Table 1. Common Opportunistic Infections in HIV
All CD4+ counts
Mycobacterium tuberculosis
• Latent TB infection affects an estimated 3% to 16% of untreated individuals with HIV. • Every organ system is involved. • Symptoms include fatigue, weakness, weight loss, and fever. • Pulmonary TB includes chronic cough and hemoptysis. • Disseminated bloodstream infections lead to lesions in many organs and have a high mortality rate. CD4+ count less than 250 cells/mm 3 • Coccidioidomycosis is a fungal disease caused by inhaling fungal spores from the ground. • Inhalation can lead to focal pneumonia with fever, cough and pleuritic chest pain, diffuse pneumonia with fever, dyspnea, hypoxemia, lethargy, and meningitis. • It is most common in hot, dry regions of Central and South America, and the southwestern U.S. (CDC, 2020b; Valiant & Gulick, 2023). CD4+ count less than 200 cells/mm 3 • This fungus, also known as PCP , has a history of fever, progressive dyspnea, nonproductive cough, and hypoxemia. • A chest x-ray shows characteristic diffuse, bilateral, symmetrical interstitial infiltrates with a ground glass pattern. • The causative organism is Candida albicans. • Oropharyngeal infections appear as painless creamy white, plaque-like lesions that scrape off easily. • Angular cheilosis is another finding. • Esophageal candidiasis presents as retrosternal burning and odynophagia, and it is similar in appearance to the oral cavity. • Vulvocandidiasis in women presents as mucosal burning and pruritis. CD4+ count less than 150 cells/mm 3 • Acute pulmonary histoplasmosis in immunocompromised individuals presents as fever, myalgia, headaches, and nonproductive cough. • Severe disseminated histoplasmosis manifests as fever, fatigue, weight loss, lymphadenopathy, hepatosplenomegaly, and mucocutaneous ulcers of the nose, mouth, tongue, and intestine. CD4+ count less than 100 cells/mm 3 • A yeast characterized by a polysaccharide capsule, which can manifest as subacute meningitis or meningoencephalitis. • Common symptoms include fever, malaise, and headache. • Pulmonary cryptococcosis presents with fever, chest pain, dyspnea, and positive blood cultures. CD4+ count less than 100 cells/mm 3 (continued) • This condition results from protozoa that are typically associated with infections of the small bowel that cause diarrhea. However, in a profoundly immunosuppressed state, they may be associated with severe extraintestinal presentation. • This is commonly associated with watery diarrhea, abdominal pain, nausea, and vomiting. • Presentations vary by organism. Encephalitozoon bieneusi, for example, which is found in both wild and domestic animals (cats, dogs, and other mammals), can cause diarrhea, malabsorption, and cholangitis. • Manifests as progressive multifocal leukoencephalopathy (PML) and is characterized as focal demyelination. • Symptoms are based on the region of the brain affected and range from unilateral weakness to hemiparesis and aphasia. • These organisms are predominately zoonotic or waterborne. • Many can transfer to humans and cause infection.
Coccidioidomycosis
Pneumocystis jirovecii pneumonia
Mucocutaneous candidiasis
Histoplasma capsulatum
Cryptococcus neoformans
Cryptosporidiosis
Microsporidiosis
JC virus infection
• Optic nerves are never involved, and the spinal cord is rarely affected. • PML can develop as a response to immune reconstitution secondary to ART. CD4+ count less than 50cells/mm 3
Cytomegalovirus (CMV)
• CMV can infect multiple parts of the body, with problems such as pneumonia, gastroenteritis, and retinitis, which is the most common symptom. • Retinitis worsens over time and can cause blindness.
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