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)




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














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.

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