Men's Health Education: In-depth Analysis of the Multi-system and Organ Damage Manifestations Caused by AIDS (Part 2)

Specific Manifestations of Multi-Organ and Multi-System Damage

1. Cardiovascular Damage: The heart may develop pericarditis, cardiomyopathy, and endocarditis. Pericarditis: All cases involving the pericardium also involve cardiomyopathy, manifesting as fever, chest pain, and cardiac tamponade. Pericardial aspiration fluid is bloody or serum-like, and cultures are often negative. Cardiomyopathy:

a. Lymphocytic myocarditis: Anderson et al. reported that in 37 out of 71 autopsies, myocarditis was present, mostly showing nonspecific inflammatory infiltration without myocardial cell damage; only 7 cases showed viral, bacterial, and fungal infections.

Non-inflammatory myocardial necrosis: HIV, CMV, and other opportunistic viral pathogens were isolated from endocardial myocardial biopsy specimens. Furthermore, it is believed that prolonged stress in patients leads to excessive catecholamine secretion, causing microvascular spasm, resulting in myocardial ischemia and necrosis. Congestive cardiomyopathy: Related to viral infection, cardiotoxins, microcirculatory ischemia in hypersensitive states, nutritional deficiencies, and side effects of AIDS treatment drugs.

Endocarditis: Manifests as nonbacterial thrombotic endocarditis, affecting all valves, but malignancy and stress are considered active factors, damaging endothelial cells, exposing the matrix, and activating the coagulation mechanism, thereby triggering local deposition of platelets and fibrin. Bacterial endocarditis is an opportunistic infection in AIDS patients, which can cause hemiplegia, aphasia, etc. due to embolism, but rarely presents with heart murmurs or positive blood cultures.

Vascular damage: Inflammatory changes are mainly vasculitis and endocarditis. Fibrocalcific arterial disease is caused by direct damage from HIV infection, with typical changes including intimal fibrosis, elastic tissue rupture, medial fibrosis and calcification, and luminal narrowing. Neoplastic cardiac damage: Kaposi's sarcoma is a nodular sarcomatous lesion affecting the anterior wall of the heart, manifesting as cardiomegaly, sinus tachycardia, gallop rhythm. The common cause of death is cardiogenic shock, with heart failure being less common.

Malignant lymphoma: Manifests as cardiomegaly, congestive heart failure, and progressive cardiac conduction block; some cases are accompanied by pericardial effusion. Drug-induced cardiovascular damage: Orthostatic hypotension may occur in some cases when pentanemid is used to treat Pneumocystis carinii pneumonia. Sinus bradycardia and conduction block, even sudden death, may occur when intravenously infused with difluoromethyl ornithine to treat fungal infections. Amphotericin B can cause hypotension and arrhythmias. The cytotoxic agent doxorubicin can cause myocarditis. Alpha-interferon can cause blood pressure fluctuations and tachycardia.

2. Lung damage: More than 50% of AIDS patients have lung damage. Several weeks before diagnosis, fever and weight loss may occur. When complicated by infection, symptoms include cough, chest pain, dyspnea, dry or wet rales in the lungs, or effusion. One study of 1067 AIDS patients showed that 441 (41%) had lung lesions, with the following incidence rates: Pneumocystis carinii pneumonia (85%), Mycobacterium avium (17%), CMV infection (16%), Kaposi's sarcoma (8%), tuberculosis (4%), and, based on other reports, pulmonary tuberculosis with a significantly higher incidence. Legionnaires' disease pneumonia (4%) is another possibility. Other infections include pyogenic bacteria, fungi, herpesviruses, adenoviruses, and Toxoplasma gondii. Key diagnostic methods include sputum acid-fast bacilli examination, chest X-ray, chest CT scan, lung gallium-6 scan, MRI, bronchoscopic biopsy, and lavage fluid sediment smears.

3. HIV-related nephropathy: Incidence 20%–50%. After kidney damage occurs, the disease progresses rapidly, often resulting in death within 16 weeks of diagnosis. Cross-reactions have been found between HIV envelope glycoproteins and surface antigens of lymphocytes and monocytes, thus allowing for the detection of multiple specific autoantigens in AIDS patients. Some researchers have found anti-collagen antibodies against type I and III collagen in the serum of AIDS patients. Factors contributing to kidney damage in AIDS patients can be summarized as follows: HIV may cause focal segmental glomerulosclerosis (FSGS); immunopathological damage; opportunistic infections can cause glomerulonephritis and interstitial nephritis, such as CMV and EBV causing immune complex nephritis, and HBV causing membranous nephropathy. Heroin-associated nephropathy (HAN): Some believe that heroin or its contaminants act as antigens, leading to kidney damage through immune responses; Kaposi's sarcoma affects the kidneys; and nephrotoxic drugs, such as suramin and acyclovir injections, can also cause kidney damage.

