Understanding the devastation of AIDS

A patient admitted to your unit this morning presents a dauntingly complex clinical picture. Maria DeJesus, 34 years old, has HIV infection, which progressed to AIDS last year with an episode of Pneumocystis carinii pneumonia. She's also experienced recurrent vaginal and esophageal candidiasis and cryptococcal meningitis, and her more recent history includes peripheral neuropathy, causing pain and numbness, as well as cognitive and motor function problems. Her admission was prompted by diarrhea that has persisted despite outpatient treatment. To provide the best care for patients like Ms. DeJesus, you need to understand HIV infection and the diseases associated with it. Yet that's a challenging task, given that the possible manifestations of advanced infection are so many and varied. Though your approach to care is holistic, you may find it helpful to consider the numerous facets of the patient's illness individually. In the following pages, we'll examine how HIV enters the body, infects immune cells, and eventually cripples the immune system. We'll look at some of the more common opportunistic infections preying on people with HIV. And we'll explore the less well-charted territory of complications attributed to HIV infection of the central and peripheral nervous systems.