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MANAGEMENT OF OPPORTUNISTIC INFECTIONS IN HIV-POSITIV PATIENTS FACT SHEETS   Forword Human immunodeficiency virus (HIV) causes a chronic infection that leads to profound immunosuppression. A hallmark of this process is the depletion of CD4+ lymphocytes, and this predisposes the patient to develop a variety of opportunistic infections and certain neoplasms. The course of the infection may vary, with some individuals developing immunodeficiency within 2 to 3 years and others remaining asymptomatic for 10 to 15 years. A typical course spanning over about 10 years is depicted in the following chart: Stage of disease CD4 count Clinical manifestations Early symptomatic HIV disease 200-500 cells/µl Constitutional symptoms (such as fever andunexplained weight loss) and cutaneous manifestations (such as seborrhoeic dermatitis, oral candidiasis, herpes zoster, recurrent herpes simplex), pneumonia and tuberculosis. Late symptomatic disease 50-200 cells/µl The risk of developing an opportunistic infection or malignancy substantially increases. Oesophageal candidiasis, Toxoplasma gondii encephalitis, Pneumocystis carinii pneumonia, Kaposi's sarcoma and lymphoma may occur. Persistent or progressive constitutional symptoms may occur, as described in early symptomatic infection. Advanced HIV disease <50 cells/µl Certain opportunistic infections are more likely to occur with profound immunosuppression, such as cytomegalovirus retinitis, cryptococcal meningitis, disseminated Mycobacterium avium complex infection, disseminated histoplasmosis and progressive multifocal leucoencephalopathy. Typically, the patient may develop co-existing infections.Neurologic disease is more prevalent at this stage and may manifest as AIDS dementia complex or primary CNS lymphoma. AIDS wasting syndrome with a weight loss of >10% of ideal body weigh is common. Thus, CD4 T-lymphocyte counts are the best-validated predictors of the likelihood of developing an opportunistic infection. Susceptibility to opportunistic infections increases as HIV-induced immunodeficiency becomes more severe. Management of HIV infection involves treating the opportunistic infections, as well as inhibiting viral replication using antiretrovirals. This collection of fact sheets focuses on management of some commonly occurring opportunistic infections in HIV patients.
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