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44 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 7 Phase 4 Phase 4 of HIV is the transition from a person being HIV positive to having AIDS. The line in the sand is when circulating CD4 cells drop below 200 units per cubic millimeter. (That's down from normal levels of 800–1,200 circulating CD4 cells per cubic millimeter of blood.) COMPLICATIONS When circulating levels of CD4 cells drop below 200 per cubic millimeter of blood, some of the complications related to a weakened immune system—the diseases and infections that develop when so many immune system cells have been destroyed—begin to arise. These are sometimes called "indicator diseases," and here are some of the most typical ones: • Cytomegalovirus: this is a common member of the herpes family that is typically not threatening to people with healthy immune systems. In those who are immune-compromised, it can cause gastroenteritis, retinitis with a risk of blindness, and other complications. • Herpes simplex and herpes zoster (shingles) are infections that are common in the general population, but occur more frequently, and possibly more severely, in people who have compromised immune systems. • Kaposi sarcoma: this is a type of cancer that is linked to infection with human herpesvirus 8. It can affect any part of symptoms are present. But during this time, it is spreading through the body, and it is communicable to other people. This phase lasts from a few weeks to six months. Phase 2 Phase 2 is called the acute primary phase, and it brings the first symptoms of infection. At this point, the immune system has caught on to the fact that an invader is present, and it launches a counterattack. The appropriate T cells and B cells get busy, and soon HIV antibodies are in the blood, so blood tests are now accurate. Many people have only minor symptoms during this phase, but some have fever and fatigue that look like flu or mononucleosis for a couple of weeks. Phase 3 Phase 3 of an HIV infection is called the asymptomatic phase, or the clinical latency stage. This phase has no specific symptoms, and the opportunistic diseases that we associate with AIDS are not active. The infection is progressing, but the immune system is able to keep up, so circulating CD4 cells are at normal or nearly normal levels. The drug therapies currently used for HIV infections work to keep people in this asymptomatic phase for as long as possible. These drugs don't eradicate the virus from the body, but they can interfere with the transcribing of the RNA into DNA that has to happen for the virus to replicate. It's unclear how long the asymptomatic phase might last, because some very successful treatment options exist right now. Without treatment, it usually lasts less than 10 years. But with treatment, many patients persist in the asymptomatic phase for decades. the body. It is most easily seen in the skin, but most dangerous when it affects the lungs, lymph nodes, or intestines. • Lymphoma, especially Hodgkin's and non-Hodgkin's lymphoma: these are cancers that begin in lymph nodes and affect lymphocytes (one of the types of cells most aggressively targeted by HIV ). • Oral thrush: this is a version of candidiasis, in which internal yeasts become prevalent. It is marked by white lesions inside the mouth; if it also invades the esophagus, trachea, bronchi, and lungs, it can be a serious problem. • Pneumocystis jiroveci pneumonia (also known as pneumocystis carinii pneumonia or PCP): this is a fungal infection of the lungs, and it is almost unknown outside of people who are severely immune-compromised. • Toxoplasmosis: toxo is an infection caused by a parasite that is carried by mammals (including cats) and excreted in their feces. This is why people who are HIV positive or otherwise immune-suppressed need to take extra care in changing their cats' litter boxes. Toxo is also found in beef and pork: meats need to be frozen for at least 24 hours and/or cooked to an internal temperature of at least 150 degrees Fahrenheit to kill these pathogens.