HIV Complications & Comorbidities
HIV can affect the entire body, especially the immune system. Changes in immune system functioning can increase the risk of developing other immune-related conditions. Additionally, HIV shares methods of transmission and/or risk factors with several other conditions, increasing the risk of certain comorbidities (conditions that occur at the same time).
The risk of developing one or more of the following conditions can vary from person to person, and treatment often depends on the type of condition experienced or its underlying cause. Common HIV-related complications, comorbidities, and coinfections are outlined below; however, this is not an exhaustive list of all possibilities.
What are opportunistic infections?
We are exposed to potentially infectious agents every day and our body’s immune system has many built-in defenses to protect us. This is why we aren’t constantly sick or have severe reactions to everything. An opportunistic infection is an infection that normally wouldn’t severely affect an individual with a healthy immune system, but can significantly affect someone who has a problem with their immune system or who has a weakened immune system.
Individuals with a weakened immune system are considered to be “immunosuppressed”, meaning their immune system is not working to the best of its ability. Opportunistic infections can be bacterial (caused by bacteria), viral (caused by a virus), parasitic (caused by a parasite), or fungal (caused by a fungus).1
Common opportunistic infections
Common infections that can be opportunistic and more severe in individuals with HIV include, but are not limited to:
- Candidiasis (thrush) in the mouth, throat, lungs, or of the vagina
- Herpes simplex virus (HSV) around the mouth, genitals, or anus
- Salmonella in the gastrointestinal tract (gut)
- Toxoplasmosis in the brain
- Tuberculosis in the lungs (but can spread to other locations in the body)
- Widespread fungal infections with fungi called cryptosporidiosis, histoplasmosis, and coccidioidomycosis
- Widespread cytomegalovirus (CMV) including cytomegalovirus retinitis in the eye
- Pneumonia (pneumocystis jirovecci pneumonia) in the lungs1,2
Rashes can come in a variety of different forms, appearances, and severities; however, they all generally involve areas of skin that are irritated, inflamed, itchy, discolored, or painful.
How are rashes related to HIV?
HIV itself can cause a rash, especially during the early or acute phase of the virus. This type of rash generally appears between two and six weeks after HIV exposure has occurred, and most individuals with the rash also have a fever. Each individual’s experience may be very different, but rashes related to acute HIV infection are generally on the upper torso, face, and neck. They often have round pinkish or red bumps. Some of these bumps may have pus or be itchy, but others may be flat and non-bothersome. The scalp, limbs, and genitals may also be involved.3,4
Additionally, HIV weakens the immune system and can increase an individual’s risk of infection. Many infections or inflammatory issues may then lead to rash.4 Some medications used to treat HIV may have rash as a side effect. These rashes typically go away in several days or weeks. If the rash is persistent, new treatment may be needed. However, rarely, HIV medications may cause a serious hypersensitivity reaction in individuals who are allergic to the medication or one of its ingredients.
Cancer comes from the uncontrolled growth of abnormal cells in the body. These cells do not respond to regular cell signals that would normally tell them not to grow, replicate, or move to different areas of the body. Sometimes, these cells can join together and form a solid mass, or tumor, in a particular area of the body. An example of this would be abnormal cell growth in the liver that leads to a liver tumor (liver cancer). In other cases, these cells can replicate and travel throughout the bloodstream, causing a blood cancer like leukemia.
Cancers related to HIV can be divided into two categories: AIDS-defining cancers and non-AIDS-defining cancers. If an individual is diagnosed with an AIDS-defining cancer, they are considered to have AIDS (Acquired immunodeficiency syndrome), the most advanced stage of HIV. Non-AIDS-defining cancers can be present in an individual with HIV and do not signify that they have progressed to AIDS.
AIDS-defining cancers include:
- Kaposi sarcoma
- Non-Hodgkin lymphoma (NHL)
- Invasive cervical cancer
Non-AIDS-defining cancers include:
- Lung cancer
- Liver cancer
- Mouth or throat cancers
- Hodgkin lymphoma (Hodgkin disease)
- Anal cancer
- Melanoma, squamous cell, or basal cell skin cancers
- Testicular cancer5-7
When an individual has kidney disease (also called renal disease), it means their kidneys are not working in the way that they should. Healthy kidneys are about the size of a fist and are bean-shaped. The two kidneys sit inside the abdomen near the middle of the back (one on each side of the spine).
The kidneys filter out waste and extra fluid from the body, specifically, from our blood. They get rid of this waste and fluid by making urine that gets passed out of the body. The kidneys also each have a gland that sits on top of them called the adrenal gland. These two glands regulate hormones that are important in many of our body’s functions.
If kidney disease is severe and function is significantly declined, an individual may progress to end-stage renal disease (ESRD). This occurs when 90 percent or more of kidney function has been lost. When kidney function is so low, the kidneys can completely fail, and an individual may need dialysis or a kidney transplant to stay alive.8-10
Hepatitis C (HCV) is a blood-borne virus (a virus in the bloodstream). Hepatitis C is one type of hepatitis viruses. Other hepatitis viruses include hepatitis A and B, among others. All hepatitis viruses cause inflammation and damage to the liver.
Like HIV, hepatitis C is a chronic, or long-term virus; however, unlike HIV, a cure is currently available for hepatitis C. If not treated, hepatitis C can cause fibrosis and cirrhosis of the liver (scarring of the liver), which can eventually lead to liver failure or liver cancer.
How is hepatitis C transmitted?
Hepatitis C is transmitted through blood-to-blood contact with blood infected with the virus. Blood transfusions and organ transplants before the 1990’s, injection drug use, sexual contact where blood is transferred (such as rough sex where vaginal or anal tearing occurs, or sexual contact where open sores are present), and mother-to-child transmission during pregnancy or childbirth are some of the most common methods of transmission.12
Sexually transmitted infections (STIs)
Sexually transmitted infections (STIs, also sometimes referred to as sexually transmitted diseases, STDs) are infections that are transmitted from person to person during sexual activity. HIV is an example of an STI. STIs can be caused by viruses, bacteria, or parasites. STIs can be via anal, vaginal, and oral sex.
Other common sexually transmitted infections besides HIV include, but are not limited to:13
- Herpes (herpes simplex virus or HSV), especially genital herpes
- Human papillomavirus (HPV)
Individuals with STIs including genital herpes, syphilis, chlamydia, and gonorrhea, among others, are three times more likely to have or transmit HIV. Essentially, the previous risk of any specific sexual behavior increases if there is another STI present during the act.14-16