opportunisticinfections- in Human immunodeficiency syndrome

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UNDERSTANDING HIV
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What Is An Opportunistic Infection?
HIV and Opportunistic Infections, Coinfections, and Conditions
What is an Opportunistic Infection?
HIV and COVID-19
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HIV Source | HIV-Related Conditions
MedlinePlus | HIV/AIDS and Infections
CDC | AIDS and Opportunistic Infections
What is an Opportunistic Infection?
Last Reviewed: August 16, 2021
Key Points
Opportunistic infections (OIs) are infections that occur more often or are more severe in people with weakened immune systems than in people with healthy immune systems. People with weakened immune systems include people living with HIV.
HIV damages the immune system. A weakened immune system makes it harder for the body to fight off OIs.
HIV-related OIs include pneumonia, Salmonella infection, candidiasis, toxoplasmosis, and tuberculosis (TB).
For people with HIV, the best protection against OIs is to take HIV medicines every day. HIV medicines prevent HIV from damaging the immune system. Because HIV medicines are now widely used in the United States, fewer people with HIV get OIs.
Word cloud containing the names of various opportunistic infections.

What is an opportunistic infection?
Opportunistic infections (OIs) are infections that occur more often or are more severe in people with weakened immune systems than in people with healthy immune systems. People with weakened immune systems include people living with HIV.

OIs are caused by a variety of germs (viruses, bacteria, fungi, and parasites). OI-causing germs spread in a variety of ways, for example, in the air, in body fluids, or in contaminated food or water. Some OIs that people with HIV may get include candidiasis, Salmonella infection, toxoplasmosis, and tuberculosis (TB). The Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV provide detailed information on HIV-related OIs.

Why do people with HIV get OIs?
Once a person has HIV, the virus begins to multiply and damages the immune system. A weakened immune system makes it harder for the body to fight off OIs.

HIV medicines prevent HIV from damaging the immune system. But without treatment with HIV medicines, HIV can gradually destroy the immune system and advance to acquired immunodeficiency syndrome (AIDS). Many OIs, for example, certain forms of pneumonia and TB, are considered AIDS-defining conditions, which are infections and cancers that are life-threatening in people with HIV.

Are OIs common in people with HIV?
In the United State

1. OPPORTUNISTIC INFECTIONS IN HIV BY ART CLINIC PRESENTER MCO MORRISH AYENI 19 TH JUN 2024

2. Opportunistic infections (OIs) are infections that occur more often or are more severe in people with weakened immune systems (people living with HIV) than in people with healthy immune systems. Definition

3. About 90% of HIV-related morbidity and mortality is due to OIs and TB is the most frequent opportunistic infections accounting for 50% of all opportunistic infections, followed by Candidiasis in 49% of cases. Pneumocystosis was seen in 16%, Cryptococcal infection in 09% and parasitic diarrhoea in 15% in India among others Epidemiology

4. Age Malnutrition N CDs Patients with HIV Patients with Inflammatory bowel disease Patients with Leukopenia Patients who uses immunosupressants Risk factors

5. Types of opportunistic infections in HIV patients Fungal infections P. jiroveci Pneumonia Oropharangeal Candiasis Cryptococcus neoformans infection   Protozoal infections Toxoplasmosis Cryptospordiasis   Bacterial infection Mycobacterium Tuberculosis   Viral infection Cytomegalo virus infection KS

6. Cause: Pneumocystitis jerovecii (Yeast like fungus) Clinical Presentation: major Non productive cough Shortness of breath on exertion diagnostic Inability to take deep breath others Fever Anorexia constitutional symptoms Weight loss Diagnosis: Exercise induced oxygen desaturation Chest radiographic appearance of bilateral interstitial shadowing Nucleic acid amplification technique Bronchoalveolar lavage CD4 count is less than 200cells/mm 3 P. jiroveci Pneumonia

7. Oropharyngeal candidisis Cryptococosis Cause: Candida albicans (Fungus) Clinical Presentation: White plaques on oral mucosa Erythamatous plaques on oral mucosa Angulus chelitis Dysphagia Odynophagia Diagnosis: Based on clinical presentation CD4<500 Cause: Cryptococcus neoformans (Fungus) Clinical Presentation: Fever Head ache Signs of meningeal irritations Diagnosis: CSF analysis,csf CrAg Blood culture, serum CrAg CD4 <100

8. Toxoplasmosis cryptosporidiosis Cause: Toxoplasma gondii (Protozoa) Clinical Presentation: Fever Head ache Confusion Seizures Diagnosis: CT Scan-Ring Enhancing Lesion Brain biopsy CD4<100 Cause: Cryptospordium parvum (Protozoa) Clinical Presentation: Abdominal pain Diarrhea Weight loss Diagnosis: Stool analysis CD4< 200

9. TB CMV Cause: Mycobacterium tuberculosis (Bacteria) Clinical Presentation: Persistent cough Coughing with blood Chest pain while coughing and breathing Unintentional weight loss Fatigue Fever Night sweats Chills Diagnosis: Tuberculin test Sputum Culture Zn Gene xpert CD4 <5OO Cause: Cytomegalovirus (Virus) Clinical Presentation: Blurred vision Visual field defects Blindness Diagnosis: Based on clinical presentation CD4 <100  

10. 1 P.jeroveci i 2 Inhalation 3 Enter in to HIV patient Residing in alveolI 4 5 Multiplication of P. jerovecii Alteration of alveolar capabilit y 6 7 Impairment of gaseous exchange Ventilation - Perfusion mismatch 8 9 Respiratory Arrest Pathophysiology of P.jerovecii Pneumonia

