HIV+ Issue 11: HIV-Related Illnesses

GUIDE

HIV-RELATED ILLNESSES

INFECTION	SYMPTOMS	TREATMENT
FUNGAL INFECTIONS
Candidiasis (thrush)	White patches on gums, tongue; pain and difficulty swallowing; loss of appetite; vaginal itching, burning, discharge.	Fluconazole, nystatin, clotrimazole, Nizoral, oral solution itraconazole. Experimental: MK-0991, LY303366, L-724, 827, SCH56592. Oral amphotericin B for patients failing other therapies. Natural agents for vaginal infection: Yogurt, vinegar douche, garlic.
Cryptococcal Disease	Meningitis: mild headaches, intermittent fevers, malaise, nausea, fatigue, loss of appetite, altered mental status, seizures (rare). Skin ulcers, pneumonia (concurrent with PCP).	Amphotericin B (AmBisome [liposome for injection] and Abelcet [lipid complex]), 5-flucytosine, fluconazole. For meningitis, lowering cranial pressure is vital.
Histoplasmosis	Skin infections, fever, swollen lymph glands, weight loss, anemia, difficulty breathing; also pneumonia.	Itraconazole, fluconazole, amphotericin B.
INFECTION	SYMPTOMS	TREATMENT
CANCERS
Kaposi's sarcoma	Cancer of skin and organs associated with a new herpes virus, HHV-8; small, purplish lesions visible on skin. Bronchoscopy used for diagnosis in lungs.	Local therapy: cryotherapy, radiation, intralesional vinblastine, alpha interferon, Panretin (alitretinoin). Systemic therapy: Doxil (liposomal doxorubicin, Taxol (paclitaxel), Daunoxome (liposomal donorubicin). Experimental: angiongenesis inhibitors (IM862,SU-5416), thalidomide, IL-12
Non-Hodgkin's lymphoma (NHL) or B-cell lymphomas	Cancer of lymphocytes—may also affect bone marrow and central nervous syndrome. B-cell lymphomas linked to Epstein-Barr virus (EBV).	First-line therapy is CHOP (cyclophosophamide, doxorubicin, vincristine , prednisone); or low-dose mBACOD; infusional CDE or EPOCH. Modified doses for patients under 100 CD4 T-cells. Experimental: C2B8 monoclonal antibody (rituximab), IL-2, bone marrow transplant.
INFECTION	SYMPTOMS	TREATMENT
PROTOZOAL INFECTIONS
Cryptosporidiosis	Diarrhea with watery stool, abdominal cramping, nausea, vomiting, fatigue, flatulence, weight loss, poor appetite, dehydration, electrolyte imbalances.	No treatments proven effective; initiate HAART. Experimental for diarrhea: nitazoxanide (NTZ), nutritional supplements, Allicin (high-dose garlic).
Microsporidiosis; Isosporiasis; E. Intestinalis	Watery diarrhea, abdominal pain, cramping, nausea, vomiting, weight loss, fever.	No proven treatments. Experimental: albendazole sulfoxide, metronidazole, thalidomide, atovaquone.
Pneumocystis carinii pneumonia (PCP)	Fever, dry cough, weight loss, night sweats, difficulty breathing, elevated liver enzymes.	Systemic treatment recommended. First line therapy: Bactrim/Septra. Alternative: IV & IM pentamidine, dapsone plus trimethoprim, clindamycin plus primaquine, atovaquone, trimetrexate. Use prednisone with caution for severe cases.
Toxoplasmosis gondii (Toxo)	Encephalitis (brain disease); also fever, pneumonia, severe headaches, confusion, lethargy, altered mental state, dementia, seizures, coma.	Pyrimethamine plus sulfadiazine, pyrimethamine plus clindamycin.
INFECTION	SYMPTOMS	TREATMENT
VIRAL INFECTIONS
CMV Neurological Disorders	Infections of the central nervous system, encephalitis (brain disease), dementia, apathy, delirium, confusion, lethargy.	Standard cytomegalovirus retinitis treatment suboptimal. Promising: aggressive ganciclovir-foscarnet combination.
Cytomegalovirus (CMV)	Fever common; affects different parts of body. In eyes: Blurry vision. In esophagus: pain, ulcers, difficulty swallowing. In colon and gut: Diarrhea, abdominal pain, wasting. In lungs: pneumonia.	Approved: Ganciclovir IV or intraocular implants (use filgrastim for neutropenia side effects); foscarnet (saline hyperhydration recommended to prevent kidney toxicity), cidofovir plus probenecid (monitor renal toxicity and eye pressure); formivirsen intraocular injection (Vitravene) for patients failing other therapies. Experimental: GEM 132, valganciclovir.
Hairy leukoplakia	White, raised patches in mouth and on tongue. Also skin rash, thirst, light-headedness, nausea. May be confused with thrush.	Acyclovir, ganciclovir, famciclovir.
Hepatitis-A, B, and C	Liver infections, fever. Chronic progressive disease is seen for B and C. Liver damage/disease progression linked to CD4 counts below 200.	Vaccine for hepatitis A and B. No treatment for A. For B: Alpha interferon (INF), Famvir-3TC; experimental: Preveon, FTC/DAPD, L-FMAU. For C: INF-ribavirin (Rebetron) should not be used by pregnnt women; Experimental: once-weekly pegylated INF (with or w/o Ribavirin), beta-INF, Il-12, amantadine or rimantadine with IFN, thymosin for B and C.
