HIV/AIDS: Complications

HIV infection weakens your immune system, making you highly susceptible to a large number of bacterial, viral, fungal and parasitic infections. You may also be vulnerable to certain types of cancers. But treatment with anti-retroviral drugs has markedly decreased the number of many opportunistic infections and cancers affecting people with HIV. It's now more likely these infections will occur in people who have not had treatment.

Bacterial Infections

• Bacterial pneumonia. Worldwide, this is one of the most common opportunistic infections occurring in people living with HIV/AIDS. Dozens of types of bacteria can cause bacterial pneumonia, which may develop on its own or after you've had an upper respiratory infection such as a cold or the flu.
• Mycobacterium avium complex (MAC). This infection is caused by a group of bacteria referred to by a single name — MAC. The bacteria normally cause an infection of the respiratory tract. But if you have advanced HIV infection and your CD4 lymphocyte count is less than 50, you're more likely to develop a systemic infection that can affect almost any internal organ, including your bone marrow, liver or spleen. MAC causes nonspecific symptoms such as fever, night sweats, weight loss, stomach pain and diarrhea.
• Tuberculosis (TB). In developing nations, TB is the most common opportunistic infection associated with HIV and the leading cause of death among people living with AIDS. About 14 million people are currently infected with both HIV and tuberculosis, and many experts consider the two diseases twin epidemics. That's because HIV/AIDS and TB have a deadly symbiotic relationship, in which each fuels the progress of the other. Having HIV makes you more susceptible to TB and far more likely to progress from dormant to active infection. At the same time, TB increases the rate at which the AIDS virus replicates. What's more, TB often strikes people with HIV years before other problems associated with HIV develop. One of the first indications of HIV infection may be the sudden onset of TB — often in a site outside the lungs.

If you're HIV-positive, get a simple skin test for TB early in your medical care. If the test is positive, you'll also need a chest X-ray and other appropriate tests to make sure you don't have an active infection. If your TB isn't active, there are treatments to prevent it from becoming active in the future. TB is more worrisome than many other opportunistic infections because it spreads from one person to another, including those with healthy immune systems.

You can get TB when someone with the disease coughs or sneezes near you. The bacteria then spread through your blood and lymph nodes to the rest of your body. TB most often affects the lungs, but people with HIV are more likely to have infection at other sites. Multidrug-resistant tuberculosis (MDR-TB), in which the disease resists treatment with traditional antibiotics, is of particular concern to people with HIV/AIDS. Ultimately, however, TB is of concern to everyone because it can affect even people with healthy immune systems.

• Salmonellosis. You contract this bacterial infection from contaminated food or water. Symptoms include severe diarrhea, fever, chills, abdominal pain and, occasionally, vomiting. Although anyone exposed to salmonella bacteria can become sick, salmonellosis is far more common in people who are HIV-positive. You can reduce your risk by washing your hands carefully after handling food and animals and by cooking meat and eggs thoroughly.
• Bacillary angiomatosis. Rarely seen in people not infected with HIV, this infection first appears as purplish to bright red patches on your skin. It often resembles Kaposi's sarcoma. But it can also cause disease in other parts of your body, including your liver and spleen.

Viral Infections

• Cytomegalovirus (CMV). This common herpes virus is transmitted in body fluids such as saliva, blood, urine, semen and breast milk. More than half the adult population has been infected. But a healthy immune system inactivates the virus, and it remains dormant in your body. If your immune system weakens, the virus resurfaces, causing damage to your eyes, digestive tract, lungs or other organs. Most commonly, CMV causes infection and inflammation of your retina (CMV retinitis). If not treated, CMV retinitis can lead to blindness.
• Viral hepatitis. Viral hepatitis is a viral infection of the liver. Signs and symptoms include yellowing of your skin and the whites of your eyes (jaundice), fatigue, nausea, abdominal pain, loss of appetite and diarrhea. There are several types of hepatitis, but the most common are hepatitis A, B and C. Hepatitis B and C can lead to persistent or chronic infection and put you at risk of long-term complications such as cirrhosis or liver cancer. If you are HIV-positive and also have hepatitis, your HIV disease may progress more rapidly, and you may be more likely to develop liver toxicity from your medications. You contract hepatitis A from contaminated food and water and through poor hygiene. Those at greatest risk include intravenous drug users; gay and bisexual men; people who live or have sex with someone who's already infected; people who live in an American Indian, Alaskan native or other community where lack of public services tends to lead to outbreaks of hepatitis A; and international travelers. You can help protect yourself from this type of hepatitis by avoiding, as much as possible, suspect food and water and by practicing good hygiene. A highly effective vaccine also is available that can help prevent hepatitis A in HIV-positive and high-risk people.

Sexually active heterosexuals, gay men and intravenous drug users have an especially high risk of acquiring hepatitis B. Infants born to mothers infected with hepatitis B, health care workers and patients on hemodialysis also are vulnerable to the disease. If you're at risk, you should be screened for hepatitis B. If you're not infected, there is a vaccine that can help protect you.

Those who are at risk of hepatitis B are also at risk of hepatitis C, which has a high likelihood of progressing to chronic infection. Unfortunately, there's no vaccine against hepatitis C.

