► Oppotunistic Infections, which ones are common in India?

[vikdoc]

If I've understood it correctly, the real danger with HIV is not the disease itself, but the opportunistic infections that could get you when your immune system is weakened by the disease. And I'm told these can vary with geography, lifestyle, age and so on.

So what are the opportunistic infections that are common in India? I'm told that TB is the big one since most of us in India have some kind of dormant TB anyway - is that correct? What about STDs like gonorrhea and syphilis? What should people be checking for?

[zeus]

Yes, the problem of AIDS/HIV infections starts because of the virus but is substantially accentuated because of the opportunistic infections. Opportunistic infections are essentially caused by pathogens, which even under normal conditions do sometimes invade our systems but are too weak to overcome the resistance of the body.
But when our body defenses come down these pathogens can raise hell.

According to one study the most commonest opportunistic infections in India are....
1. Oral Thrush(59%)- this is a form of fungal infection of the mouth
2. Tuberculosis(56%)- 64% had pulmonary while remaining 36% had extra-pulmonary tuberculosis
3. Cryptosporidiosis(43%)- bacterial diarrhoea
4. Skin infections(9%)
5. Syphilis(9%)
6. Cryptococcosis(7%)- fungal meningitis
7. Pneumocystosis(7%)- fungal pneumonia
8. Salmonellosis(4%)- bacterial diarrhoea
9. Herpes(3%)
10. Hepatitis(2%)
(The above statistics was given in the year 2003 so the scenario might have changed)

According to me tuberculosis is far more common than any other diseases above mentioned, this is because of the fact that majority of us harbor latent tubercular infection in our body, but our immune system keeps the infection under control. But if this surveillance is hindered(this could be due to any reason- from malnutrition to AIDS) the infection is bound to crop up. Tuberculosis is a trouble because treating it takes long time, its extremly debilitating and if it comes up with HIV..... the combination can be deadly.

Strictly speaking Gonorrhoea and Syphilis do not qualify as opportunistic infections, they are generally looked upon as STD's. Of the two diseases syphilis is more notorious because its symptoms are less obvious( it is painless and not easily visible....at least in the initial forms) and by the time it is diagnosed its in advanced stages. Gonorrhoea in heterosexual males more commonly causes urethritis and prostitis while in gays it is more likely to cause pharyngitis(involving of the throat) and proctitis(involving rectum and the anus), since it is associated with lot of pain it is generally presented and hence diagnosed early.
While dealing with any STD one should remember that they generally come in groups. So if you have one it is imperative to check for out others also.

Hope this was helpful....if you have any questions....i am just a message away....

[Ben]

hi : i have Pnemonia / TB since June 2008 and my dr gave me Forecox and now for 3 months 3 times a day. and now am taking Maxcox Plus 600 once a day. Recently in the last week or so have been feeling feverish and so take a crocin and am better.

having been coughing persistently especially evenings and nights more often.

Am feeling weak/Fatigue and am also going through a kind of depression, low, lonely.

I used to smoke to but have over the last few months stopped cut down etc. Sometimes I wonder if it is withdrawl symptoms.

I dont have an appetite - just struggling to eat. Am trying to go to the gym but cant exercise too much.

Am not sleeping well, have shortness of breath, panic attacks, racing or pounding heartbeat or palpitations,

Are these side effects of medication ? will this pass soon ? any advice, PLEASE. thanks.

[vikdoc]

I am really sorry to tell everyone on this forum that Ben, who posted the last mail and has been one of the few active members here, passed away a few days back.

The cause, as far as I've been able to find out, was pneumonia, but it was fairly obviously linked to HIV since his CD4s had recently dropped sharply, from 450 to 205 according to his last test about six weeks back.

Ben was someone I saw quite often and who I tried helping to the extent that could - which was obviously not enough. The problem in his case seems to have been extremely dubious medial advice he was getting.

When Ben first tested positive he started going to a doctor who had a reputation as a HIV specialist, but had generally come to be seen as discredited by people involved with HIV. But I guess his reputation to the world at large was good enough for someone like Ben, who didn't know much about medicine and was frankly scared about seeking information too openly.

