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    Website of the HIV Special Interest Group

    -as part of the College of Occupational Therapists Specialist Section - HIV/AIDs, Oncology & Palliative Care


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Following is a summary of conditions seen in HIV disease, grouped by the mechanics of pathogenesis.

As understanding develops in this area at a rapid pace, users are recommended to consult with online resources such as:

Aidsmap

Clinical Care Options

HIV i-base

HIV and illness

Understanding how impairment and illness occurs in a HIV+ person requires an understanding of how HIV works at a microcellular level.

HIV generally infects primarily CD4 cells, a type of immune cell. Damage to these cells thus results in a damaged immune system, which renders the individual to illnesses that would either not be contracted or would be easily fought off by an immunocompetent (someone with an intact immune system) individual. These illnesses are called opportunistic infections or OIs.

HIV can also directly affect other cells, in particular certain cells in the central and peripheral nervous system, causing syndromes and symptoms as a direct result. These are sometimes referred to as constitutional illnesses.

Less well understood are malignancies related to HIV, which may occur even in immunocompetent individuals and are perhaps related to long term low level immune damage, and autoimmune conditions, which

1.  Opportunistic Infections

Illnesses that occur in an immunosupressed person, that would either not be contracted by or easily fought off by an immunocompetent person

1.1Viral Infections

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Cytomegalovirus (CMV) – can cause retinitis, colitis, and in advanced stages can infect brain and lungs

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Herpes Simplex, Varicellar Zoster, Herpes Zoster – primary infection causes ulcers, cold sores; herpes zoster causes chicken pox / shingles. Can affect CNS if serious / untreated infection

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Progressive Multifocal Leukoencephalopathy (PML) – Serious virus causing brain lesions. Usually very poor prognosis.

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Human Papilloma Virus (HPV) – Genital warts 

1.2 Bacterial Infections

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Tuberculosis (TB) – can be pulmonary (lungs), also miliary (widespread), lymphatic, systemic (e.g. lungs) or affect the CNS

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Mycobacterium Avium Intracellulare (MAI); and Mycobacterium Kansasii -  Similar to TB. Can cause diarrhoea, weight loss, lung and liver problems

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Salmonella – causes diarrhoea, more serious in immunosupressed persons 

1.3 Protozoal Infections

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Pneumocystitis Carinii Pneumonia (PCP) – common microrganism, causes SOB, cough and fever. Can be fatal for immunosupressed people. Responds well to treatment

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Toxoplasmosis – common organism – in immunosupressed persons causes brain abscesses

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Cryptosporidiosis – infectious. Causes severe diarrhoea.

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Microsporidiosis - Causes severe diarrhoea.

 1.4 Fungal Infections

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Candidiasis – very common uncomfortable fungal infection usually affecting mouth. Usually responds to treatment. Can affect oesophagus, brain and lungs in very immunosupressed people

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Cryptococcal Meningitis – yeast infection causing brain impairment 

2.  HIV related malignancies

Lymphomas and KS occur at much higher prevalence than in HIV -ve population, even in individuals with otherwise good CD4 counts; it is not understood exactly why but may be linked to the effects of long term mild damage to the immune system

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Kaposi’s sarcoma (KS) – rare skin cancer, used to be more common in HIV+ population, less so now. Can also affect lungs, GIT and anywhere else in the body

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Lymphomas Can include primary CNS lymphomas (which usually have very poor prognosis), also Burkett’s lymphoma and multicentric Castleman’s Disease. Lymphomas occur at much higher prevalence than in HIV -ve population, even in individuals with otherwise good CD4 counts 

Please also refer to HIV related cancers

3.  Autoimmune conditions

 Conditions that occur as part of an underactive/overactive immune response

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    HIV arthralgias – joint pain similar to rheumatoid arthritis

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    Guilan - Barré syndrome Autoimmune peripheral nerve demyelination syndrome

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    IRIS Immune Reconsititution Inflammatory Syndrome

4.  Constitutional conditions

 Occur as direct result of HIV on cells other than T-cells 

bulletHIV Encephalopathy (HIVE) – brain impairment thought to be directly resulted to the action of HIV. Also known as AIDS Dementia Complex (ADC) or HIV Dementia. Poorly understood. May respond to ARV.
bulletPeripheral Neuropathy – loss of sensation, tingling and possibly pain in extremities, moving proximally over time. Can be secondary to other illnesses, thought to be possibly a direct result of end stage HIV infection, and can also be (often irreversible) side effect of medication. Can seriously affect mobility or upper limb function
bulletWasting Syndromes – HIV related weight loss. May also be lipodystrophy (redistribution of fat from arms, legs and buttocks to abdomen) or lipoatrophy (weight loss, often from face)

First summary completed by Sharon Cavanagh, Clinical Specialist OT, Camden & Islington Palliative Care Team, August 2002, based on teaching by Dr Rob George, HIV Consultant.

Updated June 2006 by Will Chegwidden, Senior OT, St. Bartholomew's Hospital.

 

Send mail to will.chegwidden@bartsandthelondon.nhs.uk with questions or comments about this web site.                           
Last modified: 16 May 2007