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CONCURRENT COURSE OF HIV INFECTION WITH OPPORTUNISTIC DISEASES
Gafforov Khusan Abdulmutallibovich
Assistant of the Department of Infectious Diseases
Andijan State Medical Institute,
Andijan, Uzbekistan
RELEVANCE:
HIV infection (Human Immunodeficiency Virus) remains one of the most
pressing global health challenges. Despite significant advances in antiretroviral therapy (ART)
and preventive strategies, HIV continues to predispose individuals to a wide range of
opportunistic infections (OIs). These opportunistic diseases dramatically affect the morbidity and
mortality of people living with HIV (PLHIV). In many low- and middle-income countries,
limited access to comprehensive care and late diagnosis often exacerbate the burden of
opportunistic infections [1]. Understanding the clinical, epidemiological, and immunological
aspects of opportunistic diseases, alongside ensuring effective treatment and prevention of HIV,
is critical for reducing related complications, improving patients’ quality of life, and achieving
the global goals for HIV/AIDS control [2].
Keywords:
HIV infection, Opportunistic infections (OIs), Antiretroviral therapy (ART),
Immune suppression, Tuberculosis (TB), Pneumocystis pneumonia (PCP), Cryptococcal
meningitis, Clinical management
INTRODUCTION
Opportunistic diseases commonly occur in the setting of immune suppression, where the div’s
defense mechanisms are significantly compromised. In individuals with HIV infection, the
progressive loss of CD4+ T-cells diminishes cellular immunity, making them prone to infections
and malignancies that typically do not cause severe disease in immunocompetent hosts [3].
Common opportunistic infections include Mycobacterium tuberculosis (especially in high-
prevalence regions), Pneumocystis jirovecii pneumonia (PCP), Cryptococcus neoformans
meningitis, and cytomegalovirus (CMV) retinitis, among others. These diseases may lead to
significant morbidity and mortality if not diagnosed early and managed effectively [4].
Since the scale-up of combination antiretroviral therapy (cART), the incidence of many
opportunistic infections has declined dramatically. However, late diagnosis, poor adherence to
treatment, and limited healthcare resources continue to fuel the prevalence of these infections
among PLHIV. This study aims to investigate the spectrum, clinical presentation, and outcomes
of opportunistic diseases in patients with HIV infection and to explore effective strategies for
diagnosis, treatment, and prevention [5].
MATERIALS AND METHODS
Study Design and Setting -
A prospective, observational study was conducted in the Infectious
Diseases Department of a tertiary care hospital, where both inpatient and outpatient services for
HIV-infected individuals are provided. The study lasted for 12 months, from January 2024 to
January 2025.
Study Population
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Inclusion Criteria:
Age ≥ 18 years. Confirmed diagnosis of HIV infection (by ELISA and
Western blot, or rapid testing confirmed by a secondary method). Presence of one or more
clinically or laboratory-confirmed opportunistic infections.
Exclusion Criteria:
Patients who did not give informed consent. Patients lost to follow-up
before full investigation.
Data Collection
All participants underwent:
Detailed Clinical Evaluation:
Documentation of demographics, clinical history, presenting
symptoms, and physical examination findings.
Laboratory Tests:
CD4+ T-cell count (using flow cytometry). Complete blood count (CBC).
Biochemical profile (including liver and renal function tests). Specific diagnostic tests for
opportunistic infections (e.g., sputum microscopy and culture for Mycobacterium tuberculosis,
serum Cryptococcal antigen test, PCR for CMV, etc.)
Radiological Examinations:
Chest X-ray and/or chest CT for suspected pulmonary disease.
MRI or CT scan of the brain for suspected central nervous system (CNS) infections.
Treatment and Follow-up
Antiretroviral Therapy (ART):
All patients were either on ART or initiated on treatment
according to national guidelines, typically based on the WHO recommendations.
OIs Management:
Specific antimicrobial therapies were given according to the identified
opportunistic pathogen (e.g., anti-tubercular therapy for TB, high-dose trimethoprim-
sulfamethoxazole for PCP, amphotericin B plus fluconazole for cryptococcal meningitis, etc.).
Follow-up Visits:
Patients were followed up monthly to assess clinical improvement, side
effects, adherence to therapy, and virological response if available.
Statistical Analysis -
Data were entered into a secure database and analyzed using statistical
software. Descriptive analyses (mean, median, frequencies) were performed for quantitative
variables [6]. Associations between variables were evaluated using chi-square or Fisher’s exact
test, as appropriate, with a significance threshold set at p < 0.05.
ANALYSIS AND RESULTS
Demographic and Clinical Characteristics -
A total of 200 patients with confirmed HIV
infection and at least one opportunistic disease were enrolled. The mean age of participants was
35.4 ± 8.9 years, with a male-to-female ratio of approximately 1.2:1. The median baseline CD4+
count at presentation was 162 cells/µL (range: 15–400 cells/µL).
Spectrum of Opportunistic Infections
The most common opportunistic infections identified were:
1.
Tuberculosis (TB): 40% (n=80) of cases, with pulmonary TB as the most frequent form,
followed by extrapulmonary involvement such as lymph nodes and the CNS.
2.
Pneumocystis Pneumonia (PCP): 25% (n=50) of cases, often presenting with progressive
dyspnea and hypoxia.
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3.
Cryptococcal Meningitis: 15% (n=30) of cases, with headache, fever, and neck stiffness
as the most common symptoms.
4.
Cytomegalovirus (CMV) Retinitis: 8% (n=16), presenting with visual disturbances and
fundoscopic findings of “pizza pie” retinopathy.
5.
Other OIs: 12% (n=24), including oral/esophageal candidiasis, toxoplasmosis, and herpes
simplex virus reactivations.
