Selected Infections and Conditions Associated With HIV Infection

Human immunodeficiency virus (HIV) belongs to the family Retroviridae, subfamily Lentiviridae. Retroviridae organisms share a distinct biologic characteristic: an initial stage of primary infection followed by a relatively asymptomatic period of months to years and a final stage of overt disease. HIV causes many diseases. Here are several of them.

Pneumonia

Pneumocystis carinii pneumonia (PCP) is one of the most common opportunistic infections in patients with AIDS. It typically occurs in patients with CD4 counts less than 200 cells/μL. Other factors associated with a higher risk of PCP include CD4 percentage lessthan 15%, oral thrush, recurrent bacterial pneumonia, high HIV-1 RNA level, unintentional weight loss, and previous episodes of PCP.

The onset of illness is insidious, with several days to weeks of fever,exertional dyspnea, chest discomfort, weight loss, malaise, and night sweats. Chest radiography typically shows bilateral interstitial pulmonary infiltrates, but a lobar distribution and spontaneous pneumothoraces may occur. Patients with early disease might have a normal chest radiograph. Pleural effusion is uncommon.

Tuberculosis

The resurgence of tuberculosis in the United States is not entirely explained by the HIV epidemic. Factors such as socioeconomic conditions, immigration, breakdown of the public health infrastructure, and lack of interest of the medical and scientific community in tuberculosis all play a role. In addition to the impact of HIV on the incidence of tuberculosis, there are other important interactions between HIV infection and Mycobacterium tuberculosis: tuberculosis may accelerate the course of HIV infection; unlike many of the opportunistic infections in patients with HIV infection, tuberculosis can be cured if diagnosed promptly and treated appropriately; and tuberculosis can be prevented. Tuberculosis occurs among HIV-infected persons at all CD4 counts. However, its clinical manifestation may differ depending on the degree of immunosuppression. When tuberculosis occurs later in the course of HIV infection, it tends to have atypical features, such as extrapulmonary disease, disseminated disease, and unusual chest radiographic appearance (lower lung zone lesions, intrathoracic adenopathy, diffuse infiltrations, and lower frequency of cavitation). To prevent Tuberculosis need to heal the symptoms of HIV. For this there are special medications, such as atripla. They inhibit razmnozhnie cell disease.

Mycobacterium avium Complex Infection

Organisms of the Mycobacterium avium complex are ubiquitous in the environment and include M. avium and M. intracellulare. They cause disseminated infection in HIV-infected persons, especially when immunosuppression is severe (CD4 count <50 cells/μL). Disseminated M. avium complex infection is the most common systemic bacterial infection in patients with HIV infection. Common presentations include low-grade fever, night sweats, weight loss, fatigue, abdominal pain, and diarrhea. Hepatomegaly, splenomegaly, and lymphadenopathy may be present. Common laboratory abnormalities include anemia and increased alkaline phosphatase levels. Blood cultures are usually positive; however, organisms can also be isolated from stool, respiratory tract secretions, bone marrow, liver, and other biopsy specimens. Syphilis Sexually transmitted diseases, including syphilis, that cause genital ulceration may be cofactors for acquiring HIV infection. In general, the clinical manifestations of syphilis are similar to those among non-HIV-infected persons. However, atypical presentations may occur. For example, in primary syphilis, multiple or atypical chancres can occur and primary lesions might be absent or missed. The manifestations of secondary syphilis are protean and might persist from a few days to several weeks before resolving or evolving to latent or later stages.

The most common manifestations are macular, maculopapular, or pustular skin lesions characteristically involving the palms and soles and accompanied by generalized lymphadenopathy and constitutional symptoms of fever, malaise, anorexia, arthralgias, and headache. Manifestations of tertiary or late syphilis include neurosyphilis, cardiovascular syphilis, and gummatous syphilis. Neurosyphilis has been reported to occur earlier and more frequently and to progress more rapidly in patients with AIDS than in HIV-negative patients. Concomitant uveitis and meningitis also may be more common among HIV-1-infected patients with syphilis. There are reports of false-negative and falsepositive serologic tests for syphilis in patients with HIV. However, serologic response to infection in general seems to be the same in HIV-positive and HIV-negative persons and there are no specific clinical manifestations of syphilis that are unique to HIV. Management of HIV-1-infected patients with syphilis is similar to the management of non-HIV-infected persons.