11. Pathophysiology of Toxoplasmosis

12. Pathophysiology of Tuberculosis

13. Pathophysiology of CMV infection

14. Acute Respiratory Distress Syndrome (ARDS) Encephalitis Meningitis Blindness Complications of Opportunistic Infections

15. Treatment Algorithm of Opportunistic Infections in HIV Patients

16. Give Oxygen if SPO2 <94% Cotrimox 120mg/kg/day in 2-4 divided doses x 21days Plus PO pred 2mg/kg/day in 3doses x5/7 then tapper dose to complete 21days of Rx Pentamidine 4mg/kg IV x21/7 if cotri is contraindicated (reduce in renal impairment) Clindamicin 600mg 8hrly + dapsone 100mg daily Prophylaxis Cotrimoxazole 960mg od Dapsone 100mg od To be continued until immunity recovers sufficiently Rx of PJP

17. Drugs used in Treatment of Opportunistic Infections

18. Drug Category Mode of Action Dose Adverse Effects Trimethoprim + Sulpha methoxazole Sulphonamides Inhibit folic acid synthesis in bacteria Moderate–severe: 120mg/kg i.v in 2–4 divided doses for 3 days, then 90mg/kg for 18 days Mild: 1920mg p.o . three times daily for 3 weeks Prophylaxis: 480 or 960mg p.o . daily or 960mg three times per week (960mg daily if on rifampicin ) Nausea Vomiting Diarrhoea Rash Hyperkalaemia Dapsone Antileprosy Agents Inhibit folic acid synthesis in bacteria 100mg p.o . daily (with trimethoprim 10–15mg/kg/ day in divided doses for 3 weeks for PCP treatment) Anorexia Nausea Vomiting Rash Dapsone syndrome

19. Clindamycin Lincosamide Inhibit protein synthesis in bacteria 600mg i.v./p.o. four times daily for 3 weeks 600mg i.v./p.o. four times daily for at least 6 weeks 1.2g p.o. daily in 3–4 divided doses Diarrhoea Abdominal discomfort Oesophagitis Abnormal LFTs Thrombophlebitis Primaquine Anti malarial drug Disrupts Plasmodium mitochondria 15–30mg p.o. daily for 3 weeks Nausea Vomiting Anorexia Abdominal pain Haemolytic anaemia

20. Flucanazole Anti fungal drug Disrupts fungal cell membrane 100mg p.o. daily for 2 weeks 50mg p.o. daily for 7–14 days 400mg i.v./p.o. daily for ≥8 weeks 200mg p.o. daily Headache Abdominal pain Diarrhoea Flatulence Abnormal LFTs Amphotericin B Anti fungal drug Disrupts fungal cell membrane Induction phase x 2weeks Amphotericin B 0.7-1MG od + flucytocin 100mg/day in 4 divided doses x 7days OR High dose f luconazole 800mg (12mg/kg/day in children<19kg) OR Sghort course(5-7day) Amphotericin B + high dose fluconazole 800mg/day /alt fluconazole 1200mg/day Fever Weight loss Myalgia Thrombophlebitis Epigastric pain

21. Flucytosine Anti fungal agent Inhibit protein synthesis in fungus 100mg/kg daily p.o./i.v. in four divided doses for 2 weeks (with i.v. amphotericin) Nausea Vomiting Diarrhoea Rash Hepatotoxicity Sulphadiazine Sulphonamide Inhibit folic acid synthesis in bacteria 1–1.5g i.v ./ p.o . four times daily for at least 6 weeks. 2g p.o . daily in divided doses Nausea Vomiting Rash Bone marrow suppression Crystalluria Pyrimethamine Antimalarial agent Inhibit folic acid synthesis in parasite 100mg on day 1, then 50mg p.o . once daily for at least 6 weeks Different in SPC 25mg p.o . once daily Anaemia Leucopenia Thrombocytopenia Rash

22. Nitazoxanide Anti Parasitic agent Inhibits growth of sporozoites and oocysts of Cryptosporidium and trophozoites of Giardia 500 mg PO q12hr x 3 days Headache Abdominal pain Diarrhea Nausea Chromaturia Cidofovir Anti viral agent Inhibits DNA synthesis in virus 5mg/kg weekly for two doses, then every 2 weeks thereafter Infection Chills Fever Headache Amnesia Anxiety Atovaquone Anti malarial agent Inhibits electron transport chain in Plasmodium 750mg p.o. twice daily with food for 3 weeks 1.5g p.o. twice daily for at least 6 weeks Diarrhoea Insomnia Increased LFTs Decreased sodium Anaemia

23. Improve CD4 with ART Prevent exposure To TB Pets Safe water and food Malaria vector control Safe sex chemoprophylaxis Cotrimox primary prophylaxis Dapsone TPT MAC preventive Rx(CD4<50) Cryptococal preventive Rx Immunisation Avoid Live vaccines in severely immunocompromised CD4 <200 Prevention of opportunistic infections

24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931281/pdf/nihms796285.pdf www.ijmm.org/temp/IndianJMedMicrobiol33178-2534228_070222.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4055535/pdf/nihms-545048.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2820438/pdf/1471-2180-10-11.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877069/pdf/pone.0083643.pdf UCG 2023.pdf Davidsons principles and practices of medicine 24edition.pdf National-Manual-for-TB-Control-2022update FINAL CONSOLIDATED HIV-AIDS GUIDELINES-A5 aidsinfo.nih.gov AIDSinfo , a service of the US Department of Health and Human Services (HHS ). bhiva.org British HIV Association. who.int/health-topics/ hiv -aids World Health Organization. Resources