Definition Opportunistic infections (Ols) are infections that occur more often or are more severe in people with weakened immune systems (people living with HIV) than in people with healthy immune systems.

1. BY
SRIRAM THIRUNAVUKKARASU,
PHARM.D,
PGP COLLEGE OF PHARMACY,
NAMAKKAL

2. Definition
Opportunistic infections (Ols) are infections that occur more often or are more severe in
people with weakened immune systems (people living with HIV) than in people with
healthy immune systems.
INTRODUCTION:

3. Epidemiology:
• About 90% of HIV-related morbidity and mortality is due to opportunistic
infections in World
• In one study it was found that Tuberculosis was the most frequent
opportunistic infections accounting for 50% of all opportunistic infections,
followed by Candidiasis in 49% of cases. Pneumocystosis was seen in 16%,
Cryptococcal infection in 09% and parasitic diarrhoea in 15% in India

4. Types of opportunistic infections in HIV patients
Fungal infections
P. jiroveci Pneumonia
Oropharangeal Candiasis
Cryptococcus neoformans infection
Protozoal infections
Toxoplasmosis
Cryptospordiasis
Bacterial infection
Mycobacterium Tuberculosis
Viral infection
Cytomegalo virus infection
P. jiroveci Pneumonia
Oropharangeal
Candiasis
Toxoplasmosis

5. Pneumocystis jirovecii pneumonia, commonly referred to as PJP, is an infectious
respiratory condition caused by the fungus Pneumocystis jirovecii. This pathogen
primarily affects individuals with weakened immune systems, such as those with
HIV/AIDS, organ transplant recipients, or individuals undergoing immunosuppressive
therapies.
Cause: Pneumocystitis jerovecii (Yeast like fungus)
P. JIROVECI PNEUMONIA

6. Clinical Presentation:
• Non productive cough
• Shortness of breath on exertion
• Inability to take deep breath
• Fever
• Anorexia
• Weight loss
Diagnosis:
• Exercise induced oxygen desaturation
• Chest radiographic appearance of bilateral interstitial shadowing
• Nucleic acid amplification technique
• Bronchoalveolar lavage
• CD4 count is less than 200cells/mm3

7. Pathophysiology of P. jirovecii Pneumonia
Respiratory Arrest
Ventilation - Perfusion mismatch
Impairment of gaseous exchange
Alteration of alveolar capability
Multiplication of P. jerovecii
Residing in alveoli
Enter in to HIV patient
Inhalation
P. jirovecii

8. GENERAL ;
Oxygen therapy, Ventilatory support
Mild :
Trimethoprim: Dose: Typically 15-20 mg/kg/day (divided in 2-4 doses) orally or IV. Duration: 21 days.
Dapsone: Dose: 100 mg/day orally. Duration: 21 days.
Moderate to Severe:
Clindamycin: Dose: 600-900 mg IV or orally every 6 hours. Duration: 21 days.
Primaquine: Dose: 15-30 mg orally once daily. Duration: 21 days.
Pentamidine Dose: 4 mg/kg/day IV or by aerosolized route.
Atovaquone Dose: 750 mg orally twice daily with meals. Duration: 21 days.
+ Prednisolone Dose: 40 mg orally twice daily for 5 days, then 40 mg once daily for 5 days, then 20 mg once daily for 11 days.
Prophylaxis:
Cotrimoxazole: 960 mg (800 mg of sulphamethoxazole and 160 mg of trimethoprim) once daily or three times a week
Dapsone: Dose: 50 mg once daily or 100 mg three times per week.
Neb Pentamidine: Dose: 300 mg every 4 weeks via a Respirgard II nebulizer.
Treatment:

9. Oropharyngeal candidiasis is primarily caused by Candida albicans, a type of yeast
that is normally present in small amounts in the mouth. However, when there is an
imbalance in the oral microbiota or a weakened immune system, Candida can
overgrow, leading to an infection.
Cause: Candida albicans (Fungus)
OROPHARANGEAL CANDIASIS

10. Clinical Presentation:
• White plaques on oral mucosa
• Erythamatous plaques on oral mucosa
• Angulus chelitis
• Dysphagia
• Odynophagia
Diagnosis:
• Exercise induced oxygen desaturation
• Chest radiographic appearance of bilateral interstitial shadowing
• Nucleic acid amplification technique
• Bronchoalveolar lavage
• CD4 count is less than 200cells/mm3

11. 1. Fluconazole:
Initial Dose: 200 to 400 mg orally or intravenously as a loading dose.
Maintenance Dose: 100 to 200 mg orally or intravenously once daily.
Duration of treatment may vary but is typically 7 to 14 days.
2. Itraconazole:
Oral Solution:
Dose: 200 mg (10 mL) orally once daily.
Duration: Treatment duration may vary but is generally 7 to 14 days.
Capsules :
Dose: 200 mg orally once or twice daily.
Duration: Treatment duration may vary but is generally 7 to 14 days.
3. Echinocandins (e.g., Caspofungin, Micafungin, Anidulafungin):
Caspofungin:50 mg once daily.
Micafungin: 100 mg once daily.
Anidulafungin: 100 mg on day 1, followed by 50 mg daily.
Treatment:

12. Toxoplasmosis is a parasitic infection caused by the protozoan parasite Toxoplasma
gondii. This parasite is capable of infecting warm-blooded animals, including humans.
The primary host for T. gondii is the cat family, and the infection is commonly
transmitted through the ingestion of oocysts shed in the feces of infected cats.
Cause: Toxoplasma gondii (Protozoa)
TOXOPLASMOSIS

