What are Opportunistic Illnesses? -- Questions & Answers

What are opportunistic Illnesses?
These illnesses are the "hallmark" so to speak of AIDS. Long before there was a test to tell you if you had HIV, doctors and other medical researchers needed a way to "define" AIDS.

After all it wasn't till 1987 they had an antibody test to see if you had HIV at all. Most people fail to realize from 1981-1987 there was no way of knowing if you even had HIV or AIDS till the symptoms showed up.

Opportunistic illnesses were defined as those diseases that usually would not show up in a person whose immune system is otherwise healthy. This comes as a shock to people.

With all the marketing and advertising people have come to believe their immune systems are inherently weak and unless we take extra vitamins or some other product we are doomed. This is simply false. Our immune system is constantly bombarded with germs. It is an amazing fact in of itself that we are able to fight them off. Millions of types of disease challenge our immune systems in a lifetime and almost all of them we successfully fight off without help of any medication.

When AIDS first appeared on the scene in the early 80s it doctors didn't know what was happening. It was two diseases that seemed to be infecting gay men.

What were this illnesses?
The first was caused Kaposi's sarcoma abbreviated as KS. This was the first of these diseases. Outside of a compromised immune system KS is rare. It was usually found in men of Mediterranean or African origin, who were over the age of 50. This disease is now referred to as "Classic KS." When linked with HIV infection it is called "Epidemic KS." KS is also found in people who have had organ transplants who are on immune suppressant drugs.

KS is caused by Kaposi's sarcoma-associated herpes virus (KSHV). It is important to note that it is a herpes virus. This will be discussed in later sections as some people who believe HIV is not the sole cause of AIDS link HIV infection to another herpes virus.

Like other Herpes viruses KS is not "curable" but can be controlled. For example, a cold sore also called a fever blister is a herpes virus. That lives in your system forever. It just reactivates at times.

KS is a bit odd in that other herpes viruses occur in equal frequency among the sexes but KS favours men over women, even with co-infection by HIV, women do not get it as often as men. This is also seen in Africa where KS affects men more often than women. It is suggested that some sex hormone may offer some protection to women. However gay-men over straight men have a much higher incidence of KS which also leads researches to suggest other issues are at play.

What was the second disease?
The second opportunistic illness to be found in gay men at the start of the AIDS epidemic among gay men was Pneumocystis pneumonia

Pneumocystis pneumonia is properly called Pneumocystis carinii pneumonia and is abbreviated as PCP. It was later renamed Pneumocystis jiroveci but still is commonly called PCP.

Unlike KS, which is rare, PCP is uncommon. Meaning it doesn't happen often but it can occur often enough. How's that for real life double talk. PCP is found most often in HIV infected patients and those people who have had organ transplants and are using immune suppressing drugs.

What are the symptoms of PCP?
Symptoms of PCP include high fever, non-productive cough, weight loss, shortness of breath (especially on exertion) and night sweats. As you will see these symptoms are common in other disease especially the flu.

PCP was first associated with AIDS because in the early 1980s, when it was noticed doctors were requesting the uncommonly used antibiotic pentamidine. It was one of the first clues to the existence of AIDS in the early 1980s.

PCP was the most common cause of death in AIDS patients prior to the development of more effective treatments. Even with treatment and antiviral medications, death from PCP by AIDS patients is high.

Antibiotics, antimicrobial, and steroids (to control inflammation) are the most common treatments for PCP today. A huge issue with the treatment is some of the antimicrobials that are the most effective kinds in fighting PCP are the ones most highly toxic. For instance pentamidine can lead to kidney failure and pancreatic issues.

Why is it important to know about these diseases?
These two opportunistic illnesses are the ones most gay men are familiar with. Remember prior to the test for HIV antibodies these illness were the chief way to tell if you had AIDS.

These two diseases were termed "opportunistic" because they don't occur much unless a person's immune system is damaged.

Are there other opportunistic illnesses too?
Over the years it became necessary to "define" what AIDS was. Because people can have HIV and be otherwise healthy it wasn't simply enough to say everyone who has HIV has AIDS. It needed a definition.

This occurs in other diseases too. For instance ever had a cold sore? 95% of Americans have had one. Did you know that virus is still alive in your body right now? That is correct, if you ever had a cold sore or fever blister that means you still have it. A herpes virus causes cold sores and it lives in your system. Your immune system is very effective in fighting it off. That is why your cold sore goes away. This is also why when your immune system is busy fighting off other illness this cold sore often reappears.

OK what are the other diseases?
It is important to note that these opportunistic illnesses are defined by the Center for Disease Control (CDC) in Atlanta by the United States Government. These are not the same for other countries or for the World Health Organization, part of the United Nations

In addition to KS and PCP the CDC defines the following diseases as opportunistic illnesses for people with HIV infection.

* Candidiasis of bronchi, trachea, or lungs
* Candidiasis esophageal
* Cervical cancer (invasive)
* Coccidioidomycosis, disseminated or extrapulmonary
* Cryptococcosis, extrapulmonary
* Cryptosporidiosis, chronic intestinal for longer than 1 month
* Cytomegalovirus disease (other than liver, spleen or lymph nodes)
* Encephalopathy (HIV-related)
* Herpes simplex: chronic ulcer (at least 1 month); or bronchitis, pneumonitis, or esophagitis
* Histoplasmosis, disseminated or extrapulmonary
* Isosporiasis, chronic intestinal (for more than 1 month)
* Lymphoma Burkitt's, immunoblastic or primary brain
* Mycobacterium avium complex
* Mycobaterium, other species, disseminated or extrapulmonary
* Pneumonia (recurrent)
* Progressive multifocal leukoencephalopathy
* Salmonella septicemia (recurrent)
* Toxoplasmosis of the brain
* Tuberculosis
* Wasting syndrome due to HIV

It is important to note that you can have any of these illnesses and NOT have AIDS or HIV infection. To be defined as having AIDS you must have one or more of the above illness AND have HIV infection AND have a T-helper cell count below 200.

So what is the point of defining all this? What do I care?
Probably you don't and in reality it doesn't matter. But the government needs to keep statistics. And to keep these and to track changes you need to be consistent. If you don't have guidelines how can you know?

Aren't these random? Don't other nations have other definitions?
They are choices the United States government has made. Other governments may have different choices. Although the choices appear random they are a result of "backtracking." What the government does is examine people that have died having been infected with HIV. They look for diseases they died from. They use these deaths as an indicator of future deaths. Remember almost no one dies from HIV, the virus simply weaking the immune system allowing another illness to kill you.

So the definitions could change?
Yes in fact they did change over the years and continue to be changing. Even though HIV is some 25 plus years old by disease standards it is new and unfortunately we are learning as we go.

So what real difference does it make if I have HIV or AIDS?
Part of the issue is in the disability issue. People who take anti-viral medication for HIV often have trouble working. These people are HIV+ but not ill. Therefore they are not entitled to government benefits nor are they covered by the Americans with Disabilities Act. By putting in a specific guidelines we allow people to file for claims for government assistance.

What if I have symptoms but no HIV infection?
Most likey you do not have HIV. However you may have contracted HIV and your body has not yet developed antibodies to it. It may take up to six months for the body to produce antibodies. So either way you need to take another test in three to six months.

Some people will always test negative for antibodies and for the virus itself, even if they actually have the HIV virus. There is no test in medicine today that doesn't produce false reading in some people. These are very rare, but it has happened. The thought is you probably have HIV infection but it isn't showing up.

However because HIV testing cannot be done in scientifically controlled experiments we can't be 100% sure. This is why some AIDS alternative theories have developed.

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