HIV: PROBLEMS AFFECTING THE WHOLE BODY-FEVER
Symptoms that affect the whole body, or constitution, are called constitutional symptoms. Constitutional symptoms include fever, night sweats, weight loss, fatigue, lethargy, and malaise. All these symptoms are relatively common both in the general population and in people with HIV infection. People with HIV infection tend to have constitutional symptoms when the CD4 count is low, unless the people are also depressed or have some unrelated medical problem like influenza. Some of these symptoms—fatigue, lethargy, malaise—are subjective and difficult to measure. Others—fever, severe weight loss (wasting)—are more objective. Fever-Physicians always want to know when a person with HIV infection has a fever: fever is an objective indication of a problem that is not just a day-to-day variation in health status. Fever, especially prolonged fever in people with low CD4 counts, is usually the result of infections. In people with HIV infection, the infections that are most likely are tuberculosis, sinusitis, Mycobacterium avium-intracellulare infection, cytomegalovirus infection, fungal infection, Pneumocystis pneumonia, and lymphoma. Most people with fever are aware of it. They cannot tolerate the usual range of heat and cold that most people consider normal room temperature; they have chills and sweats. In people with HIV infection, fevers often begin gradually, occurring off and on for extended periods of weeks or months. The fever is often accompanied by sweating at night, called night sweats, that may be severe enough to require changes in pajamas and sheets. It is important to measure the fever. The body temperature that is normal differs for different people and at different times of the day. The average temperature is 97 degrees F at 3:00 A.M. and 99.3 degrees F at 5:00 P.M. In general, temperatures are about two degrees higher (on the Fahrenheit scale) in the late afternoon than they are in the morning. A fever usually exaggerates this daily variation, and the highest temperatures usually come after 6:00 P.M. For this reason, people with HIV infection who think they have a fever should take their temperatures several times during the day, when they feel feverish, and in the late afternoon. Although there is no general agreement on the precise definition of fever, most physicians consider 99.6 degrees F or 100 degrees F to be a fever. (Temperature is measured on two scales: the Fahrenheit, or F scale, commonly used in the United States, and the centigrade, or C scale, used in the rest of the world and in some hospitals in the United States. A temperature of 98.6 degrees F corresponds to 37 degrees C.) Fever is basically treated by treating whatever is causing it. Treating fever itself is a little controversial. Fever actually has advantages: the immune system works better at higher temperatures, and fever is an important indicator of the course of the disease and of the effectiveness of treatment. But fever is also unpleasant for the person who has it and increases the metabolic rate, burning more calories and making good nutrition more difficult. Otherwise, there is little evidence that fever is harmful. When the decision is made to reduce fever, the usual drugs are aspirin or acetaminophen. The fever decreases or disappears when people take one of these drugs, but returns when the effect of the drug wears off. For people with persistent fever, these fluctuations in temperature can be more unpleasant than a steady, if high, temperature. For this reason, people with persistent fevers are often advised to take these drugs regularly, every four to six hours, without waiting for the fever to recur.*136\191\2*
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