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Illnesses
The following is a summary of some of the more common illnesses that people with HIV can get. The list is not comprehensive, and it’s worth remembering that the success of anti-HIV treatments means that many of the illness listed below are now very rarely seen in people with HIV in this country.
However, the PCP and tuberculosis both affect about 200 people a year in the UK. Cases of these illnesses often occur in people who are unaware that they are HIV-positive.
Treatments are constantly improving, so only very basic information about treatments has been included. More comprehensive information can be found on NAM’s website www.aidsmap.com.
Most illnesses are caused by one of the following:
- A virus. These are simple organisms which reproduce using the building blocks of your own cells. This makes it very hard to get rid of them.
- Bacteria. These are single-cell organisms that antibiotics can kill.
- Protozoa and parasites. These are more complex organisms.
- Fungi. Yeasts and organic growths.
- Cancer. Cancers develop when your own cells develop out of control.
However, it’s possible that you have already been infected with the organisms which cause many of the illnesses listed in this section. This is because they are very common across the population and only cause problems if the immune system is damaged and unable to keep them in control. Even then, there are sometimes effective treatments to stop the illnesses flaring up (preventative treatment or prophylaxis).
Candidiasis (thrush)
This is a fungus that can affect wet and warm surfaces, such as the mouth, throat, vagina, anus and top of the penis. It looks a bit like cottage cheese and can be painful. Treatments vary depending on its severity, and are effective. Thrush can begin to appear before your CD4 cell count falls below 200.
CMV (cytomegalovirus)
Cytomegalovirus means great cell virus. It can affect the eyes, gut, lungs and nervous system. If not treated early, it can cause very serious problems such as blindness. CMV occurs in people with very advanced HIV disease.
Treatment for CMV used to be given by intravenous injection, but more recently effective oral treatments have become available.
Cryptococcal meningitis
Cryptococcus is a fungus found in bird excrement. In humans, it usually infects the lungs, causing a chest infection, but can rapidly infect the meninges (the lining of the brain) causing fever, headache, stiff neck and confusion. A lumbar puncture is needed to properly diagnose it. Meningitis occurs in people with very advanced HIV disease.
Different treatments are used depending on the severity of the infection, and in very severe cases these drugs can have quite severe side-effects. After recovering from meningitis, it is important to take prophylactic treatment to stop it coming back.
Cryptosporidiosis
Cryptosporidiosis, normally abbreviated to just crypto, is caused by a parasite that gets into the gut. It is normally transmitted in the water supply, or by contact with human or animal excrement. It causes watery diarrhoea, which can lead to very rapid weight loss. It can also infect the liver, causing inflammation.
Crypto often clears up by itself after a few weeks in people with less damaged immune systems. Although many drugs can be used to treat it, none are completely effective. Anti-diarrhoea and rehydration treatments are important in limiting the severity of the illness. It is also wise to see a dietitian if you get crypto, to make sure that you are getting enough nutrients from your diet.
HIV encephalopathy
This disease, sometimes called AIDS dementia complex or HIV-associated dementia, is caused by HIV’s direct effects on the central nervous system. The first symptoms consist of minor changes in behaviour, coordination and concentration. Sometimes, those affected become apathetic or withdrawn. In some cases, it becomes much worse, resulting in a loss of control of movement, schizophrenia and suicidal impulses.
Many other illnesses can cause nervous or mental health problems, and HIV-associated dementia is very rare. However, it can occur in people who have very low CD4 cell counts.
The only effective treatment is anti-HIV therapy, and the success of anti-HIV treatments is the main reason why HIV-associated dementia is now so rare.
Kaposi’s sarcoma (KS)
KS is a cancer which occurs most commonly on the skin, but can also affect the organs and intestines. It is thought to be caused by a type of herpes virus that is sexually transmitted. Most cases of KS in this country have been seen in gay men.
KS looks like purple, brown or black marks on the skin. These can look like bruises, bites or other infections, so a biopsy of the affected area is needed to confirm KS.
KS normally develops when you have a low CD4 cell count. The best way of treating it is to boost the immune system. Anti-HIV treatment regimens based on either protease inhibitors or NNRTIs have been shown to be equally effective at getting rid of KS. Individual lesions on the skin can be frozen off, and KS affecting the internal organs or intestines can be treated with chemotherapy or radiotherapy.
Lymphoma
This is cancer of the lymphatic system: the body’s internal drainage system. It is normally seen in the lymph nodes, which swell up, but it can spread throughout the body. Symptoms include night sweats and fevers, but remember that many infections can cause these symptoms, as well as swelling of the lymph nodes.
Lymphoma has become a lot less common since effective anti-HIV treatments became available, and when it does develop, it can often be successfully treated with chemotherapy or radiotherapy.
MAI
This is caused by a bacteria similar to tuberculosis. It can be caught from soil or tap water. It only affects people with very severely damaged immune systems, when it can cause weight loss, fever and diarrhoea. If you have a very low CD4 cell count, your doctor might recommend that you take preventative treatment to stop you getting MAI. There are a number of treatments against MAI, but their success varies. As with many AIDS-defining illnesses, the best treatment is often to strengthen the immune system using anti-HIV treatments.
PCP (pneumocystis pneumonia)
PCP and tuberculosis are the two most common AIDS-defining illness in the UK. PCP affects about 200 people every year. It is a fungus that lives in the lungs and causes inflammation in a person who has a damaged immune system.
PCP can be a very dangerous infection if not treated early, so you should always tell your doctor if you have a persistent dry cough and shortness of breath. Other symptoms include fever and night sweats.
There are highly effective treatments against PCP, the most common being co-trimoxazole, but this can cause an allergic reaction. To avoid this, your doctor may desensitise you to the drug by giving you a progressively larger dose each day, over a number of days.
PCP rarely develops in people whose CD4 cell counts are above 200, the point at which you should start taking anti-HIV treatment. If your CD4 cell count is below or around 200 you should take PCP prophylaxis, even if you are taking anti-HIV treatments, until your CD4 cell count increases. PCP prophylaxis also protects against toxoplasmosis (see below).
Thrombocytopenia
This means that you have a low number of platelets in your blood – small cells that help your blood to clot. It can cause bruising and, in serious cases, internal bleeding.
As it is often caused by HIV itself, the most effective treatment is HIV therapy. It is very important not to take anti-inflammatory drugs such as ibuprofen, as they can make the condition worse and cause internal bleeding.
Toxoplasmosis
Toxoplasmosis, or ‘toxo’ for short, is caused by a parasite transmitted in raw or undercooked meat. Cat faeces is also a theoretical risk.
Toxo can cause cysts to form on the brain, leading to headaches, fever, drowsiness, and fits. Without treatment, these can become very severe and lead to coma.
The drug used to treated PCP, co-trimoxazole, is also effective against toxo – so the condition is very rare, partly because people who are at risk of toxo are already taking co-trimoxazole to stop them getting PCP.
Tuberculosis (TB)
TB and PCP are the two most common AIDS-defining illness seen in the UK, with around 200 cases of TB diagnosed in HIV-positive individuals each year. Worldwide, TB is the leading cause of illness and death in people with HIV.
TB is caused by a very small bacterium. It is a very serious infection and causes fever, coughing, chest pain and weight loss. Unlike nearly every other AIDS-defining illness, you can become ill with TB even when you have a relatively high CD4 cell count.
TB is treated with a combination of antibitotics, which are normally taken for six months. These have to be taken very rigorously, or you run the risk of developing multi-drug-resistant TB.
For more information on TB, you can read the free NAM booklet HIV and TB, which is available from HIV clinics or can be downloaded from www.aidsmap.com.