Clinical Outcomes -
Among the TB group, 70% (n=56) achieved culture conversion by the end
of the intensive treatment phase, reflecting good adherence and effective anti-tubercular therapy.
PCP treatment success was observed in 80% (n=40) of cases after standard therapy with
trimethoprim-sulfamethoxazole and adjunctive corticosteroids for moderate-to-severe cases [7].
Cryptococcal meningitis posed a higher mortality rate, with 6 (20%) deaths in that group, often
due to late presentation or severe intracranial hypertension. Visual acuity improved or stabilized
in 75% (n=12) of patients with CMV retinitis who received antiviral therapy (ganciclovir or
valganciclovir).
Factors Affecting Prognosis
CD4+ Count:
Patients with CD4+ counts <100 cells/µL had more severe disease and worse
outcomes, highlighting the need for earlier diagnosis and ART initiation.
ART Adherence:
High levels of adherence (>95%) correlated with better virological
suppression and fewer recurrent opportunistic infections.
Late Presentation:
A significant proportion of patients presented at advanced disease stages,
emphasizing gaps in HIV testing, linkage to care, and retention in care systems.
CONCLUSION
This study demonstrates that opportunistic infections remain a substantial cause of morbidity and
mortality among people living with HIV, particularly in those who present with advanced disease
and low CD4+ counts. Tuberculosis was the most common opportunistic infection, followed by
PCP and cryptococcal meningitis, highlighting the major pathogens that require vigilant
monitoring and prompt treatment [8].
Effective management of HIV and its comorbid opportunistic infections necessitates a
multifaceted approach: early HIV diagnosis, timely initiation of ART, prompt and accurate
diagnosis of OIs, and strict adherence to treatment regimens. Strengthening laboratory capacity
and improving awareness about opportunistic infections are key to reducing diagnostic delays
and improving patient outcomes [9].
RECOMMENDATIONS
Strengthen Screening and Early Diagnosis: Expand community-based HIV testing and active
case-finding for TB and other OIs, especially among high-risk populations. Implement rapid
molecular diagnostic methods for timely and accurate diagnosis [10].
Improve Treatment Access and Adherence: Ensure uninterrupted ART availability and enhance
adherence support (counseling, peer support groups). Provide integrated treatment for HIV and
OIs under one roof to reduce patient visits and improve care coordination.
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Enhance Healthcare Provider Training: Conduct regular training sessions on the diagnosis and
management of OIs for healthcare workers at all levels. Promote standardized guidelines and
protocols for the management of HIV and opportunistic infections [11].
Address Social Determinants of Health: Develop programs to reduce stigma and discrimination,
which often hamper timely care-seeking. Strengthen patient education on recognizing early
symptoms and the importance of follow-up and prophylactic treatments.
Implement Effective Surveillance and Research: Establish robust monitoring systems to identify
trends in OI prevalence and resistance patterns. Encourage research on novel diagnostics,
vaccines, and therapeutic agents to combat emerging opportunistic pathogens [12].
By reinforcing these strategies, healthcare systems can significantly lower the burden of
opportunistic infections among people living with HIV and move closer to achieving the global
goals of ending the HIV/AIDS epidemic.
REFERENCES:
1.
World Health Organization (WHO). Guidelines for Managing Advanced HIV Disease
and Rapid Initiation of Antiretroviral Therapy. Geneva: WHO; 2022.
2.
UNAIDS. Global HIV & AIDS Statistics — Fact Sheet. UNAIDS; 2023.
3.
Centers for Disease Control and Prevention (CDC). Guidelines for Prevention and
Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. 2022.
4.
Lawn SD, Zumla AI. Tuberculosis. Lancet. 2011;378(9785):57–72.
5.
Dyer JR, French MA, Nakata K, et al. Immunological and virological effects of highly
active antiretroviral therapy on cytomegalovirus retinitis in patients with AIDS. AIDS.
1998;12(9):1167–1174.
6.
Park BJ, Wannemuehler KA, Marston BJ, Govender N, Pappas PG, Chiller TM.
Estimation of the Current Global Burden of Cryptococcal Meningitis Among Persons Living
with HIV/AIDS. AIDS. 2009;23(4):525–530.
7.
Eholié SP, Aoussi EF, Ehui E, et al. Treatment of Tuberculosis in HIV-infected Patients:
Practical Guidelines. Med Mal Infect. 2014;44(3):133–143.
8.
CDC. USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons
Infected with Human Immunodeficiency Virus. MMWR Recomm Rep. 2021.
9.
Sharifjonovich, A.N.M., 2023. CLINICAL EFFECTIVENESS OF THE DRUG
VIFERON IN PREGNANT WOMEN WITH ACUTE RESPIRATORY INFECTION. Ethiopian
International Journal of Multidisciplinary Research, 10(11), pp.302-304.
10.
Marufjon, Kamoldinov. "MEASLES IN CHILDREN, ETIOLOGY, PATHOGENESIS,
DIFFERENTIAL DIAGNOSIS, PREVENTION." Web of Medicine: Journal of Medicine,
Practice and Nursing 2, no. 4 (2024): 131-135.
11.
Камолдинов, М.М. and Гаффаров, Х.А., 2022. Распространённость инфекций HCV в
различных группах детей и взрослых. Экономика и социум, (1-1 (92)), pp.464-467.
12.
Джураев, М.Г., 2024, October. ТЕЧЕНИЕ КАНДИДОЗНОЙ ИНФЕКЦИИ
ГЕНИТАЛИЙ У ВИЧ ИНФЕКЦИРОВАННЫХ БОЛЬНЫХ. In Russian-Uzbekistan
Conference (Vol. 1, No. 1).
