What Are Opportunistic Infections
Opportunistic infections are infections that occur more frequently and are more severe in people with weakened immune systems, including people with HIV.
Many OIs are considered AIDS-defining conditions. That means if a person with HIV has one of these conditions, they are diagnosed with AIDS, the most serious stage of HIV infection.
Aids Nursing Care Plans
Acquired immunodeficiency syndrome is a serious secondary immunodeficiency disorder caused by the retrovirus, human immunodeficiency virus . Both diseases are characterized by the progressive destruction of cell-mediated immunity with subsequent effects on humoral immunity because of the pivotal role of the CD4+helper T cells in immune reactions. Immunodeficiency makes the patient susceptible to opportunistic infections, unusual cancers, and other abnormalities.
AIDS results from the infection of HIV which has two forms: HIV-1 and HIV-2. Both forms have the same model of transmission and similar opportunistic infections associated with AIDS, but studies indicate that HIV-2 develops more slowly and presents with milder symptoms than HIV-1. Transmission occurs through contact with infected blood or body fluids and is associated with identifiable high-risk behaviors.
Persons with HIV/AIDS have been found to fall into five general categories: homosexual or bisexual men, injection drug users, recipients of infected blood or blood products, heterosexual partners of a person with HIV infection, and children born to an infected mother. The rate of infection is most rapidly increasing among minority women and is increasingly a disease of persons of color.
Epidemiology Of Pulmonary Infections In Hiv
Few studies have systematically described the full spectrum of HIV-associated pulmonary infections . Most investigators have focused on pneumonias of specific aetiologies. Therefore, there is no consensus on any diagnostic algorithm of pulmonary infections in HIV patients. The diagnostic decision should be different depending on the epidemiological features in a specific geographical area . Thus, the incidence of TB in HIV patients varies considerably in different geographical areas, depending on the prevalence of disease in the general population. In Africa, TB could be the most common pulmonary complication of HIV, followed by community-acquired pneumonia . However, PCP is uncommon in Africa, although the incidence seems to be increasing . It remains speculative whether this trend denotes a true increase in the prevalence of PCP or whether the early reports underestimated the actual prevalence . In Western Europe in the 1990s, PCP was the commonest AIDS-defining illness, whereas pulmonary TB was more common in Eastern Europe. Within Western Europe, TB remains more common in the south than in the north . Endemic fungi are common in HIV patients who live in endemic areas, but are exceptional in patients that have never resided in or travelled to endemic regions .
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Racial Sexual And Age
In the United States, the rate of HIV infection is highest in Blacks . The prevalence is also high among Hispanic persons . These increased rates result from socioeconomic factors rather than genetic predisposition.
In the developed world, HIV infection is much more common in males. In 2015, males accounted for 81% of all diagnoses of HIV infection among adults and adolescents in the United States. Among heterosexuals, females are more likely to acquire HIV infection from an infected male than a male is from an infected female, but a large proportion of infections in males are due to homosexual contact, with or without injection drug use. Males are also more likely to acquire HIV infection from injection drug use alone.
Males were also more likely to acquire HIV infection through contaminated blood products for treatment of hemophilia before universal testing of the blood supply was instituted. The risk of HIV exposure from factor VIII concentrates has been virtually eliminated by viricidal treatment of plasma-derived factor VIII concentrates, as well as the introduction of recombinant factor VIII concentrates and the gradual elimination of albumin from the production process used for these products.
In the developing world, HIV infection is equally common in males and females. The primary route of HIV transmission in the developing world is heterosexual contact.
Most Common Ois In People Living With Hiv
Since combination antiretroviral treatment for HIV became available, the number of people living with HIV who have had opportunistic infections has dropped drastically. If you start HIV treatment early and continue to take your HIV drugs as they are prescribed, you will keep your immune system strong and likely never get one of these OIs. This means you will also likely never be diagnosed with AIDS.
Some of the most common opportunistic infections in people living with HIV include:
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What Is Hepatitis And How Can I Prevent It
Hepatitis B and hepatitis C are common co-infections for people with HIV, especially people who inject drugs. Both are preventable and treatable. Talk to your healthcare provider about how often you should test for them.
Using a condom and not sharing needles can prevent hepatitis. You can also get vaccinated against hepatitis B.
Monitoring Of Treatment Response
Monitoring of response to treatment is done by assessing border activity and position. Photographic monitoring is helpful to detect subtle changes in the border that may indicate progression. Patients with low CD4+ T lymphocyte counts, positive blood CMV by PCR, and longer duration of AIDS are more likely to progress. With therapy, healing is generally expected in 4 to 6 weeks, although activity commonly recurs unless the underlying immunosuppression is effectively treated. Strategies for recurrence include reinduction, addition of foscarnet to ganciclovir, intravitreal injections, and implantation of the ganciclovir intraocular device. A recent review summarizes current treatment strategies for CMV retinitis.
