“AIDS-defining” conditions

HIV is a virus that attacks CD4 cells (T cells). These white blood cells serve as helper cells for the immune system. CD4 cells send a biological SOS signal to other immune system cells to go on the offensive against infections.

When a person contracts HIV, the virus merges with their CD4 cells. The virus then hijacks and uses the CD4 cells to multiply. As a result, there are fewer CD4 cells to fight infections.

Opportunistic infections and diseases

With HIV, a weakened immune system increases vulnerability to several opportunistic infections, cancers, and other conditions. The CDC refers to these as “AIDS-defining” conditions. If someone has one of these conditions, the HIV infection has advanced to stage 3 HIV (AIDS), regardless of the number of CD4 cells in their blood.

Following are some of the more common opportunistic diseases. Becoming knowledgeable about these health risks is the first step in protecting against them.

Candidiasis

Candidiasis encompasses several infections in different areas of the body caused by Candida, a genus of fungi. These infections include oral thrush and vaginitis. A fungal infection is considered AIDS-defining when found in the esophagus, bronchi, trachea, or lungs.

Powerful and sometimes quite toxic antifungal medications are used to treat candidiasis. A healthcare provider will recommend a specific medication based on the location of infection.

For instance, they may prescribe these medications for vaginitis caused by candidiasis:

• butoconazole (Gynazole)
• clotrimazole
• miconazole (Monistat)

If systemic infection is present, treatment may include medications like:

• fluconazole (Diflucan)
• itraconazole (Sporanox)
• posaconazole (Noxafil)
• micafungin (Mycamine)
• amphotericin B (Fungizone)

Cryptococcal meningitis

Cryptococcus is a common fungus found in soil and bird droppings. Some varieties also grow in areas surrounding trees, and one variety particularly prefers eucalyptus trees. If inhaled, Cryptococcus may cause meningitis. This is an infection of the membranes around the brain and spinal cord.

Very potent (and quite often toxic) antifungal medications are used to initially treat cryptococcal meningitis, as are frequent spinal taps. These medications may include in combination:

• amphotericin B
• flucytosine (Ancobon)
• fluconazole
• itraconazole

This condition can be fatal if not treated promptly. Long-term suppressive therapy is often used with somewhat less toxic medications for people with HIV.

Cryptosporidiosis

A tiny parasite that lives in the intestines of humans and animals is responsible for cryptosporidiosis. Most people get the disease by drinking contaminated water or eating contaminated produce.

Cryptosporidiosis is an unpleasant diarrheal illness for healthy people. However, for those who are HIV-positive, it can last longer and cause more severe symptoms.

A medication called nitazoxanide (Alinia) is normally prescribed to treat the disease.

Cytomegalovirus

Cytomegalovirus (CMV) is virus most commonly thought of as causing serious eye disease in people with weakened immune systems. It can potentially lead to blindness.

CMV can also lead to illness in other areas of the body, such as the digestive tract and parts of the nervous system.

There are currently no medications to cure CMV. However, several powerful antiviral medications can treat the infection. These include:

• gancliclovir (Zirgan)
• valgancilovir (Valcyte)
•  foscarnet (Foscavir) 
• cidofovir (Vistide)

In people with severely weakened immune systems, these CMV medications often need to be given at significant doses over the long term.

However, the damage from CMV infection may slow with the use of antiretroviral therapy. This can result in the rebuilding of the immune system (as demonstrated by clinically significant rises in CD4 count). Anti-CMV therapy may potentially be changed to easier-to-tolerate suppressive treatments.

Herpes simplex viruses

Herpes simplex virus (HSV) is characterized by sores on the mouth, lips, and genitals. Anyone can get herpes, but people with HIV experience increased frequency and severity of outbreaks.

There is no cure for herpes. However, relatively easy-to-tolerate medications, taken long term, can alleviate symptoms of the virus.

Pneumocystis pneumonia

Pneumocystis pneumonia (PJP) is a fungal pneumonia that can be fatal if it’s not diagnosed and treated early. PJP is treated with antibiotics. The risk of a person with HIV developing PJP rises so high that preventive antibiotic therapy may be used if their CD4 count drops below 200 cells per microliter (cells/µL).

Salmonella septicaemia

Commonly referred to as “food poisoning,” salmonellosis is a bacterial infection of the intestines. The bacteria responsible is most often transmitted via food or water that has been contaminated with feces.

The U.S. Food and Drug Administration (FDA) reports that those with weakened immune systems, such as people living with HIV, have at least a 20 times greater risk of salmonellosis. Salmonellosis can spread into the blood, joints, and organs.

Antibiotics are commonly prescribed to treat this infection.

