According to the CDC, illnesses 1 and 2 can be characterized with the following clinical features -- Oropharyngeal (OPC) (i.e., thrush): white mucosal patches. Vulvovaginal (VVC): pruritis, white discharge. Esophagitis: retrosternal pain and difficulty swallowing. Bloodstream infection and disseminated disease -- usually fever and chills unresponsive to antibacterial antibiotic therapy. Rarely, pneumonia, osteomyelitis, arthritis, hepatosplenic infection, and endophthalmitis.
OPC is one of the most common opportunistic infections in HIV-infected persons. Drug-resistant OPC and VVC are occuring in HIV-positive patients.
According to the CDC, several studies have shown an increased prevalence of cervical dysplasia, an abnormality in the size, shape, and organization of adult cells of the cervix, in women with HIV. This is a precursor lesion for cervical cancer. Additional studies have documented that a higher prevalence is associated with greater immune suppression. HIV infection also may adversely affect the clinical course and treatment of cervical dysplasia and cancer. Although cervical dysplasia or carcinoma is common, they do not necessarily progress to invasive disease -- proper recognition and treatment of cervical dysplasia can prevent invasive cervical cancer. This represents the importance of integrating gynecological care into medical services for HIV-infected women.
According to the CDC, illness 4 can be characterized with the following clinical features -- Symptomatic infection (40% of cases) usually presents as influenza-like illness with fever, cough, headaches, rash, and myalgias; also can present as acute pneumonia, rarely as chronic pneumonia, or as disseminated form (affecting meninges, skin, and bone). Severe pulmonary disease may develop in HIV-infected persons.
Coccidioidomycosis is endemic in the southwestern United States, parts of Mexico and South America and is transmitted through the inhalation of airborne arthroconidia after disturbance of soil (where it is located) in endemic-disease areas by humans or natural disasters (e.g., wind storms and earthquakes).
According to the CDC, most patients with cryptococcosis have meningitis and most patients (85%) with cryptococcosis in the United States are HIV-infected.
Immunocompromised persons, especially those infected with HIV, are in the highest risk group for this illness. The disease is never cured in persons with AIDS, and they must be kept on fluconazole maintenance for life.
According to the CDC, in people with AIDS and in others whose immune system is weakened, cryptosporidiosis (crypto) can be serious, long lasting and sometimes fatal. If your CD4+ cell count is below 200, crypto is more likely to cause diarrhea and other symptoms for a long time. Symptoms include watery diarrhea, stomach cramps, an upset stomach, or a slight fever. In some cases, persons infected with crypto can have severe diarrhea and lose weight. The first symptoms of crypto may appear 2 to 10 days after a person becomes infected.
The CDC offers a guide to preventing cryptosporidiosis specifically for persons with HIV/AIDS at www.cdc.gov/ncidod/dpd/parasites/cryptosporidiosis/factsht_crypto_prevent_hiv.htm
According to the CDC, cytomegalovirus (CMV) is a member of the herpes virus group, which includes herpes simplex virus types 1 and 2, varicella-zoster virus (which causes chickenpox), and Epstein-Barr virus (which causes infectious mononucleosis). These viruses share a characteristic ability to remain dormant within the body over a long period. Initial CMV infection, which may have few symptoms, is always followed by a prolonged, inapparent infection during which the virus resides in cells without causing detectable damage or clinical illness. Severe impairment of the body's immune system by medication or disease consistently reactivates the virus from the latent or dormant state.
Infectious CMV may be shed in the bodily fluids of any previously infected person, and thus may be found in urine, saliva, blood, tears, semen, and breast milk. The shedding of virus may take place intermittently, without any detectable signs, and without causing symptoms.
Primary (or the initial) CMV infection in the HIV-infected patient can cause serious disease. However, the more common problem is the reactivation of the dormant virus. Infection with CMV is a major cause of disease and death in immunocompromised patient and pneumonia, retinitis (an infection of the eyes), and gastrointestinal disease are the common manifestations of disease.
According to AMFAR encephalopathy is lesions in the brain, or general degeneration of brain matter.
According to the CDC, HIV encephalopathy (dementia) can be characterized by findings of disabling cognitive or motor dysfunction interfering with occupation or activities of daily living, progressing over weeks to months, in the absence of concurrent illness or condition other than HIV infection that could explain the symptoms. Cerebrospinal fluid examination and/or brain imaging can help rule out such concurrent illnesses and conditions.