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Common Opportunistic Clinical Manifestations In People With Hiv
In this section, we will be describing the clinical signs and symptoms associated with common opportunistic clinical manifestations that you may encounter in PLHIV during community visits, or at your health post. Where possible, we have included photographs showing typical clinical manifestations of an opportunistic disease in a PLHIV, so that you become familiar with them.
Identifying opportunistic infections and diseases will help your work in the context of PLHIV in two ways. First, you may be able to categorise patients in one of the four stages of the WHO HIV clinical staging. You will then be able to refer them to the nearest health centre for comprehensive HIV services, such as cotrimoxazole chemoprophylaxis , and for specific treatments for HIV/AIDS. In some cases, you will need to refer the person living with HIV urgently, whereas in others you will just need to reassure the patient, and/or treat minor ailments. Note that all conditions described below should be referred to the nearest health centre if they are clinical stage 2 and above, with increasing urgency the higher the WHO clinical stage.
Secondly, if staging has been carried out by a health worker at a health centre or hospital, you will be able to appreciate at what stage of the disease a person living with HIV is, and provide the best possible care for that patient.
21.4.1 Persistent generalised lymphadenopathy
21.4.2 Skin problems
Itching skin rash may be due to the following two conditions:
The Loop Mediated Isothermal Amplification Assay
Loop-mediated isothermal amplification is a unique, temperature-independent technique for amplifying DNA that is simple to use, providing a visual display that is easy to read. TB-LAMP does not require sophisticated instrumentation and can be used at a peripheral health center level, given biosafety requirements similar to microscopy. A meta-analysis of 10 studies reported a sensitivity of 80% and specificity of 96% to diagnose pulmonary TB . One of the data sets included in the meta-analysis stood out in terms of its findings: the study conducted in Malawi among individuals with cough reported a sensitivity of 65% , specificity of 100% , similar performance to Xpert, but lower performance compared to concentrated fluorescent smear microscopy with duplicate reading . TB-LAMP, however, provides better results than sputum smear microscopy, detecting 15% more patients with pulmonary TB, if performed in all persons presenting with signs and symptoms. If used as an add-on test after microscopy has been performed, > 40% increase in TB cases were detected among those with smear-negative results compared to other rapid tests that have been recommended by WHO in recent years.
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Opportunistic Infection And Hiv/aids
HIV is a virus that targets T cells of the immune system and, as a result, HIV infection can lead to progressively worsening immunodeficiency, a condition ideal for the development of opportunistic infection. Because of this, respiratory and central nervous system opportunistic infections, including tuberculosis and meningitis, respectively, are associated with later-stage HIV infection, as are numerous other infectious pathologies. Kaposis sarcoma, a virally-associated cancer, has higher incidence rates in HIV-positive patients than in the general population. As immune function declines and HIV-infection progresses to AIDS, individuals are at an increased risk of opportunistic infections that their immune systems are no longer capable of responding properly to. Because of this, opportunistic infections are a leading cause of HIV/AIDS-related deaths.
Phases Of Hiv Infection
Clinical HIV infection undergoes 3 distinct phases: acute seroconversion, asymptomatic infection, and AIDS. Each is discussed below.
Animal models show that Langerhans cells are the first cellular targets of HIV, which fuse with CD4+ lymphocytes and spread into deeper tissues. In humans, rapid occurrence of plasma viremia with widespread dissemination of the virus is observed 4 days to 11 days after mucosal entrance of the virus.
There is no fixed site of integration, but the virus tends to integrate in areas of active transcription, probably because these areas have more open chromatin and more easily accessible DNA. This greatly complicates eradication of the virus by the host, as latent proviral genomes can persist without being detected by the immune system and cannot be targeted by antivirals.
During this phase, the infection is established and a proviral reservoir is created. This reservoir consists of persistently infected cells, typically macrophages, and appears to steadily release virus. Some of the viral release replenishes the reservoir, and some goes on to produce more active infection.
The proviral reservoir, as measured by DNA polymerase chain reaction , seems to be incredibly stable. Although it does decline with aggressive antiviral therapy, the half-life is such that eradication is not a viable expectation.
Asymptomatic HIV infection
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Opportunistic Infections Vs Aids
While AIDS-defining illnesses can also be classified as opportunistic infections, the opposite is not necessarily true. Opportunistic infections are those caused by otherwise common, harmless viruses, bacteria, fungi, or parasites which can cause disease when immune defenses have been compromised.
Many opportunistic infections are not life-threatening and can develop even when a person’s CD4 count is high. AIDS-defining illnesses, by contrast, tend to appear during later-stage disease when the CD4 count has dropped significantly.
Some opportunistic infections, such as herpes simplex, are only considered to be AIDS-defining when they spread beyond the tissue or organ where they are typically seen.
Can Opportunistic Infections Be Treated
Once an OI is successfully treated, a person may continue to use the same medicine or an additional medicine to prevent the OI from coming back. Having an OI may be a very serious medical situation and its treatment can be challenging.
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Can Ois Be Treated
Once an OI is successfully treated, a person may continue to use the same medicine or an additional medicine to prevent the OI from coming back. The Clinical Info Drug Database includes information on many of the medicines used to prevent and treat OIs.