Herpes (Herpes Simplex Virus I and II); Shingles (Herpes Zoster)	Ulcers, painful blisters and/or itching on lips (caused by herpes simplex I), anus and/or genitals (caused by herpes simplex II). Shingles on body caused by herpes zoster.	Approved: acyclovir, oral Famvir (famciclovir) for recurrent herpes, foscarnet for acyclovir-resistant HSV, trifluridine (TFT). Experimental: cidofovir, topical penciclovir.
Progressive Multifocal Leukoencephalopathy (PML)	Neurological problems: gross dementia, paralysis, loss of all senses (in late-stage disease).	No proven treatments. Initiate HAART. Experimental: cidofovir, camptothecin derivatives (topotecan, etc.). Experimental: alpha interferon.
INFECTION	SYMPTOMS	TREATMENT
GYNECOLOGICAL
Cervical cancer	Cervical lesions and cellular abnormalities caused by sexually transmitted viruses, including herpes and HPV; detected by abnormal Pap smear; confirmed by colposcopy.	Early stage cancer: cryosurgery (freezing), laser electric excision, scraping and cone biopsy of cervix. Invasive cancer: chemotherapy, radiation, hysterectomy, surgical removal of lymph nodes. Experimental: Topical 5-flourouracil for high-grade dysplasia (not for pregnant women).
Human Papilloma Virus; genital warts	Genital warts can be felt if external; internal requires anascopy or colposcopy and possible HPV DNA testing. HPV linked to cancers of anus, penis, vagina, cervix.	Aldera, Alferon-N, podophylllin or Condylox, Imiquimod topical cream for warts. Cyosurgery, laser; then monitor: HPV can recur. Experimental: Topical 5-flourouracil, antisense compounds, HPV peptide vaccines, DFMO after lesion removal.
Pelvic Inflammatory Disease (PID)	Vaginal discharge, pain, internal ulcers, ectopic pregnancy, linked to chlamydia. Screening, early detection critical.	Ceftriaxone plus tetracycline or doxycycline or erythromycin (if pregnant or allergic).
INFECTION	SYMPTOMS	TREATMENT
BACTERIAL INFECTIONS
MYCOBACTERIUM AVIUM COMPLEX	Persistent fever, night sweats, fatigue, weight loss, chronic diarrhea, low blood platelets, nausea, dizziness, abdominal pain, soft-tissue masses and swollen lymph glands, kidney, or spleen.	Clarithromycin or azithromycin and ethambutol; rifabutin (but first check for TB and watch for rifampin resistance). Experimental: IL-12, GM-CSF (sargramostim).
SALMONELLA	Persistent diarrhea, cramping, fever, weakness, loss of appetite.	Standard antibiotics.
SYPHILIS	Many people have no symptoms. Initial signs: Chancres or sores on body, especiallly genitals. Secondary syphilis: 10-12 weeks after infection, a rash on hands and feet that spreads; fever, swollen lymph glands, diarrhea. Tertiary syphilis: Severe neurological disorders.	Aggressive treatment with penicillins (or other antibiotics if allergic). Monitor syphilis for recurrence. Treat neurosyphilis with long-acting tetracyclines after penicillin.
TUBERCULOSIS (TB)	Night sweats, cough, fever, weight loss, swollen lymph glands, fatigue, organ-specific symptoms.	First-line therapy: Isoniazid (INH), pyrazinamide and rifampin and either ethambutol and streptomycin for two months, then four months of INH/rifampin. (Note: rifampin can't be used with protease inhibitors, substitute rifabutin). Rifater, a combination pill, is also available. First-line therapy for resistant TB: Cycloserine-capreomycin with other anti-TB drugs. Alternatives: rifabutin, ethambutol, streptomycin, L-ofloxacin, ethionamide. Experimental: IL-8, methylprednisone.
INFECTION	SYMPTOMS	TREATMENT
OTHER CONDITIONS
Idiopathic thrombocytopenia purpura (ITP)	Excessive bleeding from nosebleeds and cuts; easy bruising; small and large red spots on skin. Due to HIV-related low platelet count.	Prednisone, Win-Rho, AZT, gamma globulin.
Neuropathy	Nerve damage, possibly a side effect of drugs or HIV infection. Tingling "pins and needles" in feet and legs, hands and fingers; numbness, pain. Tip: Check for drug-related toxicity.	Experimental: Nerve growth factor, lamotigrine, amytriptiline, Neurontin, lidocaine patch, B vitamins, nutritional supplements, acupuncture. Non-opiods for mild pain.
Wasting syndrome	Rapid severe weight loss, loss of appetite, chronic diarrhea, fever. Tumor necrosis factor and gluthathione levels linked to wasting.	Approved: Growth hormone, Megace, Marinol, Serostim, oxandralone. Experimental: thalidomide, steroids, nutritional supplements, vitamins, weight-bearing exercise. Also experimental: Provir for diarrhea.

