HIV/AIDS doesn't kill anybody directly. Instead, it weakens the body's ability to fight disease. It?s the opportunistic infections are more dangerous than HIV infection. Many of these infections are very serious, and they need to be treated. Some can be prevented.

 

Certain bacteria, viruses, fungi, and protozoa which do not usually cause infections in healthy people, can cause infections in people with a weakened immune system; these are called opportunistic infections.

Classification of opportunistic infection in HIV/AIDS

Bacterial and mycobacterial infections

• Mycobacterium Avium Complex
• Salmonellosis
• Syphilis and Neuroshyphilis
• Tuberculosis
• Bacillary angiomatosis

Fungal infections

• Aspergillosis
• Candidiasis (thrush)
• Coccidioidomycosis
• Cryptococcal Meningitis
• Histoplasmosis

Viral infections

• Cytomegalovirus (CMV)
• Hepatitis
• Herpes Simplex (HSV, genital herpes)
• Herpes Zoster (HZV, shingles)
• Human Papiloma Virus (HPV, genital warts, cervical cancer)
• Molluscum Contagiosum
• Oral Hairy Leukoplakia (OHL)

Protozoal infections

• Cryptosporidiosis
• Isosporiasis
• Pneumocystis Carinii Pneumonia (PCP)
• Toxoplasmosis

Other complications

• AIDS dementia complex
• Apthous ulcers
• Malabsorption
• Peripheral neuropathy

HIV associated malignancy

• Kaposi sarcoma
• Lymphoma
• Squamous cell carcinoma

Prevention of HIV related opportunistic infections

Prophylaxis against opportunistic infections in patients with AIDS

Infection	Drug used	Indications
Pneumocystis carinii pneumonia (PCP)	Trimethoprim-sulfamethaxazole- DS (cotrimoxazole)	CD4 count <200 cells thrush; unexplained fever for more than two weeks; history of PCP
Toxoplasmosis	Trimethoprim-sulfamethaxazole(double-strength)	CD4 count <100 cells and Toxoplasma sero-positive
Mycobacterium avium complex	Azithromycin	CD4 count <50 cells
Histoplasmosis	Itraconazole	CD4 count <100 cells and lives in an endemic area

 

Discontinuation of preventive treatment

• Preventive treatment for mycobacterium avium complex infection is usually discontinued when the T cell count is >100 cells/µL for 3 months.
• Preventive treatment for pneumocystis and toxoplasmosis is usually discontinued when the T cell count is >200 cells/µL for 3 months.

The World Health Organization (WHO) recommends that, in resource-limited settings, the following groups of people should begin taking cotrimoxazole:

• HIV-exposed infants/children, starting at 4-6 weeks after birth or at first contact with health care, and continued until HIV infection is excluded
• HIV-positive children less than 1 year old
• HIV-positive children aged 1-4 years who have mild, advanced or severe symptoms of HIV disease, or a CD4 count below 25%
• HIV-positive adults and adolescents who have mild, advanced or severe symptoms of HIV disease, or a CD4 count below 350 cells per ml
• HIV-positive people with a history of treated PCP.