opportunistic infections and tumours
Patients with a CD4 count of <200x10^6/litre are susceptible to infections by pathogens which would not normally cause disease in an immunocompetent individual.
Common opportunistic infections are:
- pneumocystis carinii pneumonia
- cerebral toxoplasmosis
- oesophageal candidiasis
- diarrhoea, pathogens including:
- cryptosporidium
- CMV
- atypical mycobacteria
Common malignant diseases includes:
- Kaposi's sarcoma
- the most common tumour in people with HIV infection
- is an AIDS-defining illness and is caused by the Kaposi sarcoma herpesvirus (KSHV).
- high-grade B cell non-Hodgkin's lymphoma
- two commonest subtypes are diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma/leukaemia (BL)
- both are considered as AIDS-defining illnesses (ADI).
- is the second most common tumour in individuals with HIV
- studies have indicated a decline in incidence since the introduction of HAART
- development of AIDS-related lymphomas (ARLs) has been shown to be related to older age, low CD4 cell count and no prior treatment with HAART
- cervical carcinoma
- almost all cases of invasive cancer are associated with infection with oncogenic types of human papilloma virus (HPV), particularly HPV 16 and 18
- women with HIV infection are more likely to have infection with HPV 16 or 18 than women who are HIV negative
- Invasive cancer is preceded by cervical intraepithelial neoplasia (CIN) which has a higher prevalence and incidence in women with HIV infection (1)
Note:
- all patients with HIV and malignancy should be referred to centres that have developed expertise in the management of these diseases
- most serious problems usually occur at very low CD4 counts (below 100 cells/μl) so other clinical clues to immunosuppression are likely to be present.
- Pneumocystis pneumonia (PCP) is an exception to this rule as it tends to occur at higher CD4 counts (below 200).
- it may be the first HIV-related problem for which the patient seeks advice
- the prognosis correlates directly with how early or late the infection is identified and treated: PCP can kill if diagnosed too late (2)
Reference:
clinical indicator diseases for adult HIV infection
| | other conditions where HIV testing should be offered |
| | - bacterial pneumonia
- aspergilosis
|
| - cerebral toxoplasmosis
- primary cerebral lymphoma
- cryptococcal meningitis
- progressive multifactorial leucoencephalopathy
| - aseptic meningitis/encephalitis
- cerebral abscess
- space occupying lesions of unknown origin
- Guillain -Barré syndrome
- transverse myelitis
- peripheral neuropathy
- dementia
- leucoencephalopathy
|
| | - severe or recalcitrant seborrhoeic dermatitis
- severe or recalcitrant psoriasis
- multidermatomal or recurrent herpes zoster
|
| - persistent cryptosporidiosis
| - oral candidiasis
- oral hairy leukoplakia
- chronic diarrhoea of unknown cause
- weight loss of unknown cause
- salmonella, shigella or campylobacter
- hepatitis B & C infection
|
| | - anal cancer or anal intraepithelial dysplasia
- lung cancer
- seminoma
- head and neck cancer
- Hodgkin "s lymphoma
- Castleman "s disease
|
| | - vaginal intraepithelial neoplasia
- cervical intraepithelial neoplasia Grade 2 or above
|
| | - any unexplained blood dyscrasia including:
- thrombocytopenia
- neutropenia
- lymphopenia
|
| - cytomegalovirus retinitis
| - infective retinal diseases including herpesviruses and toxoplasma
- any unexplained retinopathy
|
| | - lymphadenopathy of unknown cause
- chronic parotitis
- lymphoepithelial parotid cysts
|
| | - mononucleosis-like syndrome (primary HIV infection)
- pyrexia of unknown origin
- any lymphadenopathy of unknown cause
- any sexually transmitted infection
|
Reference: