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Understanding HIV and Opportunistic Infections: Risks, Prevention, and Treatment

If you have HIV, treating it early with antiretroviral medicines is crucial for maintaining a healthy immune system. However, if HIV goes untreated for years, it can weaken your immune system and make you vulnerable to opportunistic infections. These infections take advantage of the weakened immune systems of people with HIV but don't typically affect those with healthy immune systems.

How HIV Affects the Immune System

HIV attacks CD4 cells, which are essential for fighting off bacteria, viruses, fungi, and other germs. When your CD4 count is low, you become more susceptible to infections that can lead to illnesses, cancers, and brain and nerve problems. Some opportunistic infections are signs that your HIV has progressed to AIDS.

Common Opportunistic Infections

Almost any disease can become an opportunistic infection when your immune system is weak. Some of the most common opportunistic infections associated with HIV include:

  • Candidiasis or thrush (fungal infection in the mouth, throat, or vagina)

  • Cryptococcus neoformans (fungus that can lead to meningitis)

  • Cryptosporidiosis and microsporidiosis (protozoa infections that affect the gut)

  • Cytomegalovirus (virus that causes eye disease and can lead to blindness)

  • Herpes simplex (viruses that cause cold sores and genital sores)

  • Mycobacterium avium complex (bacteria that cause fevers, digestive problems, and weight loss)

  • Pneumocystis pneumonia (fungus that causes a deadly lung infection)

  • Progressive multifocal leukoencephalopathy (virus that affects the brain)

  • Toxoplasmosis (parasite that can lead to brain inflammation and eye damage)

  • Tuberculosis (bacterial infection that attacks the lungs and other organs)

Preventing Opportunistic Infections

The most important way to prevent opportunistic infections is to take your HIV medicines as prescribed and keep your CD4 count from becoming low. If you have a low CD4 count (less than 200 cells per microliter of blood), you can take additional steps to reduce your risk:

  • See your doctor regularly to ensure your HIV medicines are working and your immune system remains strong

  • Take other medicines and get vaccinated as recommended by your doctor

  • Practice good food safety habits (wash and cook food well, avoid raw or undercooked meats and eggs, and unpasteurized dairy)

  • Use caution when handling pet waste and keep cats indoors

  • Use a towel on shared gym equipment and avoid swallowing water in pools, lakes, or streams

  • For women, get regular pelvic exams and Pap tests to spot infections, precancers, and cancers

Diagnosis and Treatment of Opportunistic Infections

Lab tests can help determine which germs are already in your body, allowing your doctor to prescribe the appropriate medicines or vaccines in addition to your HIV drugs. If you have a low CD4 count, keep a record of your symptoms and pay attention to fever, bad diarrhea, difficulty breathing, weight loss, vision changes, or problems with your mouth, skin, or breathing. Contact your doctor when you have new or unusual symptoms, as early treatment is crucial for avoiding serious consequences and preserving your immune system.

Follow through with all prescribed treatments and don't quit early. Your doctor may also prescribe medication to prevent the infection from recurring. As your immune system recovers, you may be able to stop taking preventive medications.

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