ABSTRACT
Although the clinical course of human immunodeficiency virus type 1 (HIV-1) infection varies greatly from patient to patient, the hallmark of the disease is progressive immunosuppression, primarily owing to destruction of CD4 T lymphocytes. This results in impaired cell-mediated immunity and, ultimately, in wide-ranging immune dysfunction (1,2). Eventually patients develop certain opportunistic infections or malignancies, or experience a decline in CD4 lymphocyte cell counts to levels of fewer than 200/mm3, thereby fulfilling the casedefinition for the acquired immunodeficiency syndrome (AIDS; 3)
The number of ‘‘AIDS-defining’’ and ‘‘AIDS-associated’’ infections is vast-the present discussion, therefore, will focus on general principles of management and on individual opportunistic infections (OIs) that are most common, serious, treatable, and preventable. For the most part these are new or reactivated latent infections of the central nervous system (CNS) and eye, the respiratory system, and the gastrointestinal tracts. Others typically present as systemic febrile illnesses without organ-specific localizing signs or symptoms. Infectious agents that are manifest primarily through their role in the pathogenesis of HIV-associated malignancies (e.g., human herpesvirus-8 [HHV-8] and Epstein-Barr virus [EBV]) are presented in detail in Chapters 4 and 5.
