Monday, 23 July 2018

Co-Infections of Sexually Transmitted Diseases


With early diagnosis, proper monitoring and care, most of the illnesses caused by HIV can be prevented. They are much less frequent than they were before effective anti-HIV drugs became available.
There are a number of infections and illnesses that can develop in people who are living with HIV, particularly those people who are not able to take anti-HIV drugs. Some of these life-threatening infections are called opportunistic infections. These only occur if your immune system is quite weakened (usually in the absence of anti-HIV drug therapy) and your body becomes vulnerable to infections that would not affect you otherwise.
Co-infections are illnesses that can occur in people with normal immune systems, but they can impact how you live with HIV.

Some types of cancers are thought to be more common in people with HIV.
Increasingly, the distinction between these different types of infections—life-threatening infections, co-infections and even some cancers—is blurred, as some infections can fit all three categories (for example, human papillomavirus is a co-infection which can lead to cervical and anal cancer).
Life-threatening infections
These infections occur only when a person’s immune system has been seriously weakened by HIV due to lack of diagnosis and/or anti-HIV treatment. HIV attacks immune cells called CD4+ cells, which are needed for fighting off infections and some cancers. A normal CD4+ cell count in an HIV-negative person is around 500 to 1,500 cells in each cubic millimetre (mm3) of blood. If your CD4+ cell count gets lower, your immune system becomes unable to fight off a number of common viruses, bacteria and parasites. These infections can then take hold. (They are sometimes called opportunistic infections because they take advantage of your weakened immune system.)
Life-threatening infections are uncommon now, since most people take anti-HIV drugs, which controls their viral load, raises their CD4+ levels and stabilizes and restores immune system function. This helps prevent life-threatening infections caused by HIV.
The main danger nowadays is in not finding out you are HIV-positive until your CD4+ cell counts are already so low that you are at risk or are already sick with a life-threatening infection.
The more common life-threatening infections are listed in the accompanying table. Some of these can still occur in people with relatively high CD4+ levels but are more serious when the immune system is weakened.
Life-threatening infections include a lung infection called Pneumocystis pneumonia (PCP), an eye infection caused by cytomegalovirus (CMV), a brain infection called toxoplasmosis, and a generalized infection called Mycobacterium avium complex (MAC). If it happens that you find out you have HIV when your CD4+ cell count is very low, there are drugs you can take to prevent these infections. This is called prophylaxis.

Co-infections

Hepatitis

These are infections that can occur even in people with HIV who have adequate CD4+ levels—just as they can occur in people who do not have HIV. They are called co-infections because you have them along with HIV. Co-infections can complicate your HIV treatment and make living with HIV more difficult. HIV can also complicate the treatment and diagnosis of a co-infection. Although they may occur at normal CD4+ levels, the lower your CD4+ cell count is, the more of a problem they can be.
Chronic hepatitis is an increasingly common co-infection for many people with HIV. Hepatitis is a liver condition usually caused by viruses called hepatitis A, hepatitis B or hepatitis C. These viruses infect the liver and can cause jaundice (yellow skin and eyes), dark urine, pale stool and severe fatigue. It is a good idea for your doctor to check regularly for these infections. Hepatitis B and C are transmitted by:
·         blood-to-blood contact through sharing drug-using equipment, or personal care items like razors;
·         transfusion of blood and blood products before 1992 when the Canadian system started screening;
·         unprotected sexual intercourse;
·         being passed from mother to child during childbirth.
Hepatitis A is another, usually less serious, viral infection of the liver. Hepatitis A is spread through feces (shit), and you can be infected by contaminated food (for instance, if someone handling your food has hepatitis A and did not wash his or her hands). If you are exposed to hepatitis A, it can make you quite sick for a few weeks, but your immune system usually clears it. Hepatitis A very rarely causes permanent damage unless you already have hepatitis B or C as well.
If infected with the hepatitis A or B virus, some people get over the initial liver infection and develop immunity. This is much less likely to happen in people with HIV who are co-infected with hepatitis C. Without treatment, people can develop chronic hepatitis, remain infectious to others and develop ongoing liver problems.
As described below, there are vaccinations that will prevent you from getting hepatitis A and B infection. There is no vaccination available for hepatitis C.
Effective antiviral treatments are available for both hepatitis B and C infection. Treatment can cure hepatitis C and keep hepatitis B under control. There are interactions between drugs to treat hepatitis and HIV, so make sure you see a doctor with expertise in both conditions.

Tuberculosis (TB)

TB is a concern for people with HIV because it is so easily spread, especially in places where people live close to each other, in poverty and without adequate medical care.
TB usually infects the lungs, but it can also affect the bones, brain and other organs in your body. TB is spread through the air when someone with active TB coughs or sneezes. Diagnosis of TB is done by skin tests, tests of your sputum (phlegm) and chest X-rays. There are effective treatments for TB, but they need to be taken every day for many months. Missing doses, or stopping before the full treatment period is over, can cause the TB infection to become drug-resistant and much more difficult to treat. People with HIV with a history of previously treated TB may have it reactivate (come back again) if their immune system weakens.

