Author Archives: Dr Jonathan Brooks

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Opportunistic Infections and HIV

Over the course of time we are all exposed to bacteria, parasites, and viruses no matter how safe and precautious we are, right?!  If you are a healthy individual it is possible that you will never even know that you were exposed because you will never become infected.  However, those with human immunodeficiency virus (HIV) are at a much higher risk of not only becoming infected with these bacteria, parasites, and viruses they are also faced with more serious health threats as well.  These bacteria, parasites, and viruses are known as opportunistic infections (OIs) because they take advantage of a weak immune system and have the ability to cause potentially devastating illnesses.

OIs are the most common cause of death for those with HIV/ AIDS.  If someone who is HIV positive is diagnosed with any of the twenty AIDS-defining OIs they will be given a diagnosis of AIDS.  OIs are life threatening; signs and symptoms associated with OIs, prevention, as well as treatment should not be taken lightly.

What exactly are OIs?

OIs as mentioned above are named for their ability to attack an already weakened immune system.  OIs can be localized to one body part or they can be systemic and spread through multiple parts of the body.  So, when are you at risk of becoming infected with OIs?  Most of the time your body’s CD4 or T-cell count will determine whether or not you are susceptible.  For example the body’s normal CD4/T-cell count is roughly 500-1,600 cells/mm3.  The table below shows you a quick description of what your body is susceptible to with certain CD4/T-cell counts.

CD4/T-cell count: Susceptible to: Symptoms:
>500 cells/mm3 Usually for those with counts over 500 cells/mm3 being at risk is unlikely.  However for those with counts hovering around 500 cells/mm3, yeast infections and vaginal thrush are possible. See thrush symptoms in the box below
200-500 cells/mm3 Candidiasis (Thrush) 

 

 

 

 

 

 

 

 

Kaposi’s Sarcoma (KS)

Oral: loss of appetite, pain in the mouth and/or throat, difficulty swallowing, white patches on the tongue, lining of mouth, or gums 

Vaginal: itching, burning, irritation, white thick discharge

 

Purplish lesions on the skin or in the mouth, rare cases may also experience GI trouble

100-200 cells/mm3 Progressive Multifocal Leukoencephalopathy (PML) 

Pneumocystis Jirovecii Pneumonia (PCP)

 

Histoplasmosis/

Coccidioidomycosis

Dementia, difficulty walking and speaking, confusion, seizures 

Dry cough, fever, shortness of breath, chest pain

 

Headache, coughing, weight loss, fatigue, shortness of breath, chest pain, fever

50-100 cells/mm3 Cryptococcal infection/Cryptococcosis

 

 

 

 

Toxoplasmosis

 

 

 

Cryptosporidiosis

 

 

 

 

Cytomegalovirus (CMV)

Fever, neck stiffness, headache, and fatigue.  Memory loss and mood change may also be possible 

Fever, seizures, confusion, headaches, motor weakness

 

Nausea and vomiting, stomach cramps, weight loss, chronic watery diarrhea

 

Fever, fatigue, swollen glands, and sore throat.  Those with extremely low levels of CD4 can also experience abdominal pain, blurred vision, diarrhea, and swelling that is painful

<50 cells/mm3 Mycobaterium Aviam Complex (MAC) Night sweats, fatigue, diarrhea, abdominal pain

How to Prevent OIs

We know that germs are everywhere and in the case of OIs the infection is so widespread that is may be very difficult to avoid completely.  Like any other infection or illness there are always ways to help avoid OIs.  Keeping your CD4 counts above 500 cells/mm3 will make becoming infected with OIs less likely.  Below is a list of ways to help prevent becoming infected with OIs.

