What are common opportunistic infections in Human Immunodeficiency Virus (HIV) positive patients?

From the Guidelines

HIV positive patients are at risk of developing various opportunistic infections, including Pneumocystis pneumonia (PCP), candidiasis, tuberculosis, toxoplasmosis, cryptococcal meningitis, cytomegalovirus (CMV), and Mycobacterium avium complex (MAC), which can be prevented with effective antiretroviral therapy (ART) and chemoprophylaxis. The most common opportunistic infections in HIV patients include:

• Pneumocystis pneumonia (PCP), caused by Pneumocystis jirovecii, which presents with fever, dry cough, and shortness of breath 1
• Candidiasis (thrush), which frequently affects the mouth, throat, and esophagus, appearing as white patches on mucous membranes
• Tuberculosis, which is particularly problematic in HIV patients, often presenting atypically and with extrapulmonary manifestations
• Toxoplasmosis, which can cause brain abscesses and encephalitis
• Cryptococcal meningitis, which presents with headache, fever, and altered mental status
• Cytomegalovirus (CMV), which can affect multiple organs, especially causing retinitis that may lead to blindness
• Mycobacterium avium complex (MAC), which typically occurs with severe immunosuppression, causing fever, weight loss, and diarrhea These infections occur because HIV depletes CD4+ T cells, which are crucial for coordinating immune responses against pathogens that healthy immune systems normally control 1. Effective antiretroviral therapy (ART) that maintains CD4 counts above 200 cells/mm³ significantly reduces the risk of these opportunistic infections 1. Some key points to consider in preventing opportunistic infections in HIV patients include:
• Initiating primary prophylaxis against PCP for HIV-infected adults and adolescents with a CD4+ T lymphocyte count of <200/µL or a history of oropharyngeal candidiasis 1
• Using chemoprophylaxis against PCP, such as trimethoprim-sulfamethoxazole (TMP-SMZ), for patients with a CD4+ T lymphocyte count of <200/µL or a history of oropharyngeal candidiasis 1
• Monitoring CD4+ T lymphocyte counts regularly to determine the need for chemoprophylaxis and to assess the effectiveness of ART 1

From the Research

Common Opportunistic Infections in HIV Positive Patients

• Pneumocystis jirovecii pneumonia (PCP) is a common opportunistic fungal infection that affects HIV positive patients, particularly those with advanced disease 2, 3, 4, 5.
• Other opportunistic infections that affect HIV positive patients include:
  • Oesophageal candidiasis 4
  • Tuberculosis 4, 6
  • Central nervous system toxoplasmosis 4
  • Mycobacterium avium complex infections 6
  • Syphilis 6
  • Bacterial enteric disease 6
  • Bacterial pneumonia 6
  • Bartonellosis 6

Characteristics of Opportunistic Infections

• The incidence of opportunistic infections depends on the CD4 count and rises with CD4 decline 4.
• Opportunistic infections can be life-threatening and are a major cause of mortality in HIV positive patients 4.
• The use of antiretroviral therapy (ART) and prophylaxis can reduce the incidence of opportunistic infections 2, 3, 5.

Treatment and Prophylaxis of Opportunistic Infections

• Trimethoprim-sulfamethoxazole is considered the first-line treatment for PCP and is also effective for prophylaxis 2, 3, 5.
• Other treatment options for PCP include pentamidine, atovaquone, clindamycin, and primaquine 2, 3.
• The choice of treatment and prophylaxis regimen depends on the specific infection, the patient's CD4 count, and other factors 5, 6.