Herpes infections

Herpes is a family of viruses that includes:
·         Herpes simplex, which causes cold sores on the mouth or painful sores on the genitals.
·         Varicella-zoster, which initially causes chicken pox and when reactivated causes painful sores called shingles anywhere on the skin.
Herpes infections are common and are often transmitted by physical contact and sex. Usually, the immune system keeps herpes infection under control until something like stress or a high fever brings the sores out in an outbreak lasting seven to 10 days, or longer. The lower your CD4+ cell count, the more frequent outbreaks may be. They may also last longer.
People with HIV with extremely weak immune systems (CD4+ cell counts less than 100 cells/mm3) are at risk for herpes infections all over the body (disseminated herpes) or in the brain (herpes encephalitis). People with frequent herpes outbreaks (even with normal CD4+ levels), or people at risk for more serious herpes infections, can take antiviral drugs—usually valacyclovir or similar drugs—to keep the herpes virus suppressed.

Fungal infections

Fungal or yeast infections can happen whether you are HIV-positive or not. Women get vaginal yeast infections, and men and women can get athlete’s foot or fungal infections on the skin or nails. The more weakened your immune system is, the more this can be a problem.
Even people with moderate CD4+ cell counts can get a fungal infection in the mouth or vagina called candidiasis or thrush. Antifungal creams, pills and vaginal suppositories are available to treat these problems, and probiotic supplements or yoghurts with friendly bacteria may also help. Watch your diet because the more sugar you eat, the more susceptible you are to fungus, which loves sugar.

Sexually transmitted infections

Some of the infections discussed above can be passed on in many ways, including through sex. Some other infections, like chlamydia, gonorrhea and syphilis, and the virus HPV, are virtually always transmitted sexually. 

Cancers

Cancer is the abnormal and uncontrolled growth of cells in different parts of the body. These cancerous growths then destroy healthy cells and cause serious illness. A normally functioning immune system acts to suppress this abnormal growth of cells.
People with HIV can become more vulnerable to certain types of cancer. Some of these cancers occur only when the immune system is weakened. Other cancers seem to be more common in people with HIV even when their immune system is relatively healthy.

Kaposi’s sarcoma

Kaposi’s sarcoma (KS), a rare form of skin cancer, is caused by a member of the herpes virus family and can be life-threatening.  It causes purple lesions on the skin that looked like bruises. Although slow growing, if it spreads to internal organs it could lead to illness and death. In the early days of HIV, it was quite common in people living with HIV. When HAART was introduced, KS became uncommon and now only occurs in people with very weak immune systems.

Non-Hodgkin’s lymphoma

When the cells in the lymph nodes become cancerous, this is called lymphoma. The non-Hodgkin’s type of lymphoma (NHL) is more common in people with HIV. The symptoms of NHL may include persistently swollen lymph glands, fevers, chills and sweats and weight loss. In the case of central nervous system lymphoma, the symptoms are often headaches and seizures.
Diagnosis of lymphoma, like many cancers, is done by biopsy where a sample of tissue from a swollen lymph node is examined under the microscope for evidence of abnormal cells. In the event of central nervous system lymphoma, the diagnosis is made by examining cerebrospinal fluid tapped from the spine. Lymphoma is usually treated by chemotherapy, where powerful anti-cancer drugs are injected into the vein on a regular basis, and/or radiation therapy where high-powered X-rays are directed at the cancer cells.

Cervical cancer

The cervix is the opening of the uterus (womb) inside a woman’s vagina. Sometimes abnormal cells can start to grow on the cervix, usually as a result of HPV infection. Over time, these abnormal growths can become a pre-cancerous condition called cervical dysplasia. If dysplasia is not found and treated, it can become cancer.
To prevent this, all women should have annual Pap tests to look for dysplasia from a small scraping of cells from the cervix. Women with a history of genital warts or cigarette smoking should have Pap exams more frequently. If dysplasia is found, it is usually treated with a laser in a procedure called colposcopy.
The HPV vaccine will protect women from some, but not all, strains of HPV and so it is hoped it will prevent some cases of cervical cancer. However, this vaccine is effective only if it is given before women have been exposed to the HPV strains the vaccine targets.

Anal cancer

Cancer in the anal canal of men and women is similar to cervical cancer. It is also usually caused by infection with HPV and, like cervical cancer, develops over time from dysplasia to cancer. Risk factors include a history of anal sex and/or genital warts. Both men and women with HIV are thought to be more vulnerable to this form of cancer

Other cancers

There are many other forms of cancers that people with HIV are thought to be at slightly higher risk for, even without immune suppression. These include Hodgkin’s lymphoma, lung cancer, skin cancer, vaginal cancer in women and testicular and prostate cancer in men. Fortunately, these cancers are not common and can often be successfully treated if they do occur in people with HIV who maintain healthy immune systems with effective anti-HIV drugs.

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