99 - Differential Diagnosis and Management of Opportunistic Infections Complicating HIV Infection

Summary

Even in the era of highly active antiretroviral therapy (HAART), the preponderance of HIV-associated morbidity and mortality stems from opportunistic infections. And despite broad access to HIV screening tests in developed countries, opportunistic infections remain the first indication of HIV infection in a significant proportion of patients.

Barring a few exceptions, HIV-associated opportunistic infections (OIs) predictably manifest at discrete CD4 T-cell count boundaries below which the risk of symptomatic disease rises sharply (Figure 99.1). This enables physicians to calibrate clinical suspicions for specific OIs based on contemporaneous CD4 T-cell measurements. Current clinical approaches to the evaluation and management of HOIs are discussed in this chapter.

MUCOCUTANEOUS INFECTIONS

Candidal infections of the mouth manifest as thrush and, to a lesser extent, angular cheilitis. Thrush appears as white, loosely adherent deposits on the tongue, palate, or oropharynx. Most cases are asymptomatic; however, individuals with moderate-to-severe disease may report oropharyngeal discomfort, nausea, or dysgeusia. Treatment consists of topical or oral azoles (Table 99.1). Seborrhea dermatitis is a greasy, flaky, faintly erythematous rash. Facial involvement shows a predilection for the hairline of the forehead, eyebrows, bridge of the nose, and nasolabial folds. The role of Malazesia furfur infection in seborrhea dermatitis remains uncertain. Nonetheless, topical antifungal agents are effective in treating lesions, as are steroid creams (Table 99.1).