What the HIV-Positive Patient Needs to Know
Cryptosporidiosis (CRYPT-OH-spore-id-ee-oh-sis) is an uncommon but unpleasant AIDS-related opportunistic infection. It occurs in up to 20% of people who are infected with the human immunodeficiency virus, causing non-bloody, watery diarrhea and, less commonly, abdominal cramping and pain. Onset is generally rapid and fever is rare. Nausea, vomiting, tiredness, and jaundice -- a yellow discoloration of the skin and/or the whites of the eyes -- have been reported in some cases.
Cryptosporidium, the organism that causes this infection, gets into the intestinal tract when a person drinks contaminated water or eats unwashed or uncooked food. It can also be spread through direct contact with an infected individual, or indirectly through clothing they have worn, food they have prepared, and objects they have touched.
In HIV-positive individuals with CD4 counts -- also known as "T cell" counts -- above 200, cryptosporidiosis is a self-limiting condition that lasts from 5 to 14 days and resolves without medication, just as it does in HIV-negative individuals. The relapse rate is fairly high -- about 30% -- but these secondary flare-ups are less severe, and they usually last no more than a day or two.
In HIV-positive individuals with CD4 counts below 200, however, cryptosporidiosis is a considerably more serious affliction, one that can lead to permanent diarrheal illness. Over time, this unchecked diarrhea causes chronic malabsorption -- of fluids, nutrients, vitamins, and electrolytes. And malabsorption, in turn, leads to weight loss, wasting syndrome, and even death.
Many AIDS-related infections can cause diarrhea, among them cytomegalovirus and Mycobacterium avium complex, or MAC. All of these pathogens are a cause for concern, especially in individuals with advanced HIV disease, and persons with CD4 counts below 200 should consult a doctor if they develop diarrhea that persists for more than three days.
As a rule, a single stool specimen is usually sufficient to establish a diagnosis of cryptosporidiosis, although some physicians ask for up to three samples, each on a different day. There are no medications that will cure cryptosporidiosis once infection sets in, but Humatin® does suppress the effects of infection in most people. Zithromax® has also been used with some success in affected individuals. The recommended daily dose of Humatin® is 500 mg four times a day for a period of 14 to 28 days. The customary dose of Zithromax® is 600 mg daily for 14 to 28 days. Patients with particularly heavy infestations of cryptosporidia, those with CD4 counts below 50, and those who suffer relapses may require additional months of maintenance therapy.
With treatment, diarrhea usually abates, and for most patients it eventually ceases. As infection subsides, patients are often able to regain most or all of the weight they lost during the acute phase of infection. Humatin® and Zithromax® are not universally effective, however, and for that reason HIV-positive individuals with CD4 counts below 200 may want to take these simple precautions, which will dramatically reduce the likelihood that they will become infected with cryptosporidia: