The following points highlight the four major diseases in aids. The diseases are: 1. Cytomegalovirus (CMV) 2. Bacterial infections in HIV 3. Fungal infections 4. Secondary neoplasms of AIDS.

Disease # 1. Cytomegalovirus (CMV):

(a) CMV is a herpes vims, and infection is very common. 90 per cent of homosexual men are victimized.

(b) CD4 count is normally below 50/mm3 when clinical disease appears.

(c) Many organs are involved including the eyes, CNS, liver, gut, adrenals, mouth and lung.

(d) CMV can cause colitis presenting with dia­rrhea, weight loss, anorexia and fever.

Disease # 2. Bacterial Infections in HIV:

(a) Bacterial infections are very prevalent in AIDS causing tuberculosis. The diagno­sis in this case is very difficult.

(b) TB may accelerate HIV disease and the prognosis is poor.

(c) There is the threat of multi-drug resistant TB.

Disease # 3. Fungal Infections:

(a) Oral candidosis is almost common at some stage of HIV infection. Lesions in the mouth may initially respond to topical anti-fungal agents such as nystatin or am­photericin but in advanced stages fluconazole is required.

(b) When Candida spreads to oesophagus, painful dysphagia is frequent and barium swallow may reveal a very ragged look­ing mucosal surface.

(c) The Candida infection if is firmly estab­lished, anti-fungal therapy is to be con­tinuous and liver function tests should be monitored.

(d) The initial symptoms of cryptococcal meningitis are fatigue, fever and weight loss followed by headache, nausea, vom­iting. Diagnosis is made by Indian ink staining of the CSF to identify the organ­ism. CT scan of the brain is usually nor­mal and CSF examination may show a monocytosis and raised protein. Ampho­tericin is the standard therapy.

(e) Protozoal infection is very common in man. The brain is the most common site for lesions which is usually present with focal neurological symptoms, convul­sions, confusion, lethargy or coma. Retina is also involved. Diagnosis is usually made by cranial CT scan which shows a charac­teristic ring enhancing lesion surrounded by cerebral oedema.

Disease # 4. Secondary Neoplasms of AIDS:

(a) DNA has been identified in AIDS—asso­ciated Kaposi’s sarcoma which is most common in homosexual male AIDS pa­tients and sexually transmitted HIV infec­tion. This suggests that a cofactor trans­mitted by the sexual route is required for its development. The most common site of involvement is the skin. The mouth, the hard palate, tip of nose, penis and lower legs are also favoured sites.

(b) Lymph nodes are the second most com­mon site. Stomach or rectal involvement may present with pain, bleeding or ob­struction.

(c) Treatment with doxorubicin has produced good responses.

(d) There is an increased incidence of cervi­cal dysplasia and neoplasia in HIV in­fected women and anal carcinoma in HIV infected homosexual men. Women with HIV infection should have regular cervi­cal smears. The association between these carcinomas and HIV is due to a greater incidence of infection by the Human Pap­illoma virus in HIV—infected patients.

(e) Skin disease is very common in HIV in­fected patients. The common skin diseases are seborrhoeic dermatitis, secondary syphilis, fungal infections, drug eruptions. Skin disease consists of weight loss, diar­rhoea and dermatitis.

(f) Oral disease is prominent in HIV infec­tion and maintenance of good dental and oral hygiene is very important in these patients. Careful inspection of the mouth is essential.

(g) Nausea and vomiting are common in AIDS and are the result of drug therapy, particu­larly in high dose of cotrimoxazole in the treatment of pneumonia. But this usually responds to metoclopramide.

(h) Pulmonary disease is very common to AIDS. Pneumocystis infection is largely confined to the lung. There is often back­ground of fatigue, weight loss and fever and other signs of HIV infection. The res­piratory rate is increased with cyanosis indicating severity of the disease. The treatment for Pneumocystis pneumonia is high dose of cotrimoxazole, initially given intravenously.

(i) Meningitis may occur during the period of a sero-conversion following HIV infec­tion. The other causes of meningitis in­clude bacteria, tuberculosis, syphilis, other fungal infections and HIV itself.

(j) A positive HIV test shows a variety of re­actions ranging from anger, guilt, anxiety to depression. Patients with HIV infection may present with symptoms of organic brain syndromes.

(k) Nephropathy is usually seen in AIDS pa­tients who are intravenous drug users or due to heroin use than HIV infection. A large number of nephrotoxic drugs like amphotericin B, foscarnet and pentami­dine are commonly used in AIDS patients.

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