Clinical Manifestations and Treatment

HIV infection has a wide spectrum of clinical manifestations and pathological abnormalities. After infection, an individual may remain free of any symptoms for years, perhaps even a decade or longer. Some individuals do experience fever, rash, and malaise at the time of infection when antibodies are first produced. Patients commonly present with general lymphadenopathy, weight loss, diarrhea, or an opportunistic infection. Diagnosis may be confirmed by the presence of antibodies for HIV or by a decline in T4 helper cells. Most experts now agree that HIV infection itself should be considered a disease regardless of symptoms.

Research efforts to develop effective therapies have centered on antiviral drugs that directly attack HIV, as well as drugs likely to enhance the functioning of the immune system. Because the virus becomes encoded within the genetic material of the host cell and is highly mutable, the problem of finding safe and effective therapies has been extremely difficult, requiring considerable basic science and clinical knowledge. Studies are currently being conducted to determine the anti-HIV properties of many drugs, but the ethical and economic obstacles to clinical trials with experimental drugs are formidable. Given the immediacy of the epidemic, it is difficult to structure appropriate randomized clinical trials, which often take considerable time, to assess the safety and efficacy of a drug. At present, the U.S. Food and Drug Administration has licensed only one drug for the treatment of HIV infection, AZT (azidothymidine) which, according to clinical studies, delays but does not prevent death. Since the beginning of the epidemic, clinical reasearch has refined the treatment of opportunistic infections. Recent studies, for example, have demonstrated the effectiveness of aerosolized pentamidine, an antibiotic, in preventing the development of Pneumocystis pneumonia. Despite these advances, expected survival currently (as of 1988) averages 2 years after the onset of symptoms. With anticipated improvements in antiviral treatments, length of survival is likely to increase.

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