Toxoplasmosis

Toxoplasmosis is caused by parasites in contaminated food. The disease can also be contracted from cat feces.

The risk of significant disease from toxoplasmosis infection rises substantially once the CD4 count drops below 100 cells/µL. An HIV-positive person should ideally avoid all contact with cat feces or any other source of toxoplasmosis exposure.

People who have severely weakened immune systems (less than or equal to 100 CD4 cells/µL) should receive the same preventive antibiotic therapy as that for PJP.

Toxoplasmosis is treated with antimicrobial medications such as trimethoprim-sulfamethoxazole (Bactrim).

Tuberculosis

Tuberculosis (TB) may seem like a disease from the past, but it’s actually the leading cause of death for individuals who have HIV.

TB is caused by Mycobacterium tuberculosis bacteria and is spread through the air. TB generally affects the lungs and has two forms: latent TB and active TB disease.

Individuals with HIV are more likely to become sick with TB.

The disease is treated over the course of six to nine months with a combination of several medications, including:

• isoniazid (INH)
• rifampin (Rifadin)
• ethambutol (Myambutol)
• pyrazinamide

With treatment, both latent and active TB can be managed, but without treatment, TB can lead to death.

Mycobacterium avium complex (MAC)

Mycobacterium avium complex (MAC) organisms are present in most everyday environments. They rarely cause problems for people with healthy immune systems. For those with weakened immune systems, however, MAC organisms can make their way into the body through the GI system and spread. When the organisms spread, they may lead to MAC disease.

This disease causes symptoms such as fever and diarrhea, but it usually isn’t fatal. It can be treated through antimycobacterials and antiretroviral therapy.

Opportunistic cancers

Invasive cervical cancer

Cervical cancer begins in the cells lining the cervix. The cervix is located between the uterus and vagina. Cervical cancer is known to be caused by the human papillomavirus (HPV). Transmission of this virus is extremely common among all sexually active women. But studies have clearly demonstrated that the risk of contracting HPV rises substantially as HIV progresses.

For this reason, HIV-positive women should undergo regular pelvic exams with Pap tests. Pap tests can detect early cervical cancer.

Cervical cancer is considered invasive when it spreads outside the cervix. Treatment options include surgery, radiation therapy, or chemotherapy.

Kaposi sarcoma

Kaposi sarcoma (KS) is linked to infection by a virus called human herpes virus 8 (HHV-8). It causes cancerous tumors of the body’s connective tissues. Dark, purplish skin lesions are associated with KS.

KS isn’t curable, but its symptoms often improve or resolve completely with antiretroviral therapy. Several other treatments are available for people with KS. These include radiation therapy, intralesional chemotherapy, systemic chemotherapy, and retinoids.

Non-Hodgkin’s lymphoma

Non-Hodgkin’s lymphoma (NHL) is a cancer of lymphocytes, cells that are part of the immune system. Lymphocytes are found throughout the body in such places as the lymph nodes, digestive tract, bone marrow, and spleen.

Various treatments are used for NHL, including chemotherapy, radiation therapy, and stem cell transplants.

Source: https://www.healthline.com/health/hiv-aids/opportunistic-infections

Candida albicans Infections, Symptoms & Treatment

Candida albicans

Candida albicans is part of our natural microflora — or the microorganisms that commonly live in or on our bodies. It can be found in the GI tract, the mouth, and the vagina.

Most of the time it causes no issues, but it's possible for overgrowths and infections to happen.

Candida albicans is the most prevalent cause of fungal infections in people. Its species name, albicans, comes from the Latin word for "white." The yeast appears white when cultured on a plate. And in the case of certain infections, like thrush, it can create white patches.

Types of Candida albicans Infections

The causes, symptoms, and treatment of four of the most common types of Candida infection.

Urinary yeast infection

Candida species are the most common cause of fungal urinary tract infections (UTIs). Candida UTIs can occur in the lower portion of the urinary tract or in some cases can ascend up to the kidneys.

The following can put you at risk of developing a Candida UTI:

• Having taken a course of antibiotics
• Having a medical device inserted, such as a urinary catheter
• Diabetes
• A weakened immune system

Symptoms

Many people with a Candida UTI don't have symptoms. If symptoms are present, they can include:

• An increased need to urinate
• A painful or burning sensation when urinating
• Abdominal or pelvic pain
• Blood in your urine
• Treatment
• Treatment is only recommended for symptomatic individuals. The antifungal drug fluconazole can be used in many cases.
• If a catheter is in place, it should be removed.

Genital yeast infection

Candida albicans is the most common cause of genital yeast infections.

Normally, a type of bacteria called Lactobacillus keeps the amount of Candida in the genital area under control. However, when Lactobacillus levels are disrupted in some way, Candida can overgrow and cause an infection.

