HIV AIDS opportunistic infections
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
Overview
Before the widespread use of potent combination antiretroviral therapy (ART), opportunistic infections (OIs), which have been defined as infections that are more frequent or more severe because of immunosuppression in HIV-infected persons, were the principal cause of morbidity and mortality in this population. In the early 1990s, the use of chemoprophylaxis, immunization, and better strategies for managing acute OIs contributed to improved quality of life and improved survival.[1] However, the widespread use of ART starting in the mid-1990s has had the most profound influence on reducing OI-related mortality in HIV-infected persons in those countries in which these therapies are accessible and affordable.
HIV Opportunistic Infections
Bacteria
Disease | Description | Clinical Findings | Diagnosis | Prevention / Prophylaxis | Treatment |
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Mycobacterium avium complex (MAC) |
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Fever, night sweats, weight loss, fatigue, diarrhea, and abdominal pain. | Isolation of MAC from cultures of blood, lymph node or bone marrow. | Prophylaxis is indicated when CD4 < 50 cells/µL
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Respiratory Disease | |||||
Enteric Infections |
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Severe and prolonged diarrheal disease, potentially associated with fever, bloody diarrhea, and weight loss. |
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Antimicrobial prophylaxis to prevent bacterial enteric illness usually is not recommended. |
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Bacillary Angiomatosis |
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Cutaneous lesions (red, globular and non-blanching, with a vascular appearance), sub-cutaneous nodules. | Histopathologic examination of biopsied tissue | Primary chemoprophylaxis for Bartonella-associated disease is not recommended |
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Syphilis | Treponema pallidum is the causative pathogen. | Single painless nodule |
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Table adapted from Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents[2] |
Virus
Disease | Description | Clinical Findings | Diagnosis | Prevention / Prophylaxis | Treatment |
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Cytomegalovirus Disease |
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CMV viremia can be detected by PCR, antigen assays, or culture |
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Herpes Simplex Virus Disease | |||||
Varicella-Zoster Virus Diseases | |||||
Human Herpesvirus-8 Disease | |||||
Human Papillomavirus Disease | |||||
JC Virus Infection | |||||
Table adapted from Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents [2] |
Fungus
Disease | Description | Clinical Findings | Diagnosis | Prevention / Prophylaxis | Treatment |
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Pneumocystis Pneumonia (Click here for more information) |
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Subacute onset of progressive dyspnea, fever, nonproductive cough, and chest discomfort that worsens within days to weeks. Tachypnea, tachycardia, and diffuse dry rales are found in the physical examination. | Clinical presentation, blood tests, or chest x-rays are not pathognomonic for PCP. BAL or induced sputum samples are required for a definite diagnosis. |
Start TMP-SMX prophylaxis when CD4+ <200 cells/µL or history of oropharyngeal candidiasis. Discontinue prophylaxis when CD4+ is >200 cells/µL for >3 month. |
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Mucocutaneous Candidiasis | |||||
Cryptococcosis | |||||
Histoplasmosis | |||||
Coccidioidomycosis | |||||
Aspergillosis | |||||
Table adapted from Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents [2] |
Parasite
Disease | Description | Clinical Findings | Diagnosis | Prevention / Prophylaxis | Treatment |
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Toxoplasma gondii Encephalitis (Click here for more information) |
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Focal encephalitis with headache, confusion, or motor weakness and fever |
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Administer:
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Cryptosporidiosis (Click here for more information) |
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Acute or subacute onset of watery diarrhea, nausea, vomiting, lower abdominal pain. Fever is seen in 1/3 of patients. | Microscopic examination of oocysts in stool with direct immunofluorescence. |
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Microsporidiosis |
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Clinical syndromes can vary by infecting species. The most common manifestation is diarrhea.
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Examination of 3 stool samples with chromotrope and chemofluorescent stains |
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Table adapted from Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents [2] |
References
- ↑ Walensky RP, Paltiel AD, Losina E, Mercincavage LM, Schackman BR, Sax PE, Weinstein MC, Freedberg KA (2006). "The survival benefits of AIDS treatment in the United States". J. Infect. Dis. 194 (1): 11–9. doi:10.1086/505147. PMID 16741877. Retrieved 2012-04-05. Unknown parameter
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