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Archive for the 'Opportunistic Infections -Related Conditions' Category
Candidiasis is the most common fungal infection in people who have HIV. Candida is a yeast found in most people and is normally kept under control by “friendly” bacteria in your body. The most common fungus that causes candidiasis is called Candida albicans.
Symptoms and diagnosis
Doctors usually diagnose oral candidiasis or thrush, just by examining your mouth. Candidiasis can appear as white patches on your gums and the sides of your tongue, where it can cause a burning feeling, swelling, redness, and changes in the way things taste. Candidiasis can also appear in your esophagus (the tube that connects your mouth and stomach), where it can cause sore throat and difficulty swallowing.
Esophageal candidiasis may be diagnosed with a barium swallow and X-ray. Sometimes an endoscopy and biopsy are done. In women, symptoms of systemic candidiasis include itching and burning around the outside of the vagina, and a thick, white or yellow vaginal discharge. This is called a yeast infection.
Prevention
The risk of developing candidiasis increases if your T4 cell count falls below 400, although many people with much higher T4 counts show signs of candidiasis. Sugars can encourage the growth of candida. Some people go on sugar-free diets to decrease the risk of getting candidiasis. Others take a drug like fluconazole (Diflucan) or ketoconazole (Nizoral) to help prevent the infection. Rinsing your mouth with water and a few drops of hydrogen peroxide, tea tree oil, or grapefruit seed extract may be effective in preventing thrush.
Treatment
Mild thrush (candidiasis in your mouth) can sometimes be treated by rinsing your mouth several times a day with water and the substances described above. The bacterium called acidophilus, which is found in some brands of yogurt and also comes in pill form, may help reduce thrush. Sugar can make candidiasis worse, so you may want to eat less of it. An Aboriginal remedy called pitch uses the sap from certain trees as a mouthwash to treat thrush. Some people use a mouthwash made with apple cider vinegar and warm water.
Most come in pill form, but some are available as lozenges, mouth rinses, or vaginal suppositories. Amphotericin B can be taken intravenously (IV, or injected directly into a vein), as a lozenge, or as a specially prepared Mouth (taken by mouth) solution. Fluconazole and ketoconazole may cause nausea and headaches and, in rare cases, liver toxicity (poisoning).
The sinus medication called Seldane should be avoided if you’re taking ketoconazole or erythromycin. Nystatin in high doses can cause diarrhea or upset stomach. Since IV amphotericin B has many serious side effects, it’s often used only as a last resort.
Pneumonia is a swelling of the tissue of your lungs, and can have many different causes. Pneumonia caused by bacterium can occur at any stage in HIV infection. Bacterial pneumonias are more common in HIV-positive women than in HIV-positive men. These pneumonias are caused most often by two bacteria: Streptococcus pneumoniae and Haemophilus influenzae.
Symptoms
The most common symptoms of bacterial pneumonia are a sudden fever and a cough that produces sputum (stuff that comes up from your lungs).
Diagnosis
If you report symptoms that sound typical of bacterial pneumonia, your doctor will examine you by listening to your lungs through a stethoscope and taking your temperature. A sample of sputum is sent to the lab to be tested for bacteria. A sample of blood may also be taken and sent to the lab for a culture.
Prevention
Pneumovax (pneumococcal vaccine) and H. Influenzae Type B vaccine (Hib vaccine) are sometimes offered as protection against bacterial pneumonia. Vaccinations of any kind are controversial in HIV infection and you may want to discuss this with your doctor.
Treatment
Bacterial pneumonia is treated with antibiotics. The type of antibiotic used depends on the type of bacteria that caused the pneumonia. Some of the drugs used are penicillin, erythromycin, ampicillin, and amoxicillin.
Penicillin and penicillin-like drugs can cause allergic reactions in some people. Let your doctor know if you’ve had a reaction to penicillin in the past. The most common side effects of these antibiotics are nausea, vomiting, diarrhea, and skin rash.
