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==Overview==
==Overview==
Before the widespread use of potent combination antiretroviral therapy (ART), opportunistic infections (OIs), which have been defined as infections that are more frequent or more severe because of immunosuppression in HIV-infected persons, were the principal cause of morbidity and mortality in this population. In the early 1990s, the use of chemoprophylaxis, immunization, and better strategies for managing acute OIs contributed to improved quality of life and improved survival.<ref name="pmid16741877">{{cite journal |author=Walensky RP, Paltiel AD, Losina E, Mercincavage LM, Schackman BR, Sax PE, Weinstein MC, Freedberg KA |title=The survival benefits of AIDS treatment in the United States |journal=J. Infect. Dis. |volume=194 |issue=1 |pages=11–9 |year=2006 |month=July |pmid=16741877 |doi=10.1086/505147 |url=http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16741877 |accessdate=2012-04-05}}</ref>  However, the widespread use of ART starting in the mid-1990s has had the most profound influence on reducing OI-related mortality in HIV-infected persons in those countries in which these therapies are accessible and affordable.


==HIV Opportunistic Infections==
==HIV Opportunistic Infections==
{| style="border: 0px; font-size: 90%; margin: 3px; width:1000px;" align=center
|valign=top|
|+
! style="background: #4479BA; color:#FFF;  width: 350px;" | Disease
! style="background: #4479BA; color:#FFF;  width: 350px;" | Description
! style="background: #4479BA; color:#FFF;  width: 350px;" | Clinical Findings
! style="background: #4479BA; color:#FFF;  width: 350px;" | Diagnosis
! style="background: #4479BA; color:#FFF;  width: 350px;" | Prophylaxis
! style="background: #4479BA; color:#FFF;  width: 350px;" | Treatment
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | [[Pneumocystis pneumonia|Pneumocystis Pneumonia]] <br> <br><small>[[HIV opportunistic infection pneumocystis pneumonia: prevention and treatment guidelines|(Click here for more information)]]</small>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Caused by the fungus ''Pneumocystis jirovecii''.
*90% of cases occurred among patients with CD4+ <200
*Incidence among HIV patients: 2-3 cases per 100 person-year
| style="padding: 5px 5px; background: #F5F5F5;" |Subacute onset of progressive dyspnea, fever, nonproductive cough, and chest discomfort that worsens within days to weeks. Tachypnea, tachycardia, and diffuse dry rales are found in the physical examination. 
| style="padding: 5px 5px; background: #F5F5F5;" | Clinical presentation, blood tests, or chest x-rays are not pathognomonic for PCP.
| style="padding: 5px 5px; background: #F5F5F5;" | Start TMP-SMX prophylaxis when CD4+ <200 cells/µL or history of oropharyngeal candidiasis.  <br> Discontinue prophylaxis when  CD4+ is >200 cells/µL for >3 month.
| style="padding: 5px 5px; background: #F5F5F5;" |
*TMP-SMX
*<small>Administer adjunctive corticosteroids in patients with pO2 <70 mm Hg or arterial-alveolar O2 gradient >35 mm Hg</small>
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | [[Toxoplasma gondii]] Encephalitis<br> <br><small>[[HIV opportunistic infection toxoplasma gondii encephalitis: prevention and treatment guidelines|(Click here for more information)]]</small>
| style="padding: 5px 5px; background: #F5F5F5;" |
* Caused by the protozoan ''Toxoplasma gondii''
* The greatest risk of disease occurs among patients with a CD4+ <50 cells/µL
* Primary infection occurs after eating undercooked meat containing tissue cysts or ingesting oocysts that have been shed in cat feces and have sporulated in the environment
| style="padding: 5px 5px; background: #F5F5F5;" | Focal encephalitis with headache, confusion, or motor weakness and fever
| style="padding: 5px 5px; background: #F5F5F5;" | Diagnosis is done with IgG antibodies.  CT scan or MRI of the brain will typically show multiple contrast-enhancing lesions, often with associated edema.  Definite diagnosis requires a brain biopsy.
| style="padding: 5px 5px; background: #F5F5F5;" |Start TMP-SMX prophylaxis when CD4+ <100 cells/µL <br> Discontinue prophylaxis when  CD4+ is >200 cells/µL for >3 month.
| style="padding: 5px 5px; background: #F5F5F5;" | Administer:
* [[Pyrimethamine]], PLUS 
* [[Sulfadiazine]], PLUS
* [[Leucovorin]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | [[Cryptosporidiosis]] <br> <br><small>[[HIV opportunistic infection cryptosporidiosis: prevention and treatment guidelines|(Click here for more information)]]</small>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Caused by the protozoan ''Cryptosporidium <small>(C. hominis, C. parvum, and C. meleagridis)</small>''
*The greatest risk of disease occurs among patients with a CD4+ <100 cells/µL
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Microsporidiosis
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Mycobacterium tuberculosis
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #F5F5F5;" colspan=5| Table adapted from Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents <ref>{{cite web| url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5804a1.htm| title=Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents}} </ref>
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}

