AIDS RELATED OPPORTUNISTIC INFECTIONS AND MALIGNANCIES

1. Pneumocystis carinii Pneumonia

A. cause -- Pneumocystis carinii (parasite)

B. site -- typically lungs, has been seen in eyes

C. symptoms -- high fever, dry cough, shortness of breath

D. diagnosis -- induced sputum, bronchoscopy, open lung biopsy

E. treatment --
      1. Bactrium (IV or oral), a.k.a. Septra, TMP/SMX
      2. Dapsone (oral)
      3. Pentamidine (IV)
      4. Atovaquone (oral)
      5. Trimetrexate (oral)

F. prophylaxis (preventive treatment) --
      1. Bactrim (oral)
      2. Aerosolized Pentamidine
      3. Dapsone (oral)

2. Toxoplasmosis

A. cause -- Toxoplasma gondii (parasite)

B. site -- brain

C. symptoms -- fever, headache, neurologic changes

D. diagnosis -- toxoplasma antibody (blood test), CT scan of brain

E. treatment
      1. pyramethanine/sulfadiazine orally
      2. Clindamycin/pyramethamine

F. prophylaxis --
      1. possibly Dapsone orally
      2. Bactrium (oral)

3. Cryptosporidiosis

A. cause -- cryptosporidium (parasite)

B. site -- colon

C. symptoms -- severe diarrhea, cramping, weight loss

D. diagnosis -- stool cultures, biopsy from colon

E. treatment
      1. none proven effective
      2. possibly diclazuril orally
      3. possibly spiramyacin orally or IV
      4. attempt to slow diarrhea with various medications

F. prophylaxis -- possibly Humatin orally

4. Candidiasis

A. cause -- Candida albicans (yeast)

B. site -- mouth, vagina, esophagus (throat), GI tract

C. symptoms -- white patchy growth, painful swallowing, fever

D. diagnosis -- examine scrapings under microscope, biopsies

E. treatment --
      1. Ketoconazole (Nizoral) orally
      2. Nystatin swish in mouth
      3. Mycelex troches
      4. Amphotericin B IV
      5. Fluconazole orally/IV

F. prophylaxis --
      1. Nizoral orally
      2. Fluconazole orally

5. Cryptococcal meningitis

A. cause -- Cryptococcus neoforms (yeast)

B. site -- meninges (the covering of the brain and spinal cord)

C. symptoms -- fever, headache, difficulty touching chin to chest

D. diagnosis -- culture of spinal fluid obtained via lumbar puncture

E. treatment --
      1. Amphotericin B IV
      2. Diflucan (fluconazole) IV or orally

F. prophylaxis --
      1. Nizoral orally
      2. Diflucan orally

6. CMV retinitis/colitis

A. cause -- cytomegalovirus (virus)

B. site -- eye (retinitis), colon (colitis), lung (pneumonia)

C. symptoms -- visual changes, diarrhea, fever, difficulty breathing

D. diagnosis -- visual exam of retina; biopsy of colon, lung

E. treatment --
      1. ganciclovir (DPHG or Cytovene) IV
      2. foscarnet (Foscavir) IV

F. prophylaxis -- currently none

7. Progressive multifocal leukoencephalopathy (PML)

A. cause -- viral infection, possibly associated with JC virus

B. site -- multiple locations of white matter in the brain

C. symptoms -- rapid neurological changes, varies by location of PML

D. diagnosis -- CT scan, MRI scan, biopsy of lesion

E. treatment
      1. AZT with alpha-IFN
      2. ara-C?

F. prophylaxis -- currently none

8. Mycobacterium avium complex (MAC), also known as MAI

A. cause -- Mycobacterium avium intracellulare, other mycobacterium

B. site -- disseminated: lungs, bone marrow, lymph nodes, blood

C. symptoms -- fever, weight loss, anemia, diarrhea

D. diagnosis -- blood and sputum cultures, biopsy from bone marrow

E. treatment --
      1. rifampin
      2. ethambutol
      3. Ciproflaxin
      4. clofazamine
      5. rifabutin, also IV Amikacin
      6. Clarithromyacin? Still being investigated

F. prophylaxis -- rifabutin

9. Mycobacterium tuberculosis

A. cause -- Mycobacterium tubercule

B. site -- lungs, disseminated

C. symptoms -- chronic cough, bloody sputum, fever

D. diagnosis -- PPD skin test, chest X-ray, sputum culture

E. treatment --
      1. INH
      2. rifampin
      3. ethambutol

F. prophylaxis -- INH for one year if PPD positive

10. Kaposi's Sarcoma

A. cause -- uncertain, possibly herpes-related virus (KSHV)

B. site -- skin, lymph nodes, lungs, mouth, GI tract

C. symptoms -- slightly raised purplish lesions, usually painless

D. diagnosis -- biopsy of suspected lesion, endoscopy to biopsy internal lesions (colonoscopy, bronchoscopy, upper endoscopy)

E. treatment --
      1. Isolated lesions usually not treated
      2. Radiation of single lesion for cosmetic purposes
      3. Treatment usually initiated if multiple lesions or internal lesions noted
      4. Combination cancer chemotherapeutic (usually IV)
      5. Local injections of chemotherapeutic agents or interferons
      6. Surgical excision of tumors if needed
      7. Cryotherapy (freezing) of single lesions

F. prophylaxis -- currently none available; if found to be infectious disease, this may change

11. non-Hodgkin's lymphoma

A. cause - unknown, is a form of cancer

B. site -- brain, lymph nodes, GI tract

C. symptoms -- depends on location, may note large tumor on X-ray

D. treatment --
      1. combination cancer chemotherapy
      2. localized radiation
      3. surgical excision of tumor

E. prophylaxis -- none

Resources for Additional Information:
AIDS Treatment News -- published twice monthly
AmFAR AIDS/HIV Treatment Directory -- published quarterly
Being Alive Newsletter -- published monthly
Being Alive Medical Updates
Project Inform -- (800) 992-2873
GMHC Treatment Issues -- published monthly by Gay Men's Health Crisis in New York

All of the above information was provided courtesy of Aids Project Los Angeles (APLA) and the APLA HIV Resource Center

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