PID is an infection of the organs of a woman’s pelvis. The infection can start in your vagina, and travel through your cervix, into your uterus (womb) and to your fallopian tubes and ovaries. PID is caused by bacteria - usually the same bacteria that cause gonorrhea and chlamydia. Women with healthy immune systems can get it. However, in women with HIV, it’s more common, can be harder to treat, and takes longer to heal. PID can often develop over a long period of time and get worse before it’s properly d iagnosed.
Symptoms
Symptoms of itching, burning, soreness when your belly is touched, pain during intercourse (fucking), unusual vaginal discharge (stuff that comes out of your vagina), or changes in your menstrual period should be reported to your doctor. These may be symptoms of chlamydia or gonorrhea. If those infections are not treated, they can develop into PID. Severe belly pain accompanied by fever may be symptoms of PID. A woman with an extremely weak immune system may not show symptoms of PID.
Diagnosis
If you report symptoms that sound typical of PID, your doctor will examine you and take samples for testing. PID is diagnosed by using a cotton swab to take a small sample of fluid and cells from your cervix (the entrance of your uterus [womb]). The sample is then sent to the lab to be tested for bacteria. If belly pain is severe, your doctor may do a laparoscopy. A small incision (cut) is made in your belly button and an instrument called a laparoscope is inserted into your belly. This allows your internal organs to be examined, because PID can sometimes cause abscesses on your ovaries or uterus. Any found abscesses may be treated during the laparoscopy.
Prevention
Using condoms can help prevent transmission of some of the bacteria that cause PID. Women who use intrauterine contraceptive devices (IUDs) to prevent pregnancy are at higher risk of developing PID.
Treatment
PID can usually be successfully treated with antibiotics. The antibiotics used often include one or two of the following: cefoxitin, cefotetan, doxycycline, clindamycin, gentamicin, probenecid, amoxicillin, clavulanate, ofloxacin, and metronidazole. If your pain is severe, your doctor may want to keep you in the hospital for the first days of treatment. If you have internal abscesses, you may need to have surgery to remove them.
Tuberculosis (TB)
Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. Anyone can become infected with TB, you do not have to have a weakened immune system. TB bacteria can spread from person to person through coughs, sneezes, and breathing, but usually only after lengthy exposure or close contact with a person with active TB in their lungs or throat. TB is usually treatable, even if you have HIV / AIDS. It’s a common illness in people with HIV around the world. TB is spread through the air, so it has long been associated with overcrowded living or working conditions, poor ventilation, and lack of medical care
TB Infection
TB germs enter your body by being inhaled (breathed in). They settle in your lungs and cause a minor infection, usually with no obvious symptoms. Your body develops “walls” around the TB germs and they are forced to stop growing (they become dormant). But the germs remain in your body. If you have dormant TB germs in your lungs, you’re said to have TB infection. If the germs remain dormant, you have no symptoms, and you can not spread the disease to anybody else.
Active TB
If you have a dormant TB infection and your immune system gets weaker, the TB germs can start to grow again and multiply. This is called active TB. If you have active TB, you will probably have symptoms, and you can pass the infection on to other people.
Symptoms of Tuberculosis (TB)
Active TB in your lungs can cause a wet cough (you cough up mucus or fluid), chest pain, and difficulty breathing. It can also cause lack of appetite, weight loss, night sweats, tiredness, and fever. Other symptoms will depend on where the TB is in your body.
Diagnosis Tuberculosis (TB)
The most common method for diagnosing TB infection is a skin reaction test called the PPD (purified protein derivative), or Mantoux. A tiny drop containing proteins of the TB bacterium is injected under your skin, usually on your forearm. If the spot where the needle went in raises a small bump within a couple of days, that’s called a positive reaction.
Your doctor may also do an anergy panel (a kind of skin test) to see if your immune system is strong enough to respond to the PPD test. Doctors often do chest X-rays to make sure you do not have active TB. They may also do tests on your sputum (stuff you cough up), blood, urine (pee), or stool (shit), as well as tissues from your bone marrow, lymph nodes, or brain, to check for active TB in other Parts of your body.
