January 2013
Table of Contents
A fungus is a kind of germ. Many fungi (plural form of fungus) exist normally in and on our bodies, and in the surrounding environment, for example in soil, dust, food, water, and plants. Most fungi are harmless to humans, but there are several that can cause harmful infections, especially in people living with HIV (HIV+).
Candidiasis is a very common fungal infection usually caused by Candida albicans. This yeast-like fungus is found in all healthy people. The immune system and bacteria normally found in the body generally keep Candida in check. When Candida is not kept in check, it can cause problems like yeast infections or thrush, which are described below.
When there is an overgrowth of Candida, it can cause problems in the mouth, food pipe (esophagus), or vagina. This happens more often when the immune system is weakened by HIV or when you take antibiotics. Antibiotics can kill helpful bacteria that keep Candida in check.
The medications used to fight Candida are anti-fungal drugs called "azoles." Examples are Nizoral (ketoconazole), Diflucan (fluconazole), Sporanox (itraconazole), Vfend (voriconazole), or Noxafil (posaconazole). Pregnant women should not take oral azoles (pills or liquids), as they may cause damage to the developing baby. Topical azoles used inside the vagina like Monistat (miconazole) or Gyne-Lotrimin (clotrimazole) creams, however, are safe for use during pregnancy. In addition, several of the anti-fungal drugs interact with specific HIV drugs such as the protease inhibitor Norvir (ritonavir) and non-nucleoside reverse transcriptase inhibitors such as Sustiva (efavirenz), Viramune (nevirapine), Edurant (rilpivirine), and Intelence (etravirine).
Candidiasis can come back repeatedly. Some health care providers prescribe anti-fungal drugs on a long-term basis, but this can lead to drug-resistant Candida that is more difficult to treat.
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The fungus Cryptococcus neoformans is very common. It is found in soil and bird droppings. While most people have been exposed to this fungus, they generally have immune systems that are healthy enough to prevent Cryptococcus from causing disease.
In immune-compromised people, especially HIV+ people with fewer than 100 CD4 cells, Cryptococcus can cause a serious infection called meningitis -- an inflammation or swelling of the lining of the spinal cord and brain. If it is not treated quickly and correctly, cryptococcal meningitis can cause coma or death.
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It is very important to let your health care provider know if you experience any of these symptoms.
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Histoplasmosis is caused by infection with the Histoplasma capsulatum fungus, which is common in the soil of the Mississippi and Ohio River valleys, the Caribbean, and Central and South America.
In a healthy person, the infection is usually confined to the lungs, causing only mild symptoms. In HIV+ people with low CD4 cell counts (below 200), the infection can be life threatening. However, histoplasmosis is not a common disease in HIV+ people.
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Aspergillosis is caused by Aspergillus, a very common group of fungi. In people with healthy immune systems, it usually causes mild or moderate lung problems. In people with suppressed immune systems, it can be life threatening. Aspergillosis was more common in the earlier days of AIDS. Today it is rarely seen in HIV+ people.
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Coccidioidomycosis, commonly called Valley Fever, is a fungal infection caused by either Coccidioides immitis or Coccidioides posadasii. These fungi or molds grow in soil found in the southwestern United States, in Mexico, and in Central and South America. You get infected by breathing fungal particles (spores) into your lungs, where the infection starts.
In people with healthy immune systems, coccidioidomycosis involves mild to moderate lung problems. In those with weakened immune systems, it can cause more serious lung problems and also spread to other areas, including the skin, bones, lining of the brain and spinal cord, and lymph nodes.
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Fungal infections can be common, and in some cases, very serious for HIV+ people. However, on-going medical care allows for the effective prevention or early diagnosis and treatment of these infections. In addition, most of the more serious fungal infections are more likely to occur in HIV+ people with low CD4 cells (especially less than 100). One way to prevent fungal infections from occurring is to keep the immune system healthy by using HIV drugs and seeing your health care provider on a regular basis.