What's an opportunistic infection? It's a disease that preys on people with weak immune systems. That's what makes it an opportunist.
Fortunately, people with HIV who are taking therapy can go a long time before they suffer the immune damage that allows an opportunistic infection (OI) to rise up. Even people who have an AIDS diagnosis but respond well to HIV therapy can avoid an OI.
Unfortunately, there are still many people who don't even know they're infected until the virus develops into AIDS and an OI lands them in the hospital -- sometimes killing them. The U.S. Centers for Disease Control and Prevention (CDC) estimates that one out of four people living with HIV in this country don't realize that they have it. Tell your friends and family to get tested!
A set of guidelines for preventing and treating opportunistic infections in people with HIV is available from the U.S. Public Health Service (USPHS), in conjunction with the Infectious Diseases Society of America (IDSA). If you have an opportunistic infection, I urge you to get a copy of the guidelines. See the end of this article for ordering information. The following is some of the updated information from the guidelines since our last story on OIs, which included transmission and symptoms (see "The Stalker Awaits," Sept./Oct. 2001 on-line or write to Positively Aware for a copy).
The importance of screening people with HIV for hepatitis C is emphasized.
Children born to mothers who have both HIV and hep C infection should be tested for hep C, since women with both viruses are more likely to pass on the hepatitis than women without HIV.
People co-infected with HHV-8 (human herpesvirus 8) are at risk for developing a rare cancer, Kaposi's sarcoma (KS). If they already have KS, the cancer may become more aggressive. Safer sex avoids infection with this herpes virus, but keep in mind that it can be transmitted through deep kissing. Sharing needles also shares the virus. Unfortunately, there is no blood test available at the doctor's office to see if your partner has HHV-8.
It's been shown that taking rifabutin or clarithromycin helps protect against cryptosporidiosis, a serious diarrheal disease that results from a parasite found in water. Unfortunately, the data on people taking those medicines do not allow for a recommendation to be made.
Doctors should consider repeating the tuberculosis skin test in people whose T-cells go up above 200 after taking HIV therapy.
Beware that two-month daily tuberculosis treatment with rifampin and pyrazinamide has been associated with severe and even fatal liver injury. It would be good to avoid the pyrazinamide.
Drug treatment information for tuberculosis MAC (Mycobacterium avium complex) has also been updated.
Vaccination information has been updated for both children and adults.
For More Information
You can order a copy of the Guidelines for the Prevention of Opportunistic Infections in Persons with HIV by contacting the U.S. Department of Health and Human Services (DHHS). The document is written for medical providers, but is pretty straightforward and broken down by each OI. DHHS also has very easy-to-read brochures on many of the OIs. The toll-free number is 1-800-HIV-0440 (448-0440). Write AIDSinfo, P.O. Box 6303, Rockville, MD 20849-6303. (You can write "DHHS Guidelines" instead of AIDSinfo.) Visit www.aidsinfo.nih.gov.
- Pneumocystis pneumonia (PCP), officially called Pneumocystis jiroveci
- Toxoplasmic encephalitits
- Disseminated infection with Mycobacterium avium complex (MAC)
- Bacterial respiratory infections
- Bacterial enteric (intestinal) infections
- Cytomegalovirus disease (CMV)
- Herpes simplex virus disease
- Varicella-zoster virus disease
- Human herpesvirus 8 infection (Kaposi's sarcoma-associated herpes virus)
- Human papillomavirus infection
- Hepatitis C virus infection