Prevention from Tuberculosis (TB)
TB infection can become active TB soon after you get infected with HIV, even if you have as many as 500 T4 cells. Some people who have had a history of positive reactions to the PPD skin test, and have fewer than 500 T4 cells, take preventive medication to stop TB from becoming active. The most common preventive drug isoniazid is taken with vitamin B6. Preventive drugs may have to be taken for as long as twelve months.
TB is considered a contagious disease, and is routinely reported to the public health department. A public health nurse may contact you to tell you how to avoid passing on the infection, and may talk to other people you spend a lot of time with, like family, friends, and co-workers.
Treatment
All TB drugs are provided free in USA and Canada through regional public health departments. TB is usually treated by a combination of drugs such as isoniazid, pyrazinamide, rifampin, ethambutol, ethionimide, streptomycin, and cycloserine. Several of these drugs may cause side effects, including liver and kidney problems, skin rash, vomiting, and diarrhea. Isoniazid and rifampin can interact (react badly) with ketoconazole (Nizoral. Rifampin can interact with dapsone, a treatment for PCP, with birth control pills, and with methadone. Treatment usually continues for at least six to twelve months. It’s important to complete the entire course of treatment, even after your TB symptoms go away (usually after three weeks). Stopping too soon or not taking the drugs as prescribed can create new kinds of TB (called drug-resistant TB) that can not be treated with the Estimated drugs. This creates new problems in prevention and treatment. If you refuse to take medication to treat TB, you can be isolated in a hospital by medical or legal authorities.
MAC stands for Mycobacterium avium complex, which is sometimes also called Mycobacterium avium intracellulare (MAI). It is caused by at least two different bacteria: Mycobacterium avium and Mycobacterium intracellulare. These bacteria can get inside certain cells in your body. Because they hide in your body’s cells, they can be very hard to treat.
Symptoms
Mac can be found in many parts of the bodies of people who have AIDS. This is called disseminated MAC infection. The most common symptoms of MAC infection are persistent fever and tiredness, accompanied by night sweats, loss of appetite, abdominal pain (belly), and chronic diarrhea. It can also cause serious weight loss, swollen lymph glands, an enlarged spleen and liver, and anaemia.
Diagnosis
When you visit your doctor, you will be asked if you have any problems or symptoms. If you report symptoms that sound typical of MAC infection, and if your T4 cell count is below 100, your doctor may order some lab tests. There are two blood tests that can be done to check for MAC infection. The first test can show if your blood sample contains bacteria from the family Mycobacteria. But it can not tell the difference between MAC and other Mycobacteria, including the one that causes tuberculosis.The second test used is a blood culture. The lab will put a sample of your blood in a dish and watch to see if MAC will grow. It can take several weeks to get results. Because MAC can be a serious illness, doctors almost always recommend treatment as soon as they think you have it. Your doctor can always change the treatment if the results show that something else is causing your symptoms.
Prevention
The risk of developing MAC increases if your T4 cell count is below 50. You may be able to reduce the risk of getting MAC by taking special care in preparing foods. Wash and peel all fruit and vegetables carefully. The Food and Drug Administration in the USA says to “boil it, peel it, cook it, or forget it.” These precautions can help you avoid other germs as well. See the sections on water safety and food safety for more information.
The drug rifabutin (Mycobutin) cuts the risk of getting MAC in half for people with T4 counts below 100. If you have fewer than 100 T4 cells, you may want to talk to your doctor about rifabutin.
The most common side effects are nausea, abdominal pain (belly), and skin rash. Very rarely reported side effects are muscle and joint aches. A rare but serious side effect is neutropenia. If you take rifabutin, your doctor will check your white blood cells regularly. The urine (pee), faeces (shit), saliva (spit), sweat, tears, and skin of people who take rifabutin may be coloured orange or brown. Soft contact lenses may be permanently stained.
Once the uveitis is cleared up, if you want to take rifabutin again, your doctor may recommend taking a lower dose.