According to AMFAR, a virus that causes cold sores or fever blisters on the mouth or around the eyes and can be transmitted to the genital region. This includes herpes simplex type 1 (HSV-1), herpes simplex type 2 (HSV-2), cytomegalovirus (CMV), Epstein-Barr virus (EBV), varicella zoster virus (VZV), human herpes virus type 6 (HHV-6), and HHV-8, a herpes virus associated with Kaposi's Sarcoma. HERPES SIMPLEX VIRUS I (HSV-I) is a virus that causes cold sores or fever blisters on the mouth or around the eyes, and can be transmitted to the genital region. Stress, trauma, other infections, or suppression of the immune system can reactivate the latent virus. HERPES SIMPLEX VIRUS II (HSV-II) is a virus causing painful sores of the anus or genitals that may lie dormant in nerve tissue. It can be reactivated to produce the symptoms. HSV-II may be transmitted to a neonate (newborn child) during birth from an infected mother, causing retardation and/or other serious complications. HSV-II is a precursor of cervical cancer.
According to the CDC, the disease primarily affect the lungs however, other organs can be affected. This form of the disease is called disseminated histoplasmosis, and it can be fatal if untreated. Disseminated disease is more frequently seen in people with cancer or advanced HIV.
Respiratory symptoms, a general ill feeling, fever, chest pains, and a dry or nonproductive cough characterize the acute, benign respiratory disease. Distinct patterns may be seen on a chest x-ray. Chronic lung disease resembles tuberculosis and can worsen over months or years. Antifungal medications are used to treat severe cases of acute histoplasmosis and all cases of chronic and disseminated disease
According to the CDC, illness 12 is characterized by clinical features such as -- acute, non bloody diarrhea with crampy abdominal pain, which can last for weeks and result in malabsorption and weight loss. In HIV/AIDS patients the diarrhea can be severe. The illness is caused by the coccidian protozoan parasite, Isospora belli.
KS remains the most commonly diagnosed malignancy in HIV positive people, despite the decline of its incidence since the introduction of successful anti-retroviral therapy. According to the HIV/AIDS glossary, this is an AIDS-defining illness consisting of individual cancerous lesions caused by an overgrowth of blood vessels. KS typically appears as pink or purple painless spots or nodules on the surface of the skin or oral cavity. KS also can occur internally, especially in the intestines, lymph nodes, and lungs, and in this case is life threatening. The cancer may spread and also attack the eyes. There has been considerable speculation that KS is not a spontaneous cancer but is sparked by a virus. A species of herpes virus -- also referred to as Kaposi's Sarcoma herpes virus (KSHV) or HHV-8 -- similar to the Epstein-Barr virus is currently under extensive investigation. Up to now, KS has been treated with alpha interferon, radiation therapy (outside the oral cavity), and various systemic and intralesional cancer chemotherapies.
The HIV Clinic has a comprehensive article explaining treatment options for Kaposi's Sarcoma at www.tthhivclinic.com/kaposi.htm
The HIV/AIDS glossary defines lymphomas as cancer of the lymphoid tissues. Lymphomas are often described as being "large cell" or "small cell" types, cleaved or non-cleaved, or diffuse or nodular. The different types often have different prognoses (i.e., prospect of survival or recovery). Some of these lymphomas are named after the physicians who first described them (e.g., Burkitt's lymphoma, Hodgkin's disease). Lymphomas can also be referred to by the organs where they are active such as CNS lymphomas, which are in the central nervous system, and GI lymphomas, which are in the gastrointestinal tract. The types of lymphomas most commonly associated with HIV infection are called non-Hodgkin's lymphomas or B cell lymphomas. In these types of cancers, certain cells of the lymphatic system grow abnormally. They divide rapidly, growing into tumors.
WebMD has a comprehensive article on AIDS-related lymphoma:
my.webmd.com/content/dmk/dmk_article_58054
According to the CDC, illness 11 is characterized by the following clinical features -- disseminated infections are usually associated with HIV infection. Less commonly, pulmonary disease in non-immunocompromised persons is a result of infection with MAC. In HIV infected persons, manifestations include night sweats, weight loss, abdominal pain, fatigue, diarrhea, and anemia.
While HIV-infected persons are at high risk for the illness, incidence is decreasing among HIV- infected patients as a result of new treatment modalities e.g., protease inhibitors and antimycobacterial prophylaxis.
According to the HIV/AIDS glossary, TB is a bacterial infection caused by Mycobacterium tuberculosis. TB bacteria are spread by airborne droplets expelled from the lungs when a person with active TB coughs, sneezes, or speaks. Exposure to these droplets can lead to infection in the air sacs of the lungs. The immune defenses of healthy people usually prevent TB infection from spreading beyond a very small area of the lungs. If the body's immune system is impaired because of infection with HIV, aging, malnutrition, or other factors, the TB bacterium may begin to spread more widely in the lungs or to other tissues. TB is seen with increasing frequency among persons infected with HIV. Most cases of TB occur in the lungs (pulmonary TB). However, the disease may also occur in the larynx, lymph nodes, brain, kidneys, or bones (extrapulmonary TB). Extrapulmonary TB infections are more common among persons living with HIV.