You can also develop a Candida genital infection after participating in certain sexual activities, particularly those that involve oral-genital contact.

Although otherwise healthy individuals can get genital Candida infections, the following groups are at an increased risk:

• People that have taken antibiotics recently
• People with uncontrolled diabetes
• Immunosuppressed individuals
• Pregnant women
• People that are taking oral contraceptives or who are on hormone therapy

Symptoms

Symptoms of a genital Candida infection can include:

• A burning feeling while having sex or while urinating
• An itchy or painful feeling in or around the vagina
• Redness, irritation, or swelling around the vagina
• Abnormal vaginal discharge that can be either watery, or thick and white
• A rash around the vagina
• A rash on the penis

Candida species can also infect the male genitals, often if their partner has a vaginal Candida infection. The infection may be asymptomatic but can cause an itchy or burning rash around the head of the penis.

Treatment

Mild or moderate genital Candida infections can be treated with a short course of an over-the-counter (OTC) or prescription antifungal cream, pill, or suppository. You could also be prescribed a single dose of an oral antifungal medication, such as fluconazole.

For more complicated infections, you may be prescribed a longer course of medication, either in the form of a cream, a pill, or an ointment.

Oral thrush

Despite being a normal part of the microflora of your mouth, Candida albicans can cause infections if it overgrows. The infection may not be limited to just your mouth. It can spread to your tonsils and the back of your throat as well.

• Severe infections may spread to the oesophagus.
• People that are at an increased risk for developing oral thrush include:
• Those taking antibiotics or corticosteroid drugs
• Someone with undiagnosed or uncontrolled diabetes
• Immunosuppressed individuals
• Those who wear dentures, particularly upper dentures

Symptoms

Some of the common symptoms of oral thrush include:

white spots in your mouth that have the appearance of cottage cheese and may bleed when touched

• A burning or painful sensation in your mouth
• Redness inside your mouth or at the corners of your mouth
• Difficulty with eating or swallowing
• Loss of taste
• A cotton-like feeling inside your mouth
• If an oral thrush infection is left untreated, it can lead to a systemic Candidainfection, particularly in people with a weakened immune system.

Treatment

Oral thrush is treated with an antifungal medication that can come in the form of a pill, liquid, or lozenge. Examples of drugs that are used include nystatin or clotrimazole.

An oral course of fluconazole can be given for more severe cases.

Mucocutaneous candidiasis

Candida species can also infect your skin and mucus membranes.

Candida albicans is most often the cause of a fungal skin infection, although other Candida strains can also cause it.

Areas that are warm, moist, or sweaty provide good environments for yeast to thrive. Examples of such areas include the armpits, groin, the skin between your fingers and toes, the corners of your mouth, and the area under your breasts.

Other risk factors for developing a Candida skin infection include:

• Wearing tight or synthetic undergarments
• Having poor hygiene or changing undergarments infrequently, including infrequent diaper changes for infants
• Taking antibiotics or corticosteroid drugs
• Having diabetes
• Having a weakened immune system

Symptoms

The most common symptom of a Candida skin infection is a red rash that forms in the affected area.

In some cases, blister-like lesions can form. The skin may also become thickened or produce a white substance that has a curd-like appearance.

Treatment

Antifungal creams are typically given to clear the skin infection. They can contain antifungal drugs such as clotrimazole, miconazole, and econazole.

A steroid cream may also be given to help ease any itching or swelling. The skin should also be kept dry while recovering.

In cases where the infection is widespread, oral fluconazole pills may be prescribed.

Candida Infections Diagnosis

In order to diagnose candidiasis, your doctor will first take your medical history and ask you about your symptoms. They may also ask if you have any conditions or medications that could lead to a weakened immune system, or if you've taken a course of antibiotics recently.

Many common cases of candidiasis can often be diagnosed through a physical examination.

If your doctor is uncertain if your symptoms are due to a Candida infection, they may take a sample from the affected area. This sample can then be used to culture the organism and to identify what species it is. For example, if candidemia is suspected, your doctor will collect a blood sample for testing.

Identifying the species of Candida that's causing your infection is also helpful because your doctor will be able to prescribe an antifungal medication that will be effective in treating that particular species.

Normally, Candida species are a part of the natural microflora of the GI tract, skin, and vagina, and don't cause disease. Some circumstances, such as taking a long course of antibiotics or having a weakened immune system can increase your risk of developing a Candida infection.

The most common Candida infections, such as vaginal and skin infections, are localized and can be treated with antifungal drugs. An untreated Candida infection carries the risk of leading to a systemic infection in which other organs can become involved.

Source: https://www.medicalnewstoday.com/articles/322722.php