Now that powerful HIV medications can slow down the progression of HIV-related disease and even AIDS, more common illnesses (such as heart disease and cancer) have become a greater concern for people living with the virus.
Still, some of the same old AIDS-related bugaboos continue to be a problem. A little knowledge about these other illnesses can help prevent them, and thus assist in maintaining a healthy life with HIV. First, some background information.
In the beginning of the epidemic, and for a long time afterwards, opportunistic infections (OIs) were a major (if not the major) cause of death in people with AIDS. Opportunistic infections are those that can get stronger and cause illness as the immune system gets weaker (as can happen with untreated HIV).
OIs are a type of co-infection. For someone with a chronic (long-term) condition like HIV, having another infectious illness on top of it is called a "co-infection." For example, "He is co-infected with HIV and hepatitis C."
In HIV, other sexually transmitted infections (STIs) are also co-infections. STIs continue to be a major concern in HIV.
The U.S. National Institutes of Health (NIH) publishes OI guidelines for people with HIV. (Electronic copies only are available; visit www.aidsinfo.nih.gov.
While vaccinations, prevention drugs (called "prophylaxis"), and better strategies for dealing with OIs helped save lives in the early 1990s, it was really the very effective HIV medications of the mid-90s that helped squash these infections. For this reason, the guidelines emphasize the use of HIV drugs for the prevention, as well as treatment, of OIs.
Ironically, there's an undesirable condition that's sometimes seen as a result of starting HIV therapy. It's called "IRIS," which stands for "immune reconstitution inflammatory syndrome." This syndrome is not yet well understood. It has generally been seen in people who have advanced immune damage (low T-cell count or high viral load) at the time they begin taking HIV medicine, or sometimes when they go back on it.
The "immune reconstitution" is a good thing. It means that the immune system is recovering, or getting stronger. The "inflammatory" part is not so good. Inflammation occurs when the body is fighting disease or injury. People who experience IRIS can become very sick as their body battles an OI.
At this point, according to the OI guidelines, it seems that IRIS can occur four to eight weeks after starting therapy, and is most commonly seen with tuberculosis (TB) or disseminated MAC (mycobacterium avium complex). It can be seen with any of the OIs, however. Each OI listed in the guidelines has a section on the influence of IRIS that is known so far.
Pneumocystis jirovecii pneumonia (PCP) is probably the most common or well-known OI. It used to be known as pneumocystis carinii pneumonia until the fungus jirovecii was found to be the actual cause, and the initials PCP were kept because they were so well known.
The major symptom of PCP (as with all pneumonias) is difficulty breathing. Anyone having a hard time breathing should go immediately to the emergency room. Unfortunately, it is still common for people to find out they are HIV-positive at the time they are diagnosed with PCP (and other OIs, as well). Getting tested for HIV earlier, and treated for it, helps avoid PCP and other illnesses.
Hepatitis A (HAV), hepatitis B (HBV), and hepatitis C (HCV) are viral diseases that cause inflammation of the liver. Prevention, or early diagnosis, is important because treatment can be very difficult, as well as expensive. Hep A can be picked up through unsanitary food preparation (as in using the restroom and not washing hands before handling food). Hep B can be acquired through blood contact (as sometimes occurs with anal sex, for example). Hep C can also be transmitted through blood-to-blood contact, as well as during sex. Hepatitis C is very common among injection drug users. Symptoms of a recent viral hepatitis infection include nausea and vomiting, but hep C may not cause symptoms.
Creamy white spots on the tongue are a sign of thrush (a yeast infection also known as "candidiasis," since it's from the Candida albicans fungus). The infection can travel down the throat to the esophagus (the tube that helps take food to the stomach), causing pain or burning sensations and making eating difficult. Diflucan (fluconazole) is the treatment of choice, but other drugs might be necessary, depending on the individual's infection.
Tuberculosis (TB) is more common in poorer countries, but is not that uncommon in the U.S. in people with HIV. TB, which is usually an infection of the lungs (although the pathogen can affect other parts of the body), causes coughing. TB diagnosis in a person with AIDS can be difficult. Time spent in places like correctional facilities, homeless shelters, and nursing homes might increase the risk of infection. TB medications must be taken for six months, sometimes longer.
CMV -- cytomegalovirus -- usually affects the eyes. It can lead to partial or full blindness. CMV is very common in the U.S., but because it is an "opportunistic" infection, it does not cause illness in most people who have it. Treatment consists of pills or IV (intravenous) medications, but the immune recovery seen with HIV therapy can bring CMV under control.
Sex, Sex, Sex