According to the CDC, worldwide, TB is the leading cause of death among people with HIV. The CDC has a section on TB and HIV, if you wish to learn prevention:
www.cdc.gov/nchstp/hiv_aids/pubs/facts/hivtb.htm
According to the CDC, the presence of mycobacterium can be determined through the employment of Mycobacteriosis Microscopy of a specimen from a stool or normally sterile body fluids or tissue from a site other than lungs, skin or cervical or hilar lymph nodes that shows acid-fast bacilli of a species not identified by culture.
According to the CDC, Pneumocystis carinii pneumonia, PCP, is a severe illness found in people with HIV and is the most common serious infection among people in this group. Symptoms include fever, cough, or trouble breathing and PCP can be fatal if left untreated. The germ that causes PCP is fairly common, but there are ways to prevent PCP. The CDC offers a guide to preventing PCP specifically for persons with HIV/AIDS at www.cdc.gov/nchstp/hiv_aids/pubs/brochure/pcpb.htm.
According to the CDC and with the exception of conditions included in the 1987 AIDS surveillance case definition, pneumonia, with or without a bacteriologic diagnosis, is the leading cause of HIV-related morbidity and death. In addition, several studies have shown that persons with HIV-related immunosuppression are at an increased risk of bacterial pneumonia. Recurrent episodes of pneumonia (two or more episodes within a 1-year period) are required for AIDS case reporting because pneumonia is a relatively common diagnosis and multiple episodes of pneumonia are more strongly associated with immunosuppression than are single episodes. Data from the ASD Project indicate that the risk of an HIV-infected person for multiple episodes of pneumonia in a 12-month period is approximately 20 times higher among HIV-infected persons with CD4+ T cell count of less than 200 than among those with higher CD4+ T-cell counts.
According to the National Association of Neurological Disorders and Stroke, Progressive multifocal leukoencephalopathy is a rare disorder of the nervous system that primarily affects individuals with suppressed immune systems. The disorder, which is caused by a virus, is characterized by demyelination or destruction of the myelin sheath that covers nerve cells. Symptoms of PML include mental deterioration, vision loss, speech disturbances, ataxia (inability to coordinate movements), paralysis, and, ultimately, coma. In rare cases, seizures may occur.
HIV/AIDS glossary
A rapidly debilitating opportunistic infection caused by the JC virus that infects brain tissue and causes damage to the brain and the spinal cord. Symptoms vary from patient to patient but include loss of muscle control, paralysis, blindness, problems with speech, and an altered mental state. PML can lead to coma and death. In some cases, HAART regimens using medications known to cross the blood-brain barrier are used to treat PML. Other studies are ongoing to determine the usefulness of other medications, such as cidofovir and topotecan HCL, in the treatment of PML
According to AMFAR, a disease due to sepsis, the presence of harmful microorganisms or associated toxins in the blood. According to the CDC, prevention of recurrence requires that HIV-infected persons who have Salmonella septicemia require long-term therapy (i.e., secondary prophylaxis or chronic maintenance therapy) to prevent recurrence. Fluoroquinolones, primarily ciprofloxacin, are usually the drugs of choice for susceptible organisms (BII)
According to the HIV/AIDS Glossary, toxoplasmosis is an infection that is caused by the protozoan parasite, Toxoplasma gondii. The parasite is carried by cats, birds, and other animals, and is found in soil contaminated by cat feces and in meat, particularly pork. The parasite can infect the lungs, retina of the eye, heart, pancreas, liver, colon, and testes. Once T. gondii invades the body, it remains there, but the immune system in a healthy person usually prevents the parasite from causing disease. If the immune system becomes severely damaged, as in HIV-infected persons, or is suppressed by drugs, T. gondii can begin to multiply and cause severe disease. In HIV-infected persons, the most common site of toxoplasmosis is the brain. When T. gondii invades the brain, causing inflammation, the condition is called toxoplasmic encephalitis. While the disease in HIV-infected persons can generally be treated with some success, lifelong therapy is required to prevent its reoccurrence.
The CDC offers a fact sheet and further information on the parasitic disease:
www.cdc.gov/ncidod/dpd/parasites/toxoplasmosis/factsht_toxoplasmosis.htm
According to AMFAR, progressive, involuntary weight loss associated with advanced HIV infection.
The HIV/AIDS glossary defines the illness as involving involuntary weight loss of 10 percent of baseline body weight plus either chronic diarrhea (two loose stools per day for more than 30 days) or chronic weakness and documented fever (for 30 days or more, intermittent or constant) in the absence of a concurrent illness or condition other than HIV infection that would explain the findings.
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