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HIV1/AIDS-associated opportunistic infection

Etiology: 1) protozoal a) toxoplasmosis encephalitis b) cryptosporidia enteritis 2) viral a) cytomegalovirus b) Epstein-Barr virus - oral hairy leukoplakia c) Herpes simplex d) Herpes zoster e) progressive multifocal leukoencephalopathy 3) fungal a) Pneumocystis pneumonia (PCP, Pneumocystis jirovecii)* b) oral candidiasis, candidemia is rare [1] c) Cryptococcus d) coccidioidomycosis e) histoplasmosis (most common endemic mycosis in U.S.) f) CNS blastomycosis may occur as late complication f) aspergillosis g) Sporothrix h) Penicillium 4) bacteria a) Salmonella b) Streptococcus pneumoniae (pneumoccocal vaccination) [1] c) Haemophilus influenzae d) Mycobacteria 1] Mycobacterium tuberculosis - rule out active tuberculosis prior to treatment of latent tuberculosis [1] 2] Mycobacterium avium complex - must rule out if CD4 count < 50/uL 3] other Mycobacterial species e) Listeria f) Nocardia g) Treponema pallidum (syphilis) h) Bartonella i) Neisseria meningitis (10-fold risk) [2] * the most common AIDS-defining condition & the most common cause of death in patients with AIDS Laboratory: - CD4 count: opportunistic infections in untreated HIV1 patients generally occur with CD4 count drops below 200/uL [1] Management: - prophylaxis - Pneumocystis jirovecii - CD4 count < 200/uL - Bactrim DS QD or 3 times weekly [1] - toxoplasmosis - CD4 count < 100/uL with postitive serology - Bactrim DS BID - Mycobacterium avium complex (MAC) - CD4 count < 50/uL - azithromycin 1200 mg/week - tuberculosis - positive tuberculin skin test or IFN-gamma release assay - INH 300 mg/day for 9 months

Related

Acquired Immuno-Deficiency Syndrome (HIV infection stage 3, AIDS)

General

complications in patients with HIV1 infection opportunistic infection

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
  2. Miller L et al Elevated Risk for Invasive Meningococcal Disease Among Persons With HIV. Ann Intern Med. Published online 29 October 2013 PMID: 24166695 http://annals.org/article.aspx?articleid=1763213
  3. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV, National Institutes of Health, Centers for Disease Control and Prevention, and the HIV Medicine Association of the Infectious Diseases Society of America. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. Jun 14, 2023. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/