Malignancies and Opportunistic Infections in HIV/AIDS
17 till 20 April 2014، Tehran - Iran
Presentation Type: Speech
In HIV-infected patients CD4 cell count is a valuable marker to determine when patients are at increased risk for development of a specific opportunistic infection (OI). For example pneumocystis jirovecii pneumonia (PCP) occurs rarely in CD4> 200-250 cells/mm3 and di s - seminated mycobacterium avium complex occurs rarely in CD4 >50 cells/mm3. CD4 T-cell counts are not the only laboratory predictors of OI. HIV viral load is an independent predictor. The cytomegalovirus (CMV) viral load is also an independent predictor of the occurence of AIDS-defining events. Specific skin, blood or urine tests for individual pathogens may also be useful predictors for the occurence of OIs. Some tests such as PPD for TB, or antibody test for varicella, CMV, HSV, toxoplasma, HBV and HCV whether o not patients have been infected and might ,reactivate latent infection. Clinical findings can be useful predictors of susceptibility to supplement the information derived from CD4-cell counts and HIV viral loads. For example, development of otherwise unexplained oropharyngeal candidiasis or oral hairy leukoplakia, wasting, or any type of pneumonia is an indicator of PCP or other OIs. TB, cerebral toxoplasmosis, cryptosporidiosis, microsporidiosis, progressive multifocal leukoencephalopathy and Kaposi sarcoma are examples of other processes that cause disease much more commonly in HIV-infected patients than in those with other immunodeficiencies. Environmental exposure is an important determinant of other OIs.These exposures may be respiratory (e.g. TB, endemic mycoses, or PCP), enteric (salmonella, cryptosporidia, microsporidia,isospora belli), vector borne (malaria, leishmania,bartonella, trypanosomes),contact mediated (e.g. methicillin-resistant Staphylococcus aureus[MRSA]) or sexual(e.g. HSV-2, HHV-8,Treponema pallidum) Some fungi that cause OIs in HIV-infected patients are aspergillus, coccidioides, histoplasma capsulatum,candida and cryptococcus.