Pathological changes and clinical manifestations of AIDS-related nephropathy: Patients with predominantly renal parenchymal damage may present with edema, hypertension, changes in urine, and abnormal renal function. Patients presenting primarily with nephrotic syndrome often exhibit severe edema, massive proteinuria, hyperlipidemia, and hypoalbuminemia. Reports indicate that in the acute renal failure group, the main manifestations are tubular necrosis and interstitial nephritis, with pathological examination consistent with this diagnosis; in the chronic renal failure group, the main manifestation is nephrotic syndrome, which may be accompanied by azotemia and renal failure, with pathological examination showing focal segmental glomerulosclerosis and membranous nephropathy, progressing to end-stage renal failure within 4–16 weeks.

4. Skin and mucous membrane lesions: Divided into infectious and non-infectious types. Infectious: HIV-positive individuals have reduced Langerhans cells in the skin, leading to decreased cellular immunity, making them susceptible to infection, which is difficult to treat and prone to recurrence. Common infections include:

a. Herpes simplex virus infection: Can be localized or diffuse, manifesting as severe herpes on the oral cavity, genitals, and perianal area, which can recur repeatedly, is persistent, and may have deep ulcers; the virus can be isolated from the lesions. HIV can also cause herpetic proctitis, leading to rectal discharge, rectal bleeding, and tenesmus.

b. Herpes zoster virus infection: Herpes zoster often reappears along the trigeminal nerve or intercostal nerves, presenting in a band-like distribution, causing severe pain and easily leading to secondary infections.

c. Poxvirus infection: Infected through sexual contact, it mostly occurs in the perianal area and external genitalia, manifesting as persistent disseminated lesions consisting of dozens or hundreds of umbilical papules or molluscum contagiosum.
d. Fungal infections: Commonly seen are tinea and onychomycosis; if there is disseminated Cryptococcus neoformans or Histoplasma capsulatum infection, it can manifest as cellulitis, ulcers, vasculitis, purpura, or papular lesions.

e. Mycobacterium tuberculosis or Mycobacterium avium infection: Multiple papules, lymphadenopathy, or fistula formation may occur.

f. Skin lesions caused by CMV infection, common warts and condyloma acuminata caused by PLV infection, and oral hairy leukoplakia caused by EBV have been described in the section on opportunistic infections.

Non-infectious lesions:

a. Seborrheic dermatitis-like rash. Common in AIDS patients, the pathogen is unclear. It presents as coarse, oily, yellow scales on an erythematous base, which may appear butterfly-shaped on the face.

Sometimes accompanied by fever, joint pain, and diffuse adenosis, requiring differentiation from systemic lupus erythematosus; sometimes, this rash resembles psoriasis. Histological examination reveals superficial perivascular lymphocytic infiltration and plasma cells in the dermis, with mild psoriatic hyperplasia in the epidermis and scattered necrotic parakeratotic cells within the epidermal cells.

b. Squamous cell carcinoma of the skin and primary tumors of the anus and rectum. The former is thought to be related to herpesvirus and papillomavirus infection, while the latter is thought to be closely related to male homosexual anal sex.

c. Both lymphoma and KS can present with skin nodules.

5. Musculoskeletal system: May manifest as migratory, symmetrical redness, swelling, heat, and pain in the joints, resembling rheumatic fever, with poor response to antirheumatic treatment. It can also present as polymyositis, with significant muscle tenderness; muscle biopsy reveals necrotizing myositis. It is speculated to be related to hypergammaglobulinemia, circulating immune complex deposition, and autoantibody formation.

6. AIDS-related retinitis: Incidence can be as high as 75%, and is believed to be related to CMV, HZV, and toxoplasmosis infection. It is a major cause of blindness in AIDS patients. Fundus examination reveals primary lesions on the retina as small yellowish-white dots, which may merge to form cotton wool spots. Centrifugally distributed hemorrhagic necrotic foci are visible along the blood vessels, related to damage to the vascular adventitia. In high-risk groups or HIV-infected individuals, unexplained blurred vision accompanied by progressive weight loss should raise suspicion of this disease.

7. Mental abnormalities: Can occur before, during, or after AIDS diagnosis. A diagnosis of HIV infection is a devastating blow to patients, potentially leading to reactive psychosis. As the disease progresses, functional and organic damage to the nervous system may occur. Specific manifestations include:

a) Emotional pathology, manifesting as severe depression.

b) Adjustment changes, restlessness, accompanied by depression or anxiety.

c) Pathological unrealistic desires, cravings for the impossible.

d) Apathy, extravagance, and teetering on the brink of despair.

e) Personality changes, indecisiveness or social isolation.

f) Feelings of loss and suicidal ideation.

g) Schizophrenia.

8. Periodontal disease: HIV-related gingivitis and periodontitis have been reported to be quite common in heterosexual men and women with HIV, and are often accompanied by other HIV-related oral manifestations.

9. Endocrine system changes: One study found that 9/98 patients had low baseline and post-stimulation serum cortisol levels, decreased T³ and T⁴, and 29% of male AIDS patients had reduced serum testosterone; another study found that autopsy showed almost complete destruction of the adrenal cortex.