  • Take your HIV drug treatment as prescribed
  • Manage your stress well and get a good night’s rest
  • Quit smoking or doing other recreational drugs
  • Practice safe sex
  • Avoid drinking or cooking with contaminated/unsafe water
  • Get vaccinated
  • If you exercise you different towels to wipe your sweat off yourself and the equipment you use
  • Thoroughly wash all fruits and veggies
  • Thoroughly cook all foods and avoid raw meats, eggs, and unpasteurized dairy products
  • Exercise regularly
  • Eat a healthy diet
  • Use gloves to pick up your pets waste
  • If you are a cat lover, keep your cats indoor to help prevent them from carrying in germs that may put you at risk of becoming ill

This may look like a long list of things to do, but like any other individual who is HIV positive this is part of the lifestyle change.  Becoming aware of where your body is most susceptible and removing yourself for those situations is key.  Over time it will become almost natural to avoid areas and situations that will put you at risk of becoming infected with an OIs.

Hepatitis

What is Hepatitis B?

Did you know that approximately 600,000 people die every year from hepatitis B (Hep B) related consequences?  Or that more than 240 million people suffer from chronic liver infections?  Hep B is a potentially fatal disease that is caused by the hepatitis B virus (HBV) and can affect the liver in numerous ways.  The virus has the ability to cause chronic liver infection and/or disease, putting those infected as at a much higher risk of fatality due to cancer and/or cirrhosis (a chronic liver disease).

Hepatitis B

Hepatitis B

Why is the liver so important to us?  The liver acts as the “factory” of the body performing countless jobs that are crucial to maintaining everyday life.  The liver performs jobs such as processing, then removing toxins, drugs, and alcohol; storing glycogen which we use for our short-term energy needs, making bile which helps us digest the fats that we consume on a daily basis, and produces substances that help clot our blood.  We all know that we only have one liver, but he/she is a true champ!  The liver will continue to fight and repair itself day in and day out until it is too badly damaged to longer fight, at which point it slowly stops working all together.

How Do You Get Hep B?

Hep B is most commonly spread through infected blood and other bodily fluids (i.e. semen, open sores, and vaginal secretions).  An infected Hep B woman who is pregnant can also infect her baby with the virus at the time of birth.  Hep B can even be spread through the sharing of toothbrushes and razors of those who are infected, how crazy is that?!  Of those who are infected, Hep B can either be acute or chronic (life-long).  Acute infections can however become chronic over time.

Symptoms

During the initial or acute stage after being firstly infected with Hep B, some people may have and/or show little symptoms while others may be seriously ill for several weeks.  Possible symptoms of Hep B include: jaundice (when the skin become a yellow color or the whites of the eyes turn a orange/brownish color), fever, abdominal pain, unusual urine and/or bowel color, nausea and vomiting, as well as being fatigue without reason.  These symptoms will usually occur within one to six months after becoming infected with HBV.

Testing

Hep B testing is done through a variety of one or more blood tests by your physician or local sexually transmitted infection/disease center.  Today there are seven different types of blood tests available to diagnose Hep B.  Anyone who is at high-risk or thinks they have been infected with Hep B should be tested.

Is There A Treatment?

Unfortunately today there is no cure for Hep B, the main focus of those infected is put on a healthy diet and comfort.  For those suffering from chronic Hep B there are medications used to help prolong life but often these medications are not readily available.  However chemotherapy, liver transfusions, and surgeries are used in higher income countries in order to help prolong the life of those infected.

Healthy adults who are infected with HBV will fight the infection, recover, and completely get rid of the virus more 90% of the time.

Prevention

Since 1982, there has been a vaccination available that has been proven to be 95% effective in preventing the Hep B infection.  Practicing safe sex (using protection and limiting the number of partners), using protection against transmission, and not sharing needles or equipment with others are also ways to help prevent becoming infected with Hep B.  If you have came in contact with a Hep B positive individual through unprotected sex or sharing of other bodily fluids, it is possible to prevent your body from becoming infected by receiving the Hepatitis B immune globulin (HBIG) vaccine within 24 hours of contact with that infected individual.  After 24 hours the vaccine is no longer proven efficient.

How to Protect Others

If you or someone you know is infected with Hep B, precautions should be taken to protect others from becoming infected.  To protect others from Hep B do not donate blood or organs as the infected blood and organs are still able to spread the virus, tell your sex partners that you are infected, use protection during sexual intercourse, do not share your toothbrush or razors with others, do not share any syringes or needles with others, and if pregnant tell your doctor you are infected so that precautions can be made for your child after birth.