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Opportunistic Infections and Group Dynamics
Mar 17, 1997

I am not a physician, but I am currenly working with HIV + people in Malaysia, and I was wondering if you could answer the following question for me. As is common in many western countries, the diagnosis of HIV + status often results in the infected person seeking and gaining much benefit from supportive non-governmental organisations. Furthermore, the high prevelance of the virus in some groups such as IDU's or Homosexual communites has consequented in these support groups becoming very strong and potent commmunities in their own right. I was wondering whether it is possible that as an NGO working with these groups, I could become a latent carrier of many opportunistic infections that I do not react to, being on negative status at present, and thereby transmit life-thretening infections from one person I have been working with to another? I suppose my question is basically this: is it possible that people become MORE exposed to opportunistic infection because of the company they keep (i.e. others who either are or who have had contact with those suffering from oral thrush etc.etc.) and thereby reduce their life span because of the very support they seek in order to prolong it? I hope that this question doeas not offend - it is just a query and in no way is meant to undermine the fabulous charity work perfrmed by either the infected or the concerned.

Response from Dr. Cohen

It's a good question. Fortunately, people with HIV infection are rarely placed at risk by other people, whether HIV-infected or not. Most of the infections that cause problems are caused either by organisms that are everywhere but which are relatively harmless to people with normal immune systems, or by organisms which we are infected with earlier in life and which reactivate when you become immunosuppressed.

There are a few exceptions. You can get cryptosporidiosis from close contact with someone who has it. Tuberculosis, of course, is highly transmissible, and is especially dangerous to people with HIV infection. Sexually transmitted diseases are always an issue, and some, like syphilis, human papillomavirus, and herpes, can be more severe in HIV-infected individuals. CMV is spread form person-to-person, but most people have already become infected with it before acquiring HIV.

Most opportunistic infections, however, are not spread from person-to-person. In that list I include the most common opportunistic pathogens: Pneumocystis carinii, Mycobacterium avium complex (MAC), cryptococcus, toxoplasma, and Candida.

It's a good thing this is true, because the last thing infected people need to do is to isolate themselves from others.

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