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Opportunistic infections in AIDS in developed and developing countries
1Department of Medicine and Infectious Diseases, Liverpool School of Tropical Medicine, UK.
Summary
Acquired Immune Deficiency Syndrome (AIDS) presentations vary globally, influenced by local microbes. In Africa, enteropathic infections, tuberculosis, and herpes zoster are common in AIDS patients.
Area of Science:
- Infectious Diseases
- Immunology
- Global Health
Background:
- Acquired Immune Deficiency Syndrome (AIDS) is a global disease, but its manifestations are shaped by local microbial prevalence.
- Environmental microorganisms influence disease patterns in AIDS, including reactivated latent infections, novel pathogens, and opportunistic infections.
Purpose of the Study:
- To describe the characteristic clinical presentations of AIDS in Africa.
- To identify common and significant infections associated with HIV/AIDS in the African context.
Main Methods:
- Review of clinical presentations and associated infections in AIDS patients in Africa.
- Analysis of the prevalence and impact of various microbial infections in the context of HIV/AIDS.
Main Results:
- Enteropathic AIDS, often involving Cryptosporidium and Isospora belli, is most common, though causality for diarrhea is uncertain.
- Tuberculosis (pulmonary and extrapulmonary) is the most significant complicating infection.
- Herpes zoster frequently presents first and strongly predicts HIV positivity (95% predictive value).
- Other notable infections include frequent Salmonellosis, visceral leishmaniasis, cerebral toxoplasmosis, and cryptococcal meningitis.
- Malaria, while not directly interacting with HIV, exacerbates anemia and HIV transmission via blood transfusion.
- Measles can be more frequent and severe in HIV-exposed/infected infants and children.
- Accelerated disease progression is observed with co-infection of HIV and Mycobacterium leprae.
- Pneumocystis carinii pneumonia is rare; interactions with helminths are generally not apparent, except for a rare Strongyloides stercoralis hyperinfection case.
- Histoplasma encapsulatum infections are common in tropical America, with no observed increase in H. duboisii frequency in Africa post-AIDS.
Conclusions:
- AIDS presentation in Africa is distinct, characterized by specific prevalent infections.
- Understanding regional microbial patterns is crucial for managing AIDS and its complications effectively.
- Tuberculosis and herpes zoster are key indicators and complications of AIDS in Africa.