Opportunistic infections in HIV
Every day our bodies are exposed to various viruses and bacteria, a lot of bacteria thrive in our organism albeit our immune system fights against these microorganisms and effectively protects us. HIV affects the immune system and impairs its ability to prevent the development of infections. As a result a person develops diseases that are not common for healthy individuals. Such diseases are known as opportunistic infections. It should be pointed out that opportunistic infections may be seen not only in HIV/AIDS, but also in other conditions that weaken the immune system.
Kaposi sarcoma – a vascular neoplasm that appears in the skin, the mucous membranes and in the internal organs (the lungs, digestive tract).
Cause: Kaposi’s sarcoma herpesvirus (KSHV) or human herpesvirus 8 (HHV-8)
Symptoms: Kaposi’s sarcoma appears as nodules from reddish, purple to brown in color that raise over the surface of the skin. Commonly these tumors are seen on the parts of the skin that are exposed to the sunlight – face and limbs. Kaposi’s sarcoma of the internal organs may bleed and be life-threatening.
Treatment: The treatment of Kaposi’s sarcoma includes the optimization of antiretroviral therapy, radiation treatment and cryotherapy of the lesions. Interferon-α, pacitaxel, liposomal daunorubicin and doxorubicin are administered for extensive disease when there are numerous lesions and the internal organs are involved.
Candidiasis – is a generalized fungal infection.
Cause:Fungal infection Candida (Candida albicans, non-albicans Candida)
Symptoms: Painless, white, plaque-like lesions appear on the mucosal membranes and over the skin surface.
Treatment:Fluconazole 100-200 mg per day
Tuberculosis – is a bacterial disease which in HIV-positive individuals affect various organs.
Cause: Mycobacterium tuberculosis, Mycobacterium avium
Symptoms: Mycobacterium usually affects the lungs. However, in those who have suppressed immune system tuberculosis appears as a widespread through the whole body disease with multiple organ involvement and corresponding symptoms.
Treatment:Izoniazid 300 mg + Pyridoxine 50 mg qd for 9 months or Rifabutin 300 mg or Rifampin 6oo mg qd for 4 months
Symptoms: After a person had chickenpox, Varicella zoster virus remains in the ganglia and when the immune system is weakened, infection reactivates and herpes zoster develops. macules, papules, vesicles, pustules, and crusts are typical rash seen in herpes zoster. At first it appears on the head, then – on the trunk and at last – on the limbs. As the rash occurs a person experiences headache, fever and itching. Internal organs may also be involved.
Treatment: Valacyclovir, famciclovir or acyclovir
Cytomegalovirus diseases – a group of disorders caused by a virus of the herpes virus family.
Symptoms:Cytomeglovirus retinitis manifests with visual field defects and decreased vision acuity. Cytomegalovirus colitis causes weight loss, abdominal pain and diarrhea. For esophagitis such symptoms as nausea and discomfort while swallowing are characteristic. This virus also causes various neurologic disorders, including dementia, encephalitis and myelopathies with muscle weakness and urinary retention.
Treatment: Ganciclovir 5 mg/kg or Foscarnet 60 mg/kg intravenous
Pneumocystis pneumonia – pneumonia caused by a fungal infection.
Symptoms:The onset of the disease is characterized by a progressive shortness of breath, fever, cough, wheezing and chest discomfort. It was estimated that approximately 75% of those who are living with HIV have pneumocystis pneumonia.
Treatment: Trimethoprim/sulfamethoxazole 1 DS tablet qd or Dapsone 50 mg bid
Cause: Streptococcus pneumonia, Haemophilus species, Legionella pneumophila, Mycoplasma pneumonia, Pseudomonas aeruginosa and Staphylococcus aureus
Symptoms:These bacteria cause pneumonia with typical symptoms such as fever, chills, chest pain/pleurisy, productive cough with purulent sputum and shortness of breath.
Treatment:Treatment depends on the type of bacteria and the severity of the disease. Antibacterial treatment includes administration of antibiotics. Usually beta-lactams (amoxicillin or amoxicillin-clavulanate), macrolides (azithromycin or clarithromycin) and respiratory fluoroquinolones (moxifloxacin or levofloxacin) are used.
Toxoplasmic encephalitis – is a condition caused by the invasion of protozoan infection in the brain (acute disease or disseminated phase of toxoplasmosis).
Symptoms:Individuals with AIDS experience headache, muscular weakness, seizures, fever and confusion. A single or multiple lesions may be detected in the brain as well as a diffuse brain involvement.
Treatment: Trimethoprim/sulfamethoxazole 1 DS tablet
See also: Signs and symptoms of HIV
Cryptosporidosis – a disease caused by the invasion of the parasite into the mucosal membrane of the small intestine.
Cause: Cryptosporidium hominis, Cryptosporidium parvum, and Cryptosporidium meleagridis
Symptoms: Most HIV-positive individuals develop chronic watery diarrhea. Other symptoms include nausea, vomiting and abdominal cramps.
Treatment: Chronic diarrhea and vomiting results in severe dehydration and requires rehydration and restoration of electrolyte loss. Anti-motility agents such as loperamide or tincture of opium. Nitazoxanide 500 mg twice daily may inhibit the Cryptosporidium.
Cryptococcosis – is an invasive fungal infection.
Cause: Cryptococcus neoformans, occasionally Cryptococcosis gattii
Symptoms: Usually cryptococcosis manifests as meningitis or meningoencephalitis. Fever and headache are the typical symptoms of this infection. Other symptoms include neck stiffness, photophobia (increased, painful perception of light), confusion, memory loss, muscular weakness or altered sensations.
Treatment: Fluconazole 200 mg per day or Itraconazole 200 mg per day
This is not the full list of opportunistic infections as HIV-positive persons especially at advanced stage are susceptible to any infection.