Revision as of 20:51, 15 October 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Overview

Before the widespread use of potent combination antiretroviral therapy (ART), opportunistic infections (OIs), which have been defined as infections that are more frequent or more severe because of immunosuppression in HIV-infected persons, were the principal cause of morbidity and mortality in this population. In the early 1990s, the use of chemoprophylaxis, immunization, and better strategies for managing acute OIs contributed to improved quality of life and improved survival.[1] However, the widespread use of ART starting in the mid-1990s has had the most profound influence on reducing OI-related mortality in HIV-infected persons in those countries in which these therapies are accessible and affordable.

HIV Opportunistic Infections
Disease Description Clinical Findings Diagnosis Prophylaxis Treatment
Pneumocystis Pneumonia

(Click here for more information)
  • Caused by the fungus Pneumocystis jirovecii.
  • 90% of cases occurred among patients with CD4+ <200
  • Incidence among HIV patients: 2-3 cases per 100 person-year
 Subacute onset of progressive dyspnea, fever, nonproductive cough, and chest discomfort that worsens within days to weeks. Tachypnea, tachycardia, and diffuse dry rales are found in the physical examination. Clinical presentation, blood tests, or chest x-rays are not pathognomonic for PCP. Start TMP-SMX prophylaxis when CD4+ <200 cells/µL or history of oropharyngeal candidiasis.
Discontinue prophylaxis when CD4+ is >200 cells/µL for >3 month.
  • TMP-SMX
  • Administer adjunctive corticosteroids in patients with pO2 <70 mm Hg or arterial-alveolar O2 gradient >35 mm Hg
Toxoplasma gondii Encephalitis

(Click here for more information)
  • Caused by the protozoan Toxoplasma gondii
  • The greatest risk of disease occurs among patients with a CD4+ <50 cells/µL
  • Primary infection occurs after eating undercooked meat containing tissue cysts or ingesting oocysts that have been shed in cat feces and have sporulated in the environment
 Focal encephalitis with headache, confusion, or motor weakness and fever Diagnosis is done with IgG antibodies. CT scan or MRI of the brain will typically show multiple contrast-enhancing lesions, often with associated edema. Definite diagnosis requires a brain biopsy. Start TMP-SMX prophylaxis when CD4+ <100 cells/µL
Discontinue prophylaxis when CD4+ is >200 cells/µL for >3 month. 		Administer:
Cryptosporidiosis

(Click here for more information)
  • Caused by the protozoan Cryptosporidium (C. hominis, C. parvum, and C. meleagridis)
  • The greatest risk of disease occurs among patients with a CD4+ <100 cells/µL
Microsporidiosis
Mycobacterium tuberculosis
Table adapted from Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents [2]

References

  1. ↑ Walensky RP, Paltiel AD, Losina E, Mercincavage LM, Schackman BR, Sax PE, Weinstein MC, Freedberg KA (2006). "The survival benefits of AIDS treatment in the United States". J. Infect. Dis. 194 (1): 11–9. doi:10.1086/505147. PMID 16741877. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  2. ↑ "Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents".
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