HIV INFECTION AND ITS EFFECTS ON THE BODY: AIDS-RELATED COMPLEX, OR ARC-CONSTITUTIONAL SYMPTOMS
Constitutional symptoms of ARC are the vague, general symptoms that often accompany chronic illnesses. Included are weight loss, chronic weakness, diarrhea, fever, and fatigue. Any of these symptoms may also be caused by certain opportunistic infections. Because some of these opportunistic infections are treatable, when these symptoms develop. In people with HIV infection, the distinguishing feature of all of these constitutional symptoms is that they are chronic, that is, they don’t go away. Fever, fatigue, achiness, malaise, and diarrhea are periodically experienced by everyone; when they are caused by an acute viral infection like influenza, they interfere with daily activities, but only for a few days. These symptoms can be considered the constitutional symptoms of ARC only when they have been present for at least one month. The combination of these symptoms can be severe enough to meet the criteria for a diagnosis of AIDS. These symptoms usually occur only when the CD4 count is below 200. Weight loss. Weight loss is a common symptom for people with ARC. Some people lose weight simply because they lose their appetites. Some people lose their appetites because an infection in the mouth (such as thrush) makes eating difficult. Other people lose their appetites because they are depressed or anxious. Occasionally, people stop eating because food just does not taste good. In some cases, weight loss might result from the HIV infection itself. Many infections and chronic illnesses, especially if accompanied by fever and diarrhea, increase the body’s metabolic rate so much that the body requires more calories to maintain a stable weight. If the body does not get enough calories, it takes them out of the proteins in the muscles. The result is a debilitation that somehow further weakens the immune system. Weakened immune systems open the door to opportunistic infections. For these reasons a nutritious diet and an adequate exercise program may be especially important for people with HIV infection. Diarrhea. Diarrhea is also common for people with ARC. Sometimes diarrhea is caused by an infectious microbe which laboratory tests can identify. For many people, however, diarrhea is irregular: on some days loose stools are frequent and on other days bowel habits are relatively normal. Such cases of diarrhea are not often caused by an infectious microbe. Instead, they are caused either by HIV infection itself or by some opportunistic infection produced by a microbe that cannot be detected. Fever. Fever, like other constitutional symptoms, is common; it can be caused by an opportunistic infection, or it can simply be due to HIV. The temperature we call a “normal body temperature” is actually different for different people; furthermore, a person’s “normal” temperature usually varies during the course of a day. Usually a person’s temperature is relatively low in the morning and has increased by about one or two degrees by the evening. This daily fluctuation in temperature is exaggerated during any illness. Though no single temperature is considered normal for everyone, temperatures above 99.6 degrees F (37.5 degrees C) are at the upper limits of normal, especially if measured during the day (rather than at night). Most people with a fever are aware that they have a fever; nevertheless, the physician will want to know what the person’s temperature is when measured by a thermometer. Rapid rises in temperature are commonly preceded by chills. Chills are an indication of the body’s attempt to retain heat by constricting the blood vessels of the skin where heat is given off. Along with fever, some people also have “night sweats,” sweating^ night which can be severe enough to require changes in bed clothing. Night sweats are usually but not invariably accompanied by fever. The combination of fever, chills, and night sweats is relatively common in the late stages of HIV disease. Often fevers, especially fevers over 101 degrees or those accompanied by shaking chills, indicate the presence of some infection other than HIV. If you have such a fever, see a physician. The person with fever who does not have a specific treatable infection can obtain relief with aspirin, acetaminophen, or a variety of drugstore remedies that contain these agents. Acetaminophen carries on the label a warning that it causes liver or kidney damage; although the probability of this is low, it might be best to limit the amount of acetaminophen you take. The maximum adult dose is 0.6-0.9 mg (usually two or three pills) taken every four to six hours. Fatigue. Fatigue is another constitutional symptom of ARC. It is a symptom that is difficult to measure objectively. It is also hard to separate fatigue that is caused by HIV infection from fatigue caused by anxiety or depression or by an opportunistic infection. Fatigue can be part of the apathy caused by AIDS dementia; a careful neurologic examination will reveal whether this is so. Fatigue caused by HIV infection will usually be accompanied by a low CD4 cell count or a low blood count. Fatigue caused by depression may occur with CD4 counts that are high or low; it requires psychological support. Fatigue may be profound. In some instances, people may be unable to perform everyday activities, may need to sleep more, or may feel muscle aches or joint pains that limit activity as well. At the extreme, the person may reach the point of “bed-chair existence,” spending virtually all the time either in a bed or in a chair.
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