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Opportunistic Infections in HIV

Protect your health

Fast facts

  1. Opportunistic infections are common in people with HIV because their CD4 counts are lower than the healthy levels.
  2. A healthy CD4 count ranges from 500 to 1,600 cells per microliter (cells/µL).
  3. People whose HIV has developed into AIDS are at an even higher risk of contracting an opportunistic infection.

According to the Centers for Disease Control and Prevention (CDC), 1.2 million Americans were living with human immunodeficiency virus (HIV) at the end of 2012. Advances in antiretroviral treatment (ART) has made it possible for people with HIV to live a longer and healthier life.

However incredible the advances in care, you still have an important role to play in safeguarding your health. You’ll want to work closely with your doctors and stay on top of your ART. There are also steps you can take to protect yourself from opportunistic infections (OIs). These are a special threat when you’re HIV-positive.

How does HIV work?

HIV is a virus that attacks CD4 cells. These are white blood cells that are also referred to as T cells. These helper cells are a part of your immune system that send a biological SOS signal to other immune cells. They send a message to go on the offensive against infections.

When you’re infected with HIV, the virus merges with your CD4 cells. The virus then hijacks and uses the CD4 cells to multiply. As a result, you have fewer CD4 cells to fight infections. It’s why your doctor uses blood tests to identify how many CD4 cells are in your blood. This is one measure of the severity of your illness.

Opportunistic infections and diseases

With HIV, your compromised immune system makes you vulnerable to a number of opportunistic infections, cancers, and other conditions. Certain diseases are common to people with HIV. The CDC calls them “AIDS-defining” conditions. If you have one of these diseases, your infection with HIV has advanced to acquired immunodeficiency syndrome (AIDS).

Some of the more common opportunistic diseases are listed below. It’s important to become knowledgeable about these health risks. In many instances there are steps you can take can take to protect yourself.

Candidiasis

Candidiasis encompasses a number of infections in different areas of your body caused by Candida, a genus of fungus. These infections include oral thrush and vaginitis. A fungal infection is considered AIDS-defining when found in the esophagus, bronchi, trachea, or lungs. Powerful and sometimes quite toxic antifungal drugs are used to treat candidiasis.

The name of drugs varies by the location of infection. For instance, vaginitis caused by candidiasis is treated with drugs like:

If systemic infection is present, treatment may include drugs like:

Cryptococcal meningitis

Cryptococcus is a common fungus found in soil and bird droppings. It also grows in areas surrounding trees, particularly eucalyptus trees. Normally inhaled, Cryptococcus can cause meningitis. This is an infection of the membranes around your brain and spinal cord. Very potent and frequently toxic antifungal drugs are used to initially treat cryptococcal meningitis. These drugs may include in combination:

This condition can be fatal if not treated promptly. Long-term suppressive therapy is often used with somewhat less toxic medications for people with HIV.

Cryptosporidiosis

A tiny parasite that lives in the intestines of humans and animals is responsible for cryptosporidiosis. Most people get the disease by drinking contaminated water or eating contaminated produce. Cryptosporidiosis is an unpleasant, diarrheal illness for healthy people.

However, if you’re HIV-positive it can last longer and cause more severe symptoms. A medication called nitazoxanide is normally prescribed to treat the disease.

Cytomegalovirus

Cytomegalovirus (CMV) is a viral infection most commonly thought of as causing serious eye disease in immunocompromised people. It can potentially lead to blindness. CMV can also be responsible for illness in other areas of the body. These areas include the GI tract and parts of the nervous system. There are currently no drugs to cure CMV. However, there are a number of powerful antiviral medications that can help treat the infection. These include:

In people with profound and prolonged immunosuppression, these CMV medications often need to be given at significant doses over the long term. However, the damage from CMV infection may slow with the use of antiretroviral therapy (ART). This can result in the rebuilding of the immune system (as demonstrated by clinically significant rises in CD4 count). Anti-CMV therapy may potentially be changed to easier to tolerate suppressive treatments.

Herpes simplex viruses

Although anyone can get herpes, having HIV places you at greater risk of getting herpes and having more frequent and severe outbreaks. Herpes simplex virus (HSV) is characterized by sores on the mouth, lips, and genitals. There is no cure for herpes. However, chronic (although relatively easy to tolerate) medications can alleviate symptoms of the virus.

Pneumocystis pneumonia

Pneumoncytis pneumonia (PCP) is a fungal pneumonia and can be fatal if it’s not diagnosed and treated early. PCP is treated with antibiotics. The risk of a person with HIV developing PCP rises so high that preventive antibiotic therapy may be used if their CD4 count drops below 200 cells per microliter (cells/µL).

Salmonella septicemia

Commonly referred to as “food poisoning,” salmonellosis is a bacterial infection of the intestines. It’s most often transmitted via food or water that has been contaminated with feces. The U.S. Food and Drug Administration (FDA) reports that if you are HIV positive, your risk of being infected by salmonella is at least 20 times greater than a healthy person. Salmonellosis can spread into your blood, joints, and organs. Antibiotics are commonly prescribed to treat it.

Toxoplasmosis

Toxoplasmosis is caused by parasites. You can get the condition by eating contaminated food. You also can contract the disease from cat feces. The risk of significant disease from toxoplasmosis infection rises substantially once the CD4 count drops below 100 cells/µL. An HIV-positive person should ideally avoid all contact with cat feces or any other routine source of toxoplasmosis exposure. People are severely immunocompromised (less than or equal to 100 cells/µL) should receive the same prophylactic antibiotic as people getting PCP prophylaxis. Toxoplasmosis is treated with antimicrobial medications such as sulfa (Bactrim).

Opportunistic cancers

Invasive cervical cancer

Cervical cancer begins in the cells lining the cervix. The cervix is located between the uterus and vagina. Cervical cancer is known to be caused by the cancer-causing virus, human papillomavirus (HPV). HPV infection is extremely common among all sexually active women. But studies have clearly demonstrated that the risk of this infection rises substantially as your immunocompromise from HIV progresses. For this reason, HIV-infected women should undergo regular pelvic exams with Pap smears. Pap smears can detect early cervical cancer. Cervical cancer is considered invasive when it spreads outside the cervix. Treatment options include surgery, radiation, or chemotherapy.

Kaposi’s sarcoma

Kaposi’s sarcoma (KS) is linked to infection by a virus called human herpes virus 8 (HHV-8). It causes cancerous tumors of the body’s connective tissues. You may be familiar with the dark, purple-ish skin lesions that are associated with KS. KS isn’t curable but its symptoms often improve with ART. A number of other treatments are available for people with KS. These include radiation, intralesional chemotherapy, systemic chemotherapy, and retinoids.

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma (NHL) is a cancer of lymphocytes, cells that are part of the immune system. Lymphocytes are found throughout your body, including in your lymph nodes, digestive tract, bone marrow, and spleen. Various treatments are used to fight NHL, such as chemotherapy, radiation, and stem cell transplants.

Prevention

If you’re HIV positive, see your doctor promptly if you are ill or have new symptoms. You may be able to avoid some infections by following these basic guidelines:

  • Stay current with your ART.
  • Take recommended vaccinations or prophylactic medications.
  • Practice safe sex.
  • Avoid cat litter and feces of farm animals and pets.
  • Use latex gloves when changing baby diapers that contain feces.
  • Avoid people who are ill with conditions that may be contagious.
  • Don’t eat rare or raw meats and shellfish, unwashed fruits and vegetables, or unpasteurized dairy products.
  • Wash your hands and any items that come in contact with raw meat, poultry, or fish.
  • Don’t drink water from lakes or streams.
  • Don’t share towels or personal care items.

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