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In the USA, the definition of AIDS is governed by the Centers for Disease Control and Prevention (CDC). In 1993, the CDC expanded their definition of AIDS to include healthy HIV positive people with a CD4 positive T cell count of less than 200 per µl of blood. The majority of new AIDS cases in the United States are reported on the basis of a low T cell count in the presence of HIV infection
Approximately half of those infected with HIV don't know that they are infected until they are diagnosed with AIDS. HIV test kits are used to screen donor blood and blood products, and to diagnose HIV in individuals. Typical HIV tests, including the HIV enzyme immunoassay and the Western blot assay, detect HIV antibodies in serum, plasma, oral fluid, dried blood spot or urine of patients. Other tests to look for HIV antigens, HIV-RNA, and HIV-DNA are also commercially available and can be used to detect HIV infection prior to the development of detectable antibodies. However, these assays are not specifically approved by the U.S. Food and Drug Administration for the diagnosis of HIV infection.
The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems. Most of these conditions are infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages. Opportunistic infections are common in people with AIDS . Nearly every organ system is affected. People with AIDS also have an increased risk of developing various cancers such as Kaposi sarcoma, cervical cancer and cancers of the immune system known as lymphomas.
Additionally, people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss . After the diagnosis of AIDS is made, the current average survival time with antiretroviral therapy is estimated to be between 4 to 5 years , but because new treatments continue to be developed and because HIV continues to evolve resistance to treatments, estimates of survival time are likely to continue to change. Without antiretroviral therapy, progression to death normally occurs within a year . Most patients die from opportunistic infections or malignancies associated with the progressive failure of the immune system .
The rate of clinical disease progression varies widely between individuals and has been shown to be affected by many factors such as host susceptibility , health care and co-infections , and peculiarities of the viral strain . Also, the specific opportunistic infections that AIDS patients develop depends in part on the prevalence of these infections in the geographic area in which the patient lives.