2. Objectives
⢠Discuss basic factors regarding Opportunistic
infections (OIs)
⢠See the frequency with which these OIs occur &
Clinical features, Diagnosis & treatment of some
OIs.
⢠Discuss patient education messages for
preventing OIs.
3. AIDS Definition
⢠CDC definition of an HIV +ve person as having
AIDS
-- Has had at least one of over 21 AIDS
defining OIs
and/or
--Has had a CD4 cell count of 200 or less
⢠NACO Definition: AIDS has been defined as the
occurrence of life threatening opportunistic
infections, malignancies, neurological diseases
and other specific illnesses in patients with HIV
infection and/or with CD4 count less than
200/cmm
4. HIV Related infections and
illnesses
BACTERIAL VIRAL FUNGAL PARASITIC OTHER
ILLNESSES
Tuberculosis Varicella zoster Candidiasis Isosporiasis AIDS -dementia
Bacterial respiratory
infections
Oral leukoplakia Cryptococcosis Microsporidi-osis Invasive
cervical cancer
Bacterial enteric
infections
HSV
CMV
Penicilliosis Cryptosporid-iosis Non-Hodgkin's
lymphoma
Pneumocystis
jiroveci pneumonia
Human herpes
virus type 8
Giardiasis
Toxoplasmosis
Kaposi's
sarcoma
Atypical
mycobacteriosis
Human papilloma
virus
Strongyloidiasis
5. The basics of OIs
⢠HIV infects a type of WBC called CD4 cells
⢠When the immune system loses too many CD4
cells OIs are more likely to develop
⢠Different type of OIs develop at different levels of
CD4 count, depending on the microbes or
pathogens endemic in that particular region
6.
7. % of OIs in AIDS cases in INDIA
NACO reported cases (n=5204)
0
10
20
30
40
50
60
70
80
90
100
TB Can Cryp. Dia HZ Tox Bact. Inf. PCP Cryp.
Men
KS
8. Presenting symptoms & signs in AIDS
patients
NACO reported cases (n=5204)
0
10
20
30
40
50
60
70
80
90
100
Wt. loss Diarrhea Fever Asthenia Cough LAP
9. Tuberculosis
⢠Major world wide co-infection.
⢠Clinical features:-cough,
-hemoptysis,
- weight loss,
-evening rise of temp.
⢠Diagnosis: sputum for AFB, chest X-ray, culture
of specimen from the site (in case of extra
PTB), Skin test (PPD)
⢠Treatment: DOTS as per RNTCP
10. Candidiasis
⢠Oral Candidiasis may be the initial sign of HIV
infection.
⢠Clinical features: -oral thrush,
-dysphagia
⢠Diagnosis: C/F, KOH preparation of the
scrapings
⢠Treatment: Gentian
violet, Clotrimazole, Miconazole in mild cases
(Oral Can.) & Fluconazole in severe cases
(esophageal Can.)
11. Cryptosporidiosis
⢠Found in about 35% of AIDS diarrheal cases.
⢠Clinical features: -watery diarrhea,
-Abdominal bloating,
-profound weight loss .
⢠Diagnosis: Microscopy
⢠Treatment: Paromomycin/ Azithromycin.
Response is poor with all available therapies.
Prevention of malnutrition & symptomatic
relief vital in management.
12. Pneumocystis carinii Pneumonia
⢠Occurs in advanced HIV disease, when CD4
falls below 250
⢠Clinical features:-fever,
-dry cough,
-chest pain,
-shortness of breath.
⢠Diagnosis- C/F, sputum tests, X-ray
⢠Treatment-TMP-SMZ (co-trimoxazole)
13. Cytomegalovirus
⢠Never occurs unless CD4 cell count less than 50
⢠Most typically affects the eyes
⢠Clinical features:-Blurry vision,
- Respiratory, CNS &
Gastrointestinal complications.
⢠Diagnosis: specialist (ophthalmologist)
examination
⢠Treatment: Gancyclovir, Foscarnet.
14. Cryptococcal meningitis
⢠Most common cause of meningitis in AIDS
⢠Clinical features:
-headache, fever,
-nausea and vomiting,
-confusion and impaired consciousness,
-signs of meningism (only in about 40%)
⢠Diagnosis: CSF examination (Indian ink staining,
Ag Titre)
⢠Treatment: Amphotericin B/Fluconazole with or
without 5-flucytosine.
15. Toxoplasmosis
⢠Commonest cause of focal cerebral lesions in
HIV/AIDS
⢠Clinical features:
-focal neurological deficit (FND),
-Seizures, intracranial hemorrhage,
-altered mental state and coma
⢠Diagnosis: CT Brain
⢠Treatment: Sulfadiazine or Clindamycin,
plus Pyrimethamine & Folinic acid.
16. Mycobacterium Avium Complex
⢠Usually occurs only if the CD4 count is less than
75
⢠Clinical features:-Flu like fever,
-chills, sweats,
-anemia, fatigue.
⢠Treatment-Clarithromycin, ethambutol
⢠Note: certain infections like
Histoplasmosis, Blastomycosis, Mycobacterium
Avium intra cellular (MAC) have not been
reported from our country so far
17. Patient Education
⢠Best way to prevent OIs is to keep immune
system strong
⢠Appropriate medication at certain CD4 cell levels
can prevent many OIs (prophylaxis)
⢠Treatment options available if OIs develop
⢠After recovery from OIs on-going maintenance
treatment is still needed
⢠Can stop prophylaxis or maintenance treatment
if CD4 cell count goes up
⢠Should not discontinue any treatment without
discussing first with Doctor
18. &âŚ
General preventive measures:
⢠Prevent exposure to ill patients.
⢠Personal hygiene (washing hands etc.)
⢠Avoid contact with raw food, soil, cats, bird
excreta, litter boxes etc.
⢠Wash vegetables before cooking, avoid raw
meat intake, drink boiled water.
⢠Use condoms during sexual contact.
19. ThusâŚ.
⢠OIs develop in an HIV infected individual
depending on the CD4 count & microbial
environment
⢠Most common OIs are TB, Candidiasis,
Cryptosporidiosis, Herpes zoster, Toxoplasmosis,
PCP
⢠Patient education plays vital role in preventing OIs