WHY GET Tested?

Having HIV and having AIDS are not the same thing. HIV is a virus that attacks the immune system, eventually causing a range of illnesses—called opportunistic infections—that result in acquired immune deficiency syndrome, or AIDS. You can be infected with HIV and remain healthy for years, but without treatment most people will eventually get sick.
An HIV antibody blood test is commonly used to see whether a person has been exposed to the virus. This test looks for HIV antibodies—special proteins produced by the body to fight HIV. An FDA-approved home-testing kit can measure HIV antibodies in blood. Most HIV antibody tests use the ELISA method of detection, which is 99% accurate; a more-sensitive Western blot test is used to confirm a positive ELISA test result.
A positive test result means that a person has been exposed to HIV; it does not mean that the person has AIDS. If you test positive, you should plan to see a physician familiar with HIV and consider other tests for HIV and treatment options to prevent the onset of AIDS [see "Taking Control of HIV Infection"].
A negative test result means a person has not been exposed to the virus or that it is too soon since the time of infection to accurately tell; it takes from two weeks to six months for the body's immune system to start developing antibodies to HIV after a person has been exposed to the virus. A negative test result does not protect a person against possible infection in the future.
Counseling is an important aspect of getting an HIV antibody test. A trained counselor can address fears and help a person prepare for getting the test results [see "Vital Resources"].