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Being Alive

A Quick Walk Through Some of the Common Opportunistic Infections Seen With HIV


Being Alive 1994 Feb 5: 7

[ Note: This was published as a chart in the Newsletter. I had to format it differently for this text version. ] A = Opportunistic Infection B = Causes disease most commonly in C = May present with symptoms such as D = May be diagnosed by tests such as E = And is most effectively treated with (Rx=treatment, Px=prophylaxis, prevention) A Pneumocystis carinii (PCP) B Lungs (pneumonia) C Fever, shortness of breath, cough (may be non-productive, i.e. no sputum) D Chest X-ray, sputum smear, arterial blood gases, bronchoscopy E Rx: TMP-SMX (Bactrim/Septra) or atovaquone (Mepron) or primaquine+clindamycin or pentamidine or trimetrexate/ usually prednisone as well Px: TMP-SMX-DS daily (or even every other day) or dapsone pyrimethamine or aerosolized pentamidine for CD4 < 200-250 (or % < 20) A Cytomegalovirus (CMV) B Eyes (retinitis), GI tract, lungs, brain, gallbladder C Blurry vision, abdominal pain, diarrhea, GI bleeding, shortness of breath D Ophthalmological exam; blood, stool, or other GI tissue smears/ cultures (may be obtained through endoscopy or colonoscopy) E Rx: ganciclovir (Cytovene) or foscarnet (Foscavir) I.V.

Px: none approved (oral ganciclovir or valaciclovir or high dose acyclovir all being studied) A Mycobacterium avium complex (MAC) B Bone marrow, blood, GI tract, liver, lungs C Night sweats, fever, chills, weight loss ("wasting"), loss of appetite, fatigue, muscle aches, diarrhea D Blood cultures, bone marrow smear and cultures, stool cultures (may be obtained through sigmoidoscopy/colonoscopy) E Rx: 2 or 3 drugs -- usually clarithromycin (Biaxin) or azithromycin (Zithromax) plus ethambutol (Myambutol) plus clofazimine (Lamprene) (possibly ciprofloxacin, rifampin) Px: rifabutin (Mycobutin) for CD4 < 100; (possible efficacy of clarithromycin also being studied) A Mycobacterium tuberculosis (TB) B Lungs, bone marrow, blood, gut, kidneys, adrenals C As in MAC, but more likely (if in lungs) shortness of breath, cough with sputum, "consumption" D Sputum smear + culture, chest X-ray as for MAC E Rx: usually 4 drugs (or more if multi-drug resistance suspected): isoniazid (INH) plus rifampin plus pyrazinamide plus ethambutol Px: isoniazid 1 year if PPD positive (and in some cases where PPD not diagnostic) A Toxoplasma gondii ("toxo") B Brain (encephalitis), eyes C Headaches, fever, seizures, changed mental status D CAT scan, MRI, brain biopsy, blood for toxo titer E Rx: pyrimethamine plus sulfadiazine or clindamycin (atovaquone or azithromycin may be used if above fail) Px: none officially approved but many use TMP-SMX or pyrimethamine A Cryptococcus neoformans ("Crypto") B Brain (meningitis), urine, lungs, skin C Fever, headache, changed mental status D Spinal tap, serum cryptococcal antigen, blood and cerebrospinal fluid (CSF) cultures E Rx: amphotericin-B 5-flucytosine I.V. followed by maintenance oral fluconazole (Diflucan) Px: none officially approved but some use fluconazole or ketoconazole (Nizoral) A Candida Albicans ("Yeast") B Vagina (vaginitis), mouth (thrush), esophagus C Vaginal discharge/itching, whitish discharge in mouth (scrapes off), painful, difficult swallowing D Direct inspection, wet mount preparation, GI endoscopy E Rx: nystatin or clotrimazole (Mycelex) troches or oral ketoconazole or oral fluconazole Px: none officially approved, but any of the above may be used by some A Papovavirus, causing Progressive Multifocal Leuko-encephalopathy (PML) B Brain C Changed mental status with progressive loss of body functions D MRI, brain biopsy E Rx: none officially approved but intrathecal (injection into spinal fluid via tap) cytosine arabinoside has been tried A Cryptosporidiosis B GI tract, gallbladder C Diarrhea, abdominal bloating/pain (usually without significant fever) D Stool smears, perhaps sigmoidoscopy or colonoscopy E Rx: none officially approved, but under study are paromomycin (Humatin), azithromycin or letrazuril Px: none A Microsporidiosis (Enterocystozoan bienusi or Septata intestinalis) B GI tract C Diarrhea, abdominal bloating/pain D As above, possibly with upper GI endoscopy E Rx: none officially approved but albendazole is often tried


Information in this article was accurate in February 5, 1994. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.