HIV and Opportunistic Infections

HIV and Opportunistic Infections

• HAART therapy is the most effective way to prevent opportunistic infections associated with HIV.

Bacterial Opportunistic Infections

• Mycobacterium Avium Complex (MAC) occurs in the late phase of HIV infection and can infect the upper respiratory, GI tract, or every organ.
• Symptoms of MAC include fever, debility, weight loss, malaise, lymphadenopathy, severe anemia, and splenomegaly.
• Mycobacterium Tuberculosis requires annual PPD testing for HIV patients, and treatment is necessary if the test is positive ( > 5 mm induration).

Protozal Infections

• Pneumocystitis carinii pneumonia causes increased alveolar capillary membrane permeability, leading to degenerative lung cell changes.
• Symptoms include dyspnea, non-productive cough, intermittent fever, fatigue, weight loss, anorexia, severe hypoxia, and diffuse bilateral infiltrates.
• TMZ-SMZ (Bactrim) is used prophylactically, but not for patients with a sulfa allergy.
• Pentamidine (Pentam 300) is used to interfere with parasite reproduction, but can cause side effects such as blood dyscrasias, DM, rapid, irregular pulse.

Cryptosporidium

• This infection can be transmitted from animal to human and human to human.
• It affects the small intestine and can cause fever, diarrhea, vomiting, severe watery stools, and cramping.
• Diagnosis is made through stool specimen, and treatment involves pain management and fluid replacement with IV therapy and TPN if necessary.

Toxoplasma Gondii

• This protozoa infects both humans and domestic animals, primarily through ingestion of meats and vegetables.
• It can cause encephalitis in persons with AIDS, with symptoms including headache, confusion, fever, hemiparesis, seizure, and loss of vision.
• Prophylactic drug therapy is used to prevent infection, and treatment may involve anti-viral drugs.

HIV Related Cancer

• Kaposi's sarcoma is the most common malignancy associated with AIDS, occurring in 1-2% of patients.
• It is characterized by irregularly shaped, purple-brown palpable lesions that are usually not painful or pruritic.

Strategies to Facilitate Adherence

• Establishing readiness to start therapy, providing education on medication dosing, and reviewing potential side effects can facilitate adherence.
• Simplifying regimens, dosing, and food requirements can also help.
• Using social networks, engaging family and friends for support, and using a team approach with a trusting healthcare team can also improve adherence.

Health Teaching

• Monitoring and reporting signs and symptoms of infection is crucial.
• Strategies to prevent infection include handwashing, removing fresh plants and flowers, avoiding raw fruits and vegetables, and using a 1:10 solution of house bleach and water for disinfection.

Prevention

• HIV testing is part of routine medical care, and all individuals between 13-64 years should receive testing.
• Primary therapy involves a combination of sulfadiazine and pyrimethamine.
• Adjunctive therapy includes dexamethasone (Decadron) for cerebral inflammation and edema.

Opportunistic Infection- Fungal

• Candidiasis is a common opportunistic infection, often one of the earliest signs of HIV infection.
• Symptoms include glistening white patches on the tongue, oral mucosa, or creamy white vaginal discharges.
• Treatment involves clortrimazole/fluconazole, nystatin suspension (swish and spit QID for 7-10 days).

Cryptococcal Infection

• This infection can manifest as meningitis in AIDS patients, primarily affecting the CNS and lung.
• If untreated, it can cause cerebral edema and coma.
• Amphotericin B is used to treat systemic fungal infections, but can cause serious side effects.