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September 13, 2011
Infections associated with the AIDS syndrome

This week we will continue with the infections associated with the AIDS syndrome. As I discussed last week, AIDS is the final, terminal stage of HIV infection.

The gastrointestinal tract may be affected and oral thrush or candida (a fungus or yeast, yes the same one causing vaginal candidiasis!) is a main presenting symptom of HIV and AIDS.{{more}} However, in AIDS, it usually affects the gullet or esophagus, to cause difficulty and pain swallowing. Other bugs like the herpes virus and TB may also infect the gullet, causing difficulty swallowing and may therefore contribute to these patients’ weight loss. AIDS may also cause chronic diarrhea due to inflammation of the small or large intestines (enteritis or colitis). Common bacteria like salmonella and listeria and the uncommon ones like TB (does not cause diarrhea in normal individuals), fungi and strange viruses are the culprits. AIDS patients on long-term antibiotics are more likely to suffer from a very bad form of diarrhea caused by the brother to the gas gangrene and tetanus bug called ‘clostridium difficile’.

Other infections: AIDS patients are more prone to all types of infections. They are usually simple infects that take long to heal or do not heal except with prolonged antibiotics. The bugs that cause these infections are also weak and uncommon. Classic examples are simple cuts and scratches becoming infected or clean surgical wounds opening and becoming infected (the immune system is also responsible for healing). I remember a patient I operated on in Jamaica whose wounds broke down after 4 hours of surgery, only to find out that he was HIV positive after the surgery. When AIDS patients pick up blood infections, they tend to be fatal if not treated quickly with high-dose antibiotics for prolonged periods of time. The common “flu”, which most people will “fight” off on their own, will usually cause havoc and sometimes death in AIDS patients, because it is usually caused by a strange “virus” like the herpes virus CMV. Likewise, most of the tissue infections mentioned above will cause blood infections and death if not treated quickly with prolonged, high-dose antibiotics.

TUMORS: To some people, it is strange that AIDS is associated with tumors and not just tumors, but also cancerous ones. As we discussed already, AIDS is the end stage of HIV infection. The immune system is responsible for destroying abnormal and sometimes cancer forming cells. If this system is severely affected in the AIDS syndrome, then it is obvious that persons afflicted by AIDS can and do develop cancers. The cancers are not the common culprits, but when the common ones (like breast, colon and prostate) do develop, they are usually more aggressive and lethal and respond poorly to conventional treatment. They also tend to occur at a younger age in AIDS patients. The common types of cancers that occur tend to be caused by viruses. These viruses are called cancer-forming viruses, also known medically as onco-viruses. The viruses are a herpes virus (type 8), a wart virus and another called the E-B virus. The herpes virus causes a skin tumor called Kaposi’s sarcoma. These appear as purple nodules on the skin, but can occur in the mouth, the intestines or the lungs where they can cause bleeding on brushing the teeth and difficulty eating or swallowing, intestinal bleeding and obstruction, or a cough with bloody sputum. The warts or papilloma virus can cause an aggressive, invasive form of cervical cancer, while the EB virus causes an aggressive form of lymphoma called Burkitt’s lymphoma. The E-B virus and the herpes virus type 8 (the same causing Kaposi’s sarcoma) can also cause other types of lymphomas, affecting the gastrointestinal tract and the brain. The cancers outlined above were the most common type of cancers associated with and used to define the AIDS syndrome. That is, if you developed any of the above tumors after contracting the HIV virus, you were considered to have developed AIDS; However, other cancers are more common in patients with AIDS; these include rectal and anal cancers, liver cancer, lung cancers, Hodgkin’s lymphoma and some head and neck tumors. Next week, we will discuss the treatment of patients afflicted with the HIV virus.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: [email protected]