• Herpes simplex virus (HSV). HSV, which usually causes genital herpes, may be transmitted during unprotected anal or vaginal sex. Initial symptoms include pain or irritated skin in the genital area. Later, sores that ooze and bleed erupt on the genitals, buttocks and anus. Although these sores eventually heal, the virus periodically reappears, causing the same symptoms. If you have HIV, your skin infection is likely to be more severe than would occur in people who don't have HIV, and the sores may take longer to heal. Systemic symptoms may also be more severe. Although the herpes virus isn't life-threatening in adults, it may cause brain damage, blindness or death in infants infected during delivery.
• Human papillomavirus (HPV). This is one of the most common causes of sexually transmitted disease. Some types of this virus cause common warts; others cause warts on the genitals. If you're HIV-positive, you're especially susceptible to infection with HPV and more prone to recurrent infections. HPV infection is especially serious because it increases a woman's risk of cervical cancer. Infection with both HPV and HIV increases a woman's risk even further - cervical cancer seems to occur more often and more aggressively in women who are HIV-positive. About half of all women with HPV have no symptoms. Women who are HIV-positive or have unprotected sex with more than one partner should have a Pap test - a test that examines cells taken from the cervix - every year to check for cervical cancer, HPV and other sexually transmitted diseases. Anyone who engages in anal sex should be tested for anal cancer because HPV increases the risk of this type of cancer in both men and women.
• Progressive multifocal leukoencephalopathy (PML). PML is an extremely serious brain infection caused by the human polyomavirus JCV. Symptoms vary and may include speech problems, weakness on one side of the body, loss of vision in one eye or numbness in one arm or leg. PML usually occurs only when your immune system has been severely damaged.

Fungal Infections

• Candidiasis. Candidiasis is a common HIV-related infection. It causes inflammation and a thick white coating on the mucous membranes of your mouth, tongue (thrush), esophagus (Candida esophagitis) or vagina. Children may have especially severe symptoms in the mouth or esophagus, which can make eating painful and difficult.
• Cryptococcal meningitis. Meningitis is an inflammation of the membranes and fluid surrounding your brain and spinal cord (meninges). Cryptococcal meningitis, the most common central nervous system infection associated with HIV, is caused by a fungus that is present in soil. Symptoms include headache, high fever, a stiff neck and sensitivity to light. Cryptococcal meningitis can be successfully treated with antifungal medications, but early treatment is essential. Meningitis is a serious disease that can cause severe complications or prove fatal in a short period of time. Once you've had cryptococcal meningitis, you'll need to be on long-term medication to prevent a recurrence.

Parasitic Infections

• Pneumocystis carinii pneumonia (PCP). This is the most common opportunistic infection that occurs with AIDS in the United States. PCP attacks your lungs, making it difficult for you to breathe. Symptoms include a cough that doesn't go away, fever and trouble breathing. PCP is the leading cause of death in children with HIV. In recent years antiretroviral medications that boost the immune system have helped reduce the number of cases of this serious disease.
• Toxoplasmosis. Toxoplasmosis is the most common cause of brain lesions in people with advanced HIV disease. It's caused by Toxoplasma gondii, a parasite spread primarily by cats. Infected cats pass the parasites in their stools, and these may then spread to other animals. Humans generally contract toxoplasmosis by touching their mouths with their hands after changing cat litter or by eating raw or undercooked meat, especially pork, lamb and venison. If you become infected with the parasites while pregnant, you may pass the infection to your baby. Once you're infected, the parasites can spread to every organ in your body, including your heart, eyes and lungs. For many people with AIDS, toxoplasmosis leads to encephalitis, an infection of the brain. Signs and symptoms may include disorientation, seizures and difficulty walking or speaking.
• Cryptosporidiosis. This infection is caused by an intestinal parasite that's commonly found in animals. You contract cryptosporidiosis when you ingest contaminated food or water. The parasite grows in your intestines and bile ducts, leading to severe, chronic diarrhea in people with AIDS.

Cancers

• Kaposi's sarcoma. Kaposi's sarcoma is a tumor of the blood vessel walls. It's the most common cancer found in HIV-positive people, especially gay and bisexual men, but is extremely rare in people not infected with HIV. It usually appears as pink, red or purple lesions on your skin and in your mouth. In people with darker skin, the lesions may look dark brown or black. Kaposi's sarcoma can also affect your internal organs, including your digestive tract and lungs. Smaller skin lesions may be treated with liquid nitrogen, low-dose radiation or chemotherapy applied directly to the lesion. If the cancer is more severe or has spread to your internal organs, you may be treated with systemic chemotherapy.
• Non-Hodgkin's lymphoma. This cancer originates in lymphocytes, a type of white blood cell. Lymphocytes are concentrated in your bone marrow, lymph nodes, spleen, digestive tract and skin. Although lymphomas can start in other organs, they usually begin in your lymph nodes. The most common early symptom is painless swelling of the lymph nodes in your neck, armpit or groin.

Other Complications

 Researchers identified wasting syndrome as a complication of AIDS in the 1980s. Although current aggressive treatment regimens have reduced the number of cases, wasting syndrome still affects many people with AIDS. It is defined as a loss of at least 10 percent of your body weight and is often accompanied by diarrhea, chronic weakness and fever.