Once called “AIDS wasting,” weight loss is a sign of more advanced illness and could be due in part to severe diarrhea. ”If you’re already losing weight, that means the immune system is usually fairly depleted,” Dr. Malvestutto says. “This is the patient who has lost a lot of weight even if they continue to eat as much as possible. This is late presentation. We still see a lot of these.” It has become less common, however, thanks to antiretroviral therapy.
A person is considered to have wasting syndrome if they lose 10% or more of their body weight and have had diarrhea or weakness and fever for more than 30 days, according to the U.S. Department of Health and Human Services.
Have a bad cough that Benadryl, antibiotics, and inhalers don’t seem to fix? This symptom—an “insidious cough that could be going on for weeks that doesn’t seem to resolve,” Dr. Malvestutto says—is typical in very ill HIV patients.
About half of people get night sweats during the early stages of HIV infection, Dr. Malvestutto says. These can be even more common later in infection and aren’t related to exercise or the temperature of the room. Similar to the hot flashes that menopausal women suffer, they’re also hard to dismiss, given that they soak your bedclothes and sheets.
Another sign of late HIV infection are nail changes, such as clubbing (thickening and curving of the nails), splitting of the nails, or discoloration (black or brown lines going either vertically or horizontally). Often this is due to a fungal infection, such as candida. “Patients with depleted immune systems will be more susceptible to fungal infections,” Dr. Malvestutto says.
Another fungal infection that’s common in later stages is thrush, a mouth infection caused by Candida, a type of yeast. ”It’s a very common fungus and the one that causes yeast infections in women,” Dr. Malvestutto says. “They tend to appear in the mouth or esophagus, making it difficult to swallow.” Ron woke up one day to find white patches on his tongue. He had thrush. For him, “It was not bothersome other than I didn’t like having it.” The infection was hard to get rid of, but finally cleared up after Ron started taking drugs to combat HIV.
Confusion or Difficulty Concentrating
Cognitive problems could be a sign of HIV-related dementia, which usually occurs late in the course of the disease. In addition to confusion and difficulty concentrating, AIDS-related dementia might also involve memory problems and behavioral issues such as anger or irritability. It may even include motor changes: becoming clumsy, lack of coordination, and problems with tasks requiring fine motor skills such as writing by hand.
Cold Sores or Genital Herpes
Cold sores (oral herpes) and genital herpes can be a sign of both ARS and late-stage HIV infection. Having herpes can also be a risk factor for contracting HIV. This is because genital herpes can cause ulcers that make it easier for HIV to enter the body during sex. And people who have HIV tend to have more severe herpes outbreaks more often because HIV weakens the immune system.
Tingling & Weakness
Late HIV can also cause numbness and tingling in the hands and feet. This is called peripheral neuropathy, which also occurs in people with uncontrolled diabetes. ”This is when the nerves are actually damaged,” Dr. Malvestutto says. These symptoms can be treated with over-the-counter pain relievers and antiseizure medicines such as Neurontin (gabapentin).
Advanced HIV disease appears to increase the risk of having menstrual irregularities, such as fewer and lighter periods. These changes, however, probably have more to do with the weight loss and poor health of women with late-stage infection rather than the infection itself. Infection with HIV also has been associated with earlier age of menopause (47 to 48 years for infected women compared to 49 to 51 years for uninfected women).