Treatment
Treatment for MAC infection is lifelong. Once the infection has been brought under control, it requires treatment to permanently keep the bacteria from making you sick again. Combinations of several different antibiotics are the usual treatment for MAC infection. For example, you may be given clarithromycin (Biaxin) or azithromycin (Zithromax), plus ethambutol, and rifabutin. Other antibiotics that may be used are rifampin, clofazimine, ciprofloxacin, ethambutol, and amikacin. The choice of drugs depends on how well you tolerate them, which drugs are most effective for you, and how expensive they are. Clarithromycin and azithromycin are relatively new drugs, and they are very expensive. Provincial or territorial drug programs and many private drug insurance programs may not pay for these drugs for people with MAC. One month’s supply can cost hundreds of dollars.
The most commonly reported side effects from the antibiotics used to treat MAC are nausea and vomiting, diarrhea, abdominal pain (belly), and rashes. Because you usually take two or more of these drugs at the same time, it’s hard to tell which is causing which drug side effect. It can take a month or more before you will know if the drugs are clearing up the infection.
Most drug treatments are used to control or get rid of an infection. Others deal with specific symptoms caused by an infection (for example, controlling pain). You may be taking anti-HIV drugs like AZT or ddI, as well as drugs to prevent or fight other infections. At some point, you may find that you’re taking a lot of different drugs. Many drugs can cause unwanted side effects.
Sometimes these side effects can be just like the symptoms of an infection (for example, fever or chills). And drugs can interact (react with each other) in ways that may either hurt you or make the drugs work less well. Your doctor may have to adjust your medications from time to time.
New drugs are constantly being developed. Some of the drugs listed in this chapter are still being studied and may not be available yet. But remember, treatment information is changing all the time.
The germs that cause infections
Many of the germs that cause opportunistic infections are widespread and common in daily life. For example, approximately half the adult population of Canada has been infected with CMV. When people with healthy immune systems are infected with CMV they may have no symptoms at all or they may have a short, flu-like illness. People with weakened immune systems, such as people who have received organ transplants or people with AIDS, can develop serious problems from CMV.
Some germs can cause problems in people with healthy immune systems. For example, the bacteria that cause food poisoning can make anyone sick. But people who have HIV are much more likely than others to get sick from them.
There are four kinds of germs that can cause opportunistic infections: bacteria, fungi, protozoa, and viruses.
Bacterial infections that can cause disease in people who have HIV include Mycobacterium avium complex (MAC), tuberculosis (TB), and bacterial pneumonias. Protozoa can cause toxoplasmosis, microsporidiosis, cryptosporidiosis, and isosporiasis. Fungi can cause Pneumocystis carinii pneumonia (PCP), thrush, cryptococcosis (which can cause meningitis and pneumonia), and histoplasmosis. Viruses that can cause problems for people with HIV include cytomegalovirus (CMV), herpes zoster (which causes shingles), and herpes simplex.
A damaged immune system affects each person differently. One person may get certain symptoms or infections and may get another completely different ones. You will not get all of them. You may not get any. Men and women, children and adults, and people from different parts of the world get different kinds of infections. And you may still get ordinary colds and flus.
At that time, AIDS seemed to be a condition that killed people very quickly. Those people had probably been living with HIV for many years without showing any symptoms. And, when they did get sick, there were very few treatments available.
Now it is known that most people can live with HIV for many years without showing any signs of illness. And when people with HIV do get sick, there are many new treatments that can help control and prevent infections. Although there’s still no cure, it’s important to remember that lots of progress has been made in managing HIV / AIDS.
Other conditions
People who have HIV / AIDS can also develop other conditions that may or may not be caused by a germ. These include cancer of the cervix, Kaposi’s sarcoma (KS), lymphoma (cancer of the lymph system), wasting, AIDS dementia complex (ADC), and skin problems.
The human immunodeficiency virus (HIV) is believed to cause damage to your immune system. When your immune system is damaged, you can get sick from germs that would not normally cause diseases. These germs take advantage of the opportunity created by your weakened immune system to cause an infection. This is why they’re called opportunistic infections. They’re also sometimes called secondary infections, because they happen after, or second to, HIV, which is believed to be the primary (main) infection