HIV/AIDS and Opportunistic Infections

HIV (human immunodeficiency virus) attacks the body's white blood cells -- specifically a subset called CD4 or helper T cells. This attack allows opportunistic infections to take advantage of a weakened immune system, and can lead to illnesses, cancers, or neurological problems. If you have HIV and develop an opportunistic infection, your HIV infection may have progressed to AIDS (acquired immunodeficiency syndrome). But with careful monitoring, self-care, and treatment, you can prevent many infections and stay healthier if you do develop an infection.

Where HIV Opportunistic Infections Come From

A wide variety of germs can cause HIV opportunistic infections. These include bacteria, viruses, protozoa, or fungi. Even before you have HIV, you have many of these in your body. But a healthy immune system normally keeps them under control. These are examples of other places where you can pick up germs that cause HIV opportunistic infections:

• Unwashed raw foods
• Soil or water
• Contact with animal feces
• Contact with other people, through unsafe sex or in places where germs are common, such as hospitals, day care centers, or schools
• Contact with blood through sharing needles or intravenous drugs

Common HIV Opportunistic Infections

Almost any disease can become an HIV opportunistic infection when the immune system is weak. Some are more common than others, though. And some are more likely to occur at certain levels of CD4 counts than others. Here are some of the more common HIV opportunistic infections:

• Candidiasis (thrush): a fungal infection in the mouth, throat, or vagina.
• Cryptococcus neoformans (Crypto): a fungus that can lead to meningitis, a serious inflammation of membranes surrounding the brain and spinal cord.
• Cryptosporidiosis and microsporidiosis: protozoa affecting the gastrointestinal tract.
• Cytomegalovirus (CMV): a virus that causes eye disease and can lead to blindness. It can also cause severe diarrhea and ulcers.
• Herpes simplex: viruses that can cause severe genital or cold sores.
• Mycobacterium avium complex (MAC): a bacterium that can cause fevers, problems with digestion, and serious weight loss.
• Pneumocystis pneumonia (PCP): a fungus that can cause fatal pneumonia.
• Progressive multifocal leukoencephalopathy (PML): a virus affecting the brain.
• Toxoplasmosis (Toxo): a protozoa that sometimes causes encephalitis, an inflammation of the brain.
• Tuberculosis (TB): a bacterial infection that attacks the lungs and can invade other organs. TB can lead to meningitis at its most severe.

There are some differences between women and men with respect to opportunistic infections. Here are a few of them:

• Men are eight times more likely to develop a cancer called Kaposi's sarcoma.
• Women are more likely to develop bacterial pneumonia and herpes simplex infections.
• Women are also more at risk for certain infections that can lead to cancers of the reproductive system.

Preventing HIV Opportunistic Infections

Some of the germs that cause HIV opportunistic infections are so widespread they're difficult to avoid. But you can take steps to prevent some.

• Make nutritious food choices to help boost your immune system.
• Get regular exercise, but check with your doctor before starting an exercise program.
• Get enough rest and learn new ways to manage stress.
• If you smoke or use drugs, get help quitting.
• Thoroughly wash and cook all foods. Avoid raw or undercooked meats or eggs and unpasteurized dairy foods. Thoroughly wash and disinfect hands, knives, cutting boards, and counters where you prepare food.
• Keep cats indoors to prevent their exposure to germs that could harm you. Have others handle cat litter or pick up dog feces -- or use gloves if you do.
• Practice safe sex.
• Use a towel on shared gym equipment. Use a different towel to dry yourself.
• Avoid swallowing water in pools, lakes, or streams that might be contaminated.
• Get vaccinations your doctor recommends.
• Take HIV drugs to keep your immune system strong.

If your CD4 count stays up, HIV opportunistic infections are less likely to be a problem. However, if your CD4 count is low, you can take preventive drugs, called prophylaxis, to reduce your chances of becoming sick. Federal guidelines recommend anti-HIV therapy if CD4 cell counts fall to 350 or below or if you have symptoms of HIV disease -- even if cell counts are not low.

Diagnosing and Treating HIV-Related Opportunistic Infections

Many germs that cause HIV-related opportunistic infections are very common. You can undergo lab tests to learn which ones are already in your body. This will help your doctor know how to treat them and which ones you can focus on preventing. Unfortunately, as many as one out of four people in the U.S. aren't aware they're infected with HIV. Some don't find out until they end up in the hospital with a serious HIV-related opportunistic infection.
HIV makes copies of itself more quickly when HIV-related opportunistic infections occur. So early treatment is important not only to prevent serious results of infection, but to also preserve the immune system. Here's what you can do to receive diagnosis and treatment as early as possible.

• See your doctor regularly -- two to 12 times a year. Make sure you have a primary care doctor who is experienced in HIV treatment and knows how to coordinate care well with other specialists.
• If you're a woman, get regular pelvic exams and Pap tests to spot infections, precancers, or cancers of the reproductive system.
• Keep a record of symptoms to help with diagnosis of HIV-related opportunistic infections. These include fever for more than two days, weight loss, a change in vision, or mouth problems, skin problems, or breathing problems.
• Go to your doctor if you have any new or unusual symptoms. Don't wait for your regularly scheduled visit.
• Prepare for appointments by coming with questions and a way to take notes.
• Follow through with your course of treatment. Don't quit early.

Preventing Recurrence of HIV-Related Opportunistic Infections

Take the maintenance therapy your doctor prescribes. This is medication to prevent recurrence of infections. As your immune system recovers, you may be able to stop taking these at some point.