A Quick Walk Through Some of the Common Opportunistic Infections Seen With HIV

A Quick Walk Through Some of the Common Opportunistic Infections Seen With HIV

Being Alive; February 1994
Mark Katz, MD

[ Note: This was published as a chart in the Newsletter. I had to format it differently for this text version. ]

A = Opportunistic Infection

B = Causes disease most commonly in C = May present with symptoms such as D = May be diagnosed by tests such as E = And is most effectively treated with (Rx=treatment, Px=prophylaxis, prevention)

A Pneumocystis carinii (PCP) B Lungs (pneumonia) C Fever, shortness of breath, cough (may be non-productive, i.e. no sputum) D Chest X-ray, sputum smear, arterial blood gases, bronchoscopy E Rx: TMP-SMX (Bactrim/Septra) or atovaquone (Mepron) or primaquine+clindamycin or pentamidine or trimetrexate/ usually prednisone as well Px: TMP-SMX-DS daily (or even every other day) or dapsone pyrimethamine or aerosolized pentamidine for CD4 < 200-250 (or % < 20)

A Cytomegalovirus (CMV) B Eyes (retinitis), GI tract, lungs, brain, gallbladder C Blurry vision, abdominal pain, diarrhea, GI bleeding, shortness of breath D Ophthalmological exam; blood, stool, or other GI tissue smears/ cultures (may be obtained through endoscopy or colonoscopy) E Rx: ganciclovir (Cytovene) or foscarnet (Foscavir) I.V. Px: none approved (oral ganciclovir or valaciclovir or high dose acyclovir all being studied)

A Mycobacterium avium complex (MAC) B Bone marrow, blood, GI tract, liver, lungs C Night sweats, fever, chills, weight loss ("wasting"), loss of appetite, fatigue, muscle aches, diarrhea D Blood cultures, bone marrow smear and cultures, stool cultures (may be obtained through sigmoidoscopy/colonoscopy) E Rx: 2 or 3 drugs -- usually clarithromycin (Biaxin) or azithromycin (Zithromax) plus ethambutol (Myambutol) plus clofazimine (Lamprene) (possibly ciprofloxacin, rifampin) Px: rifabutin (Mycobutin) for CD4 < 100; (possible efficacy of clarithromycin also being studied)

A Mycobacterium tuberculosis (TB) B Lungs, bone marrow, blood, gut, kidneys, adrenals C As in MAC, but more likely (if in lungs) shortness of breath, cough with sputum, "consumption" D Sputum smear + culture, chest X-ray as for MAC E Rx: usually 4 drugs (or more if multi-drug resistance suspected): isoniazid (INH) plus rifampin plus pyrazinamide plus ethambutol Px: isoniazid 1 year if PPD positive (and in some cases where PPD not diagnostic)

A Toxoplasma gondii ("toxo") B Brain (encephalitis), eyes C Headaches, fever, seizures, changed mental status D CAT scan, MRI, brain biopsy, blood for toxo titer E Rx: pyrimethamine plus sulfadiazine or clindamycin (atovaquone or azithromycin may be used if above fail) Px: none officially approved but many use TMP-SMX or pyrimethamine

A Cryptococcus neoformans ("Crypto") B Brain (meningitis), urine, lungs, skin C Fever, headache, changed mental status D Spinal tap, serum cryptococcal antigen, blood and cerebrospinal fluid (CSF) cultures E Rx: amphotericin-B 5-flucytosine I.V. followed by maintenance oral fluconazole (Diflucan) Px: none officially approved but some use fluconazole or ketoconazole (Nizoral)

A Candida Albicans ("Yeast") B Vagina (vaginitis), mouth (thrush), esophagus C Vaginal discharge/itching, whitish discharge in mouth (scrapes off), painful, difficult swallowing D Direct inspection, wet mount preparation, GI endoscopy E Rx: nystatin or clotrimazole (Mycelex) troches or oral ketoconazole or oral fluconazole Px: none officially approved, but any of the above may be used by some

A Papovavirus, causing Progressive Multifocal Leuko-encephalopathy (PML) B Brain C Changed mental status with progressive loss of body functions D MRI, brain biopsy E Rx: none officially approved but intrathecal (injection into spinal fluid via tap) cytosine arabinoside has been tried

A Cryptosporidiosis B GI tract, gallbladder C Diarrhea, abdominal bloating/pain (usually without significant fever) D Stool smears, perhaps sigmoidoscopy or colonoscopy E Rx: none officially approved, but under study are paromomycin (Humatin), azithromycin or letrazuril Px: none

A Microsporidiosis (Enterocystozoan bienusi or Septata intestinalis) B GI tract C Diarrhea, abdominal bloating/pain D As above, possibly with upper GI endoscopy E Rx: none officially approved but albendazole is often tried

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