13. Clinical Presentation:
• Fever
• Head ache
• Confusion
• Seizures
Diagnosis:
• CT Scan-Ring Enhancing Lesion
• Brain biopsy

14. PATHOPHYSIOLOGY OF TOXOPLASMOSIS
Neurological signs and symptoms
Hemorrhage or Thrombosis
Fibrosis or Necrosis
Perivascular inflammatory response
Reach to CNS via systemic circulation
Enter in to HIV patient
Food
T.gondii

15. Sulphadiazine : Dose: The typical adult dose is 1 to 1.5 grams orally every 6 hours.
Pyrimethamine : Dose: The initial loading dose is commonly 200 mg orally,
followed by a maintenance dose of 25 to 50 mg daily.
Folic Acid: Dose: Folic acid is often co-administered to mitigate the hematologic side
effects of pyrimethamine. The usual dose is 10 to 25 mg daily.
Corticosteroids (e.g., prednisone): Initial Dose: The starting dose can vary but may
range from 5 to 60 mg per day, depending on the severity of symptoms and the
condition being treated.
Anticonvulsants (e.g., phenytoin): Dose: The initial dose of phenytoin for seizure
control may be around 100 to 300 mg per day, divided into two or three doses
Treatment:

16. Mycobacterium infections are caused by bacteria belonging to the genus
Mycobacterium. These bacteria are characterized by a unique cell wall structure
containing mycolic acids, which makes them resistant to many common antibiotics.
The most well-known species within this genus is Mycobacterium tuberculosis,
responsible for tuberculosis (TB), but other species like Mycobacterium leprae can
cause leprosy.
Cause: Mycobacterium tuberculosis (Bacteria)
MYCOBACTERIUM INFECTION

17. Clinical Presentation:
• Persistent cough
• Coughing with blood
• Chest pain while coughing and breathing
• Unintentional weight loss
• Fatigue
• Fever
• Night sweats
• Chills
Diagnosis:
• Tuberculin test
• Sputum Culture

18. PATHOPHYSIOLOGY OF TUBERCULOSIS
TB spreads to remaining organs
Inflammatory changes in lungs
Bacteria is deposited in terminal airways (alveoli) and ingested by macrophages
Enter in to lungs of HIV patients
Generate droplet nuclei of M. tuberculosis
Coughing and Sneezing of Patients with active pulmonary TB

19. 1.Isoniazid (INH):
1. Dose: The standard daily dose for adults is 5 mg/kg (up to a maximum of 300
mg) orally once a day.
2.Rifampicin (RIF):
1. Dose: The standard daily dose for adults is 10 mg/kg (up to a maximum of 600
mg) orally once a day.
3.Pyrazinamide (PZA):
1. Dose: The standard daily dose for adults is 25-30 mg/kg (up to a maximum of 2
grams) orally once a day.
4.Ethambutol (EMB):
1. Dose: The standard daily dose for adults is 15-20 mg/kg (up to a maximum of
1.2 grams) orally once a day.
Treatment:

20. Cytomegalovirus (CMV) is a type of herpesvirus that can infect people of all ages. It is
a common virus that may not cause noticeable symptoms in healthy individuals but
can lead to severe complications in those with weakened immune systems. CMV
spreads through bodily fluids such as saliva, blood, urine, and breast milk. Infection
can occur through direct contact with infected individuals or by coming into contact
with contaminated surfaces.
Cause: Cytomegalovirus (Virus)
CYTOMEGALOVIRUS INFECTION

21. Clinical Presentation:
• Blurred vision
• Visual field defects
Diagnosis:
• CT scan
• CMV antibodies

22. PATHOPHYSIOLOGY OF CYTOMEGALO VIRUS INFECTION
Blindness
Diminished visual acuity
Necrosis
Edema, Hemorrage
Inflammatory response in eye
Reach to eye via systemic circulation
Enter in to body of HIV patient through saliva, breast milk and genital secretion
Cytomegalovirus

23. Ganciclovir
Drug Class: Antiviral
Mechanism of Action: Inhibits viral DNA polymerase, preventing viral replication.
Dosage:
• Induction Therapy: Typically 5 mg/kg IV every 12 hours for 14-21 days.
• Maintenance Therapy: 5 mg/kg IV once daily or 6 mg/kg orally once daily.
Foscarnet
Drug Class: Antiviral
Mechanism of Action: Inhibits viral DNA polymerase and reverse transcriptase.
Dosage:
• Induction Therapy: Usually 40 mg/kg IV every 8 hours for 2-3 weeks.
• Maintenance Therapy: 40-120 mg/kg IV once daily or three times weekly.
Treatment:

24. Cidofovir
Drug Class: Antiviral
Mechanism of Action: Inhibits viral DNA polymerase.
Dosage:
• Induction Therapy: 5 mg/kg IV once weekly for 2 weeks.
• Maintenance Therapy: 5 mg/kg IV every 2 weeks.
Probenecid
Drug Class: Adjunctive therapy
Mechanism of Action: Delays renal excretion of cidofovir, increasing its concentration in the blood.
Dosage:
• Administered orally with cidofovir.
• Example dosage: 2 g orally 3 hours before cidofovir, followed by 1 g orally at 2 and 8 hours
after cidofovir.
IV Hydration
Fluid: Normal saline or lactated Ringer's solution

25. THANK YOU