Opportunistic Infections and Cancers Associated with HIV Disease/AIDS

Some Common Opportunistic Diseases Associated with HIV Infection and Possible Theraphy

*(Stine 105)

Organism/VirusClinical ManifestationPossible Treatments
Cyptosporidium murisGastroenteritis (inflammation of stomach-intestine membranes)Investigational only
Isospora belliGastroenteritisTrimethoprim-sulfamethoxazole (Bactrim)
Toxoplasma gondiiEncephalitis (brain abscess), retinitis, disseminatedPyrimethamine and leucovorin, plus sulfadiazine, or Clindamycin, Bactrim
Candida sp.Stomatitis (thrush), proctitis, vaginitis, esophagitisNystatin, clotrimazole, ketoconazole
Coccidioides immitisMeningitis, disseminationAmphotericin B, fluconazole, ketoconazole
Histoplasma capsulatumPneumonia, disseminationAmphotericin B, fluconazole, itraconazole
Pneumocystis cariniiPneumoniaTrimethoprim-sulfamethoxazole (Bactrim, Septra), Pentamidine, Dapsone
Mycobacterium aviumcomplex (MAC)Dissemination, pneumonia, diarrhea, weight loss, lymphadenopathy, severe gastrointestinal diseaseRifampin + ethambutol + clofazimine + cirpofloxacin +/- amikacin; clarithromycin & azithromycin (both investigational)
Mycobacterium tuberculosis(TB)Pneumonia (tuberculosis), meningitis, disseminationIsoniazid (INH) + rifampin + ethambutol +/- pyrazinamide
Cytomegalovirus (CMV)Fever, hepatitis, encephalitis, renitis, pneumonia, colitis, esophagitisGanciclovir, Foscarnet
Epstein-BarrOral hairy leukoplakia, B cell lymphomaAcyclovir
Herpes simplexMucocutaneous (mouth, genital, rectal) blisters and/or ulcers, pneumonia, esophagitis, encephalitisAcyclovir
Papovavirus J-CProgressive multifocal leukoencephalopathynone
Varicella-zosterDermatomal skin lesions (shingles), encephalitisAcyclovir, Foscarnet
Kaposi's sarcomaDisseminated mucocutaneous lesions often involving skin, lymph nodes, visceral organs (especially lungs & GI tract)Local injection, surgical excision or radiation to small, localized lesions; Chemotherapy with vincristine & Bleomycin
Primary lymphoma of the brainHeadache, palsies, seizures, hemiparesis, mental status, or personality changesRadiation and/or chemotherapy
Systemic lymphomasFever, night sweats, weight loss, enlarged lymph nodesChemotherapy

With a weakened immune system, which could be caused by HIV, parasites such as viruses, bacteria, fungi, and protozoa can cause disease. The infections they cause are known as opportunistic infections (OIs). Thus, OIs occur after a disease-causing virus or microorganism, normally held in check by a functioning immune system, gets the opportunity to multiply and invade host tissue. OIs are associated directly or indirectly with about 90% of deaths in AIDS patients. People who test HIV positive often suffer from OIs like Pneumocystis carinii pneumonia, toxoplasmosis, Kaposi's sarcoma, candidiasis, cytomegalovirus renitis, cryptococcal meningitis, mycobacterium avium complex, herpes simple, and varicella-zoster. However, due to improved medical technology, medications and radiations used in bone marrow or organ transplantation and cancer chemotherapy, there is a steadily growing number of patients who live longer.

Through 1995, the Centers for Disease Control and Prevention (CDC) has promulgated guidelines for chemoprophylaxis of only 3 OIs: Pneumocystis carinii pneumonia (PCP), Mycobacterium tuberculosis (MTb), and Mycobacterium avium-intracellularecomplex (MAC). The use of drug prophylaxis against OIs has become one of the most successful threatments for AIDS patients. For example, PCP has dropped 40% from 1987 to 1994. The downside to OI prohylaxis is that it is difficult to find drugs that work without harmful side effects; besides, OIs, become resistant to the drugs over time.