhaustive. Adapted from Crowe SM, Carlin JB, Stewart KI, Lucas CR and Hoy JF (1991) Predictive value of CD4 lymphocyte numbers for the development of opportunistic infections and malignancies in HIV‐infected persons. Journal of Acquired Immune Deficiency Syndromes 4(8): 770–776. © Lippincott Williams.



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Pinto, Angie N, Kelleher, Anthony D, and Cooper, David A(Jun 2014) AIDS: Clinical Manifestations. In: eLS. John Wiley & Sons Ltd, Chichester. [doi: 10.1002/9780470015902.a0002237.pub3]