Facts and Issues [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

At first, these opportunistic infections are relatively harmless but uncomfortable eg. oral
thrush (Candidiasis), or athlete's foot, caused by the fungus Condido albicans. As the immune
system further deteriorates (CD4 cell count less than 200 cells/ml), the infections become
more severe.
Common Opportunistic Infections / Concers
* Pneumocystis carinii pneumonia (PCP), a common lung infection
* Tuberculosis, caused by the bacterium Mycobacterium tuberculosis, and usually
affecting the lungs
* Mycobacterium ovium complex (MAC), a bacterium which tends to cause respiratory
tract infections
* Other bacteria such as Legionello and Salmonello, which cause diarrhea
* Toxoplasmosis, caused by Toxoplasma, a parasite which infects the brain and can lead to
seizures and coma
* Cryptosporidiosis, a parasitic infection caused by Cryptosporidium, which usually inhabits
the intestine to cause chronic diarrhea and cramping abdominal pain
* Cryptococcosis (Cryptococcus neoformans), a fungal infection which causes meningitis
and damages the liver, bone, skin and other tissues
* Histoplasmosis (Histoplasma capsulatum), a fungal infection which affects liver, bone
marrow and other tissues and causes chronic fevers
* Cytomegalovirus (CMV), a virus which causes pneumonia, encephalitis, blindness and
gastrointestinal inflammation
* Other herpes viruses (Herpes simplex, Herpes (Varicello) zoster HSV,VZV) which usually
cause skin infections, but can also affect the brain
* Kaposi's sarcoma, a formerly rare skin cancer which may be caused by human herpes virus
8 (HHV8)
* Lymphoma, cancer of the lymph tissue
The incidence of infection varies with the organism and with geographic region. In the
developed world, the majority of people living with AIDS would suffer from PCP without
prophylactic therapy, while MAC infection affects approximately 15-40% of AIDS patients.
CMV retinitis (eye disease) will eventually occur in 15-20% of AIDS patients but the
incidence of toxoplasmosis is often low, particularly in the USA.The spectrum of infections
seen in the developing world is quite different.
Approved and Experimental Therapies to Prevent and Treat Opportunistic Infections (Ols)
Opportunistic infections (Ols) are serious and treatment becomes crucial to survival.There
are two approaches to managing opportunistic infections: treatment of the acute infection
or prophylaxis (prevention). Primary prophylaxis is given to prevent or postpone the first
occurrence of an 01. Secondary prophylaxis is given to prevent recurrences. PCP prophylaxis
is given to all patients with CD4 cell counts below 200 cells/mm and has been a major
contributor to prolonged survival in HIV-infected people. Prophylaxis for some other infections may not start until the CD4 cell count has reduced further. For example, prophylaxis
for MAC often does not commence until CD4 cell counts have fallen to below 75/ml.
Conventional or experimental therapies exist for all the above infections, and many of the
more common ones are listed on page 26.