Opportunistic infections in HIV

Despite significant advances in the field of HIV, people with HIV remain at risk of opportunistic infections (OI) if they have a low CD4 T cell count, resulting in advanced immunosuppression. This can occur after a late diagnosis or with insufficient adherence to effective antiretroviral therapy (ART), which in itself can result from a number of different barriers. People with HIV are still at risk of common infections affecting the general population, such as influenza. When people with HIV present unwell, it is important to obtain a thorough history including current ART, HIV viral load and CD4 count, and any history of HIV-associated conditions (e.g. previous OI). Acute illness should be investigated and treated as per local guidelines. The extent of immunosuppression, defined by CD4 T cell count, determines the likelihood of different OIs. Patients frequently present with simultaneous, coexisting OI conditions. Symptoms and signs should be assessed, and empirical therapy should be initiated where clinically indicated and where delay can risk severe disability or death. Appropriate investigations (e.g. blood tests) and cross-sectional imaging are used to confirm a suspected OI diagnosis and guide further management. Transfer to a specialist HIV inpatient centre for continuing management of suspected OIs should be considered at the earliest opportunity.