HIV and Opportunistic Infections


Marijke Vroomen Durning, RN

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With so many viruses, bacteria, fungi and parasites in our environment, it’s surprising we don’t get sick more often than we do. People with healthy immune systems can fight off most of the invaders that could cause illness, although they occasionally do need a bit of help, perhaps with an antibiotic or antiviral medication, for example. But if you have a weakened immune system, your ability to recognize and fight infections is compromised and infections that others may shrug off could be very serious for you, sometimes fatal. These are called opportunistic infections – they take hold because they have the opportunity to do so.

HIV and Infections

When human immunodeficiency virus (HIV), which can lead to acquired immunodeficiency virus (AIDS), was first detected in humans in the early 1980s, people were understandably scared. HIV lowers the body’s immune system to the point that it can’t fight the simplest of infections. People with HIV were developing opportunistic infections or illnesses, such as Kaposi’s sarcoma, which were rarely seen before, presenting a serious challenge for diagnosis and treatment. It took considerable time and research before effective medications were found that would help people with HIV keep their immune system working for an extended period of time.

Today, an HIV diagnosis isn’t a death sentence as it was a few decades ago. Although people with HIV must always be vigilant about watching for infections, with the help of consistent prescription medication, they are living long and active lives.

An Increase in Fungal Infections

Fungal infections other than those such as athlete’s foot or vaginal yeast infections are not common in people with healthy immune systems. Fungi are everywhere around us and can be difficult to get rid of once they do take hold. The most common fungal infections that affect people with HIV include:

  • Cryptococcosis, found primarily in soil contaminated with bird droppings, in particular pigeons.

  • Coccidioidomycosis, also may be called valley fever. It is caused by breathing in fungus from soil, mostly in desert regions.

  • Histoplasmosis, caused by a protozoa called Histoplasma, is often caught during clean up or demolition where there may be bird and bat droppings. The movement sends spores into the air and they are breathed in.

  • Pneumocystis carinii pneumonia (PCP), which was recently renamed Pneumocystis jiroveci pneumonia (PJP), is the most common opportunistic respiratory infection among HIV-positive individuals.

Exposure to fungal infections vary according to where you visit or live. For example, you can be at higher risk of developing histoplasmosis if you are in the Ohio and Mississippi River valleys, central New York, and Texas, but there is a higher risk of contracting blastomycosis in the eastern and central United States.

Viral Infections More Common

Viruses make you sick by invading the cells in your body. Different viruses target different cells and while they may not be able to invade the cells of people with healthy immune systems, those with HIV are vulnerable. Common viruses affecting people with HIV include:

  • Cytomegalovirus (CMV), a common virus that usually does not cause symptoms in people with healthy immune systems.

  • Herpes

  • Hepatitis

If you have HIV, speak with your healthcare provider about what types of vaccinations would be best for you. Vaccinations can reduce the risk of contracting many viruses.

More Bacterial Infections

Bacterial infections are common opportunistic infections affecting people with HIV. While any bacterial infection could cause serious illness, the most often seen include:

  • Tuberculosis

  • Mycobacterium avium complex infections (MAC), bacteria that is around us everywhere, in water, soil, foods and many animals. It does not cause symptoms or illness in most people with healthy immune systems.

  • Syphilis

  • Bacterial pneumonia

If you have HIV and you develop a bacterial infection, it may take stronger doses or several types of antibiotics to eliminate the infection.

Preventing Infections If You Have HIV

Infection prevention is a part of our everyday lives. We do this every time we wash our hands, clean raw food, cook meat thoroughly, and get vaccinations. People who have HIV must be even more careful to reduce their risk of contracting an infection. Here are some tips:

  • Do not eat or drink undercooked eggs and unpasteurized dairy products or fruit juices.

  • Do not drink untreated water, such as in streams or lakes. If you are traveling, drink only bottled water that has been sealed until you opened it.

  • Get recommended vaccinations and ensure your vaccinations are up to date.

  • Use condoms every time you have a sexual encounter.

  • Do not share drug injection equipment.

Speak with your healthcare team about any concerns you have and how you can best reduce your risk of developing an infection. If you show any signs of illness that could be from an infection, contact your doctor as soon as possible.


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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Oct 7, 2016

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Medical References

  1. Overview of Fungal Infections. Merck Manual.
  2. People living with HIV/AIDS. Centers for Disease Control and Prevention.
  3. A Timeline of HIV/AIDS.
  4. HIV/AIDS. Mayo Clinic.
  5. Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. AIDS Info. National Institutes of Health.
  6. Opportunistic infections and their relationship to HIV/AIDS.
  7. El-Atrouni W, Berbari E, Temesgen Z. HIV-associated opportunistic infections. Bacterial infections. J Med Liban. 2006 Apr-Jun;54(2):80-3.
  8. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. National Institutes of Health.

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