The mystifying thing about this doctor was why he kept off putting Ben on ARVs for so long. He had a theory, which Ben repeated to me, about the 'bonus period' that you enjoy until you start ARVs. Once you start ARVs you had, he told Ben, about 10-15 years, so you should put off starting them till as long as possible.

I tried telling Ben that all this sounded very dubious, and he did listen. But I think he had established some level of comfort with this guy, and he was in general scared of doing anything proactive with relation to HIV.

It was only recently when Ben's general state of health had really started deteriorating that he started considering shifting doctors. In the last six weeks, as his last mail indicates, he was palpably unwell - you could see it, and the problems he was complaining of, like night sweats and stomach cramps, were all symtomatic for AIDS.

Its around this time that he did the test that showed the CD4 drop and that damn doctor STILL DID NOT RECOMMEND ARVs. He was going, I guess, by the Indian government norms, which only start ARVs below 200 and, as per the test, Ben was still just above. But the combination of his symtoms and the drop should, I imagine, have indicated ARVs, and other treatment for the infections as well.

I told Ben this was just absurd, he had to confront the doctor about when to start ARVs. Ben did so, and got some statement from the doctor that he thought ARVs should start when CD4s were around 150, but he agreed that Ben needed some help so he recommended another round of tests.

The complicating factor here was that Ben also had TB - the medicines he mentions in his last post are TB medicines. I've been told that the practice in India is if there is TB then ARVs are not started until the TB is sorted out. Perhaps Ben's original doctor wanted to do this. I know he had prescribed Ben do a CT scan. So I don't know about this TB factor and perhaps people on this forum could help with info?

I have to say, to my non-medical training, there is something bizarre if you don't give ARVs for fears of how they might be affected by the person's TB - and the person ends up dead anyway.

Anyway, Ben had finally lost patience with his original doctor so he told me he had decided to switch to a doctor I recommended, and he had taken an appointment and done the tests necessary to show him. He was supposed to collect these new results and go today. But it was too late and yesterday, I'm told, he suddenly took sick and collapsed very fast.

I will probably post more on this, and I hope other forum members will too, but I really don't think I can post more at the moment.

Vikram

[zeus]

This is very very sad.....and outrageous, generally I am against blaming doctors, but here, in this case the doctor was clearly wrong for waiting so long in initiating ART. It is certainly difficult to decide on what basis did he chose to follow such a regimen 'cause the Indian government guidelines are pretty clear...

1. If the CD4 count is less than 200 ART's are to be started irrespective of the clinical stage.
2. If the CD4 cell count is between 200-300 ART is to be offered to symptomatic patients, treatment should be initiated before CD4 counts droop below 200 for asymptomatic patients.
3. If the count is less than 350, no treatment is required, if the patient is asymptomatic.
(Source www.nacoonline.org/National_AIDS_Control_Program/Treatment/)
So it is clear that NO treatment is required if THE PATIENT IS ASYMPTOMIC BUT IS ESSENTIAL IN SYMPTOMATIC CASES.

Moreover symptoms that Ben was suffering from, were not related to AIDS directly, they were as a matter of fact side effects of the AKT i.e. the anti-Kochs therapy or simply the anti-tubercular drugs. It was also the physicians duty to check on him regularly, a person who is taking a combination of Rifampicin and INH (the combination Ben was taking) should be constantly checked for any liver dysfunction......and the drugs should be withdrawn as soon as any sign of hepatitis occurs. AKT drugs by themselves have high toxicity and their side effects are more pronounced in a HIV positive people than others.

Anti-tubercular drugs esp. Rifampicin is a major trouble, it has ability to increase the levels of liver enzymes that are responsible for metabolism of varity of drugs including the HIV protease inhibitors, the HIV non-nucleoside reverse transcriptase inhibitors (drugs that are commonly used in ART) hence reducing their efficacy. But in spite of this AIDS patients and other immunocompromised patients may be managed with chemotherapeutic regimens similar to those used in immunocompetent individuals, although treatment is often extended to 9 months.
I will try to come back with more information on this, but this is it for now.