Avoidance Of Infectious Exposure
The following may be avoided as a preventative measure to reduce risk of infection:
- Eating undercooked meat or eggs, unpasteurized dairy products or juices.
- Potential sources of tuberculosis .
- Any oral exposure to feces.
- Contact with farm animals, especially those with diarrhea: source of Toxoplasma gondii, Cryptosporidium parvum.
- Cat feces : source of Toxoplasma gondii, Bartonella spp.
- Soil/dust in areas where there is known histoplasmosis, coccidiomycosis.
- Reptiles, chicks, and ducklings that are a common source of Salmonella.
- Unprotected sexual intercourse with individuals with known sexually transmitted infections.
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What Are The Most Common Opportunistic Infections
This is a list of some of the most common HIV-related opportunistic infections:
Also known as thrush, candida is a very common fungal organism that is found almost everywhere in the environment and can be isolated from around 30-50% of healthy people. Most of the time, it does not cause any symptoms of infection however, in people with HIV, there can be invasive candida overgrowth in the esophagus and airways. It is often the first sign of a weakened immune system in previously undiagnosed individuals.
Caused by the fungus cryptococcus neoformans, this can infect any part of the body, but most commonly will invade the lungs or the brain .
Caused by an intracellular virus, this infection can cause inflammation of the brain, lungs, intestines, and eyes. CMV retinitis of the eye is sight-threatening and should be treated as a medical emergency.
4) Herpes Simplex Virus
Another common virus, Herpes Simplex Virus can cause symptoms in people with a normal immune system as well usually cold sores or blisters around the mouth, genital region or anus. However, in people with a weak immune system, outbreaks tend to be more frequent, severe, and prolonged in duration, and can also invade the lungs and esophagus.
5) Mycobacterium Tuberculosis & other Mycobacterial infection
6) Pneumocystis Carinii Pneumonia
7) Salmonella septicemia
9) Kaposis Sarcoma
10) Invasive cervical cancer
Fungal Infections Other Than Pcp
Some studies suggest a decline in the incidence of endemic fungal infections since the introduction of HAART. This is difficult to demonstrate, as the incidence of these infections has not been fully determined . The three major endemic fungi are Histoplasma capsulatum, Coccidiodes inmitis and Blastomyces dermatitidis. They are acquired by inhalation. These diseases can represent primary infection caused by exogenous exposure or reactivation of a latent focus. Infections in patients who reside outside endemic regions generally represent reactivation of latent foci of infection from previous residence in these areas . Reactivation may occur even years after moving to other geographic areas. Endemic areas include the southwest USA, northern Mexico and parts of Central and South America.
Histoplasmosis is the most common endemic mycosis in HIV patients. Most cases of disseminated histoplasmosis and coccidioidomycosis occur with CD4 lymphocyte counts â¤100 cells per mm3, but focal pneumonia is the most common in those with a CD4 cell count > 250 cells per mm3. Blastomycosis is an uncommon, but serious complication in HIV-infected persons. All of these endemic fungal infections have a wide spectrum of manifestations in HIV-infected patients with frequent lung involvement. Treatment is based on amphotericin B and triazoles .
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Management In Patients With Pulmonary Infections Receiving Art
When the infection occurs within 12 weeks of starting ART, many cases can represent unmasking IRISs treatment of the infection should be started and ART should be continued . When the infection occurs > 12 weeks after initiation of ART, despite complete virological suppression, therapy for the infection should be initiated and ART should be continued if the CD4 responses has been suboptimal, modification of the ART regimen could be considered . When the infection occurs in the setting of virological failure, infection therapy should be started and the ART regimen should be modified to achieve better virological control .
Tests For Hiv And Aids
Blood tests are the most common way to diagnose the human immunodeficiency virus , the virus that causes acquired immunodeficiency syndrome . These tests look for antibodies to the virus that are present in the blood of infected individuals. People exposed to the virus should get tested immediately.
Early testing is crucial with HIV. If you test positive for the virus, you and your doctor can develop a treatment plan to help fight HIV and ward off complications. Early testing also can alert you to avoid high-risk behavior that could spread the virus to others.
Because it can take from six weeks to six months to develop antibodies to the virus, follow-up tests may be needed. Your doctor will ask about your symptoms, medical history and risk factors and perform a physical examination.
The primary tests for diagnosing HIV and AIDs include:
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
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How Can You Prevent Getting Opportunistic Infections
If you have HIV, the best thing you can do to stay healthy and prevent OIs is to take HIV medicine exactly as prescribed and get and keep an undetectable viral loada level of HIV in your blood so low that a standard lab test cant detect it.
It is also important to stay in HIV medical care and get lab tests done. This will allow you and your health care provider to know when you might be at risk for OIs and discuss ways to prevent them.
Some of the ways people with HIV can reduce their risk of getting an OI include:
- avoiding exposure to contaminated water and food
- taking medicines to prevent certain OIs
- getting vaccinated against some preventable infections
- traveling safely