HIV 11 - HIV and Opportunistic infections

HIV 11 - HIV and Opportunistic infections

Doctors were first alerted to the existence of AIDS when patients clinically presented with opportunistic infections.1a

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What is an opportunistic infection?

An opportunistic infection is an infection that is more frequent or more severe because of a weakened immune system, called HIV immunosuppression.2a

When a person with HIV gets an opportunistic infection, they will get diagnosed with AIDS (also known as HIV stage 3), the most serious stage of HIV infection.2b

HIV treatments have become better at keeping the immune system strong and the level of HIV low. As a result, opportunistic infections have become less common, compared with when HIV first become a public health issue, where the rate of opportunistic infections were high.1b,2a

It wasn't until the mid-1990s with the introduction of highly effective combination antiretrovirals that opportunistic infection-related illness and death in persons with HIV was reduced. To this day, if a person infected with HIV is not virally suppressed, then opportunistic infections will continue to cause preventable illness and death.1b
Learn here more about opportunistic infections and preventative measures to keep them under control.

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Why would a person get an opportunistic infection?

If a patient takes their HIV treatment properly, the levels of HIV virus in their body are kept low. This allows their immune fighting cells to recover and fight off these opportunistic infections.2a,q

It is important to know about the most common infections that occur in people living with HIV so that they can be detected early and treated.2c

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Types of opportunistic infections

Medical name of infection

Type of infection

How it presents 

Oropharyngeal and oesophageal candidiasis

Fungal infection

This illness is caused by an infection with a common type of fungus called Candida.2d Candidiasis is most often observed in patients with a CD4 cell count of less than 200 cells/mm3.1c However, candidiasis is only considered an opportunistic infection when it infects the oesophagus (swallowing tube) or lower parts of the lung.2d Signs include painless, creamy white, plague-like lesions that occur on or in the mouth area.1d

Cryptococcosis (also called cryptococcal disease/ meningitis)

Fungal infection2x

Cryptococcal meningitis is a common opportunistic infection, and a leading cause of death in people living with HIV.3a

Most cases are observed in patients who have CD4 cell counts < 100 cells/μL.1u In HIV-infected patients, cryptococcosis commonly presents as a type of meningitis with fever, malaise, and headache,1u though it can also infect any part of the body, for example the lungs, and cause pneumonia.2x

Cytomegalovirus (CMV)

Viral infection2g

Can infect multiple parts of the body  and cause pneumonia, gastroenteritis, infection of the brain, and sight-threatening retinitis (infection of the back of the eye).2g Retinitis may present with floaters or vision deficits. If CMV infects the colon or oesophagus it can cause symptoms of weight loss, loss of appetite, stomach pain, nausea and fever.1v

Diarrhoeal disease


Different types of organisms can cause diarrhoea.2f,h,i Usually picked up from contaminated food or water.2i People with HIV and low CD4 cell counts have more severe diarrhoea and associated illness as they have little immunity to fight off the germs.1e


Herpes simplex virus (HSV)

Viral infection

A common virus, that for most people, does not cause major problems but in HIV-infected patients, can cause more serious infections. HSV can cause painful cold sores (fever blisters) in and around the mouth or painful ulcers in the genital area.2j

Human papillomavirus (HPV)

Viral infection

Certain types of HPV can increase the risk of cervical cancer (cancer of the lower part of the uterus in a woman).1f,w,2e HIV infection and low CD4 cell count are strongly associated

with HPV infection and with the development of cancerous cervical cells.1g

Kaposi’s sarcoma

Viral infection

This cancer, also known as KS, is caused by a virus that causes the small blood vessels (capillaries) to grow abnormally. Because capillaries are located throughout the body, KS can occur anywhere, seen as pink or purple spots on the skin that can be raised or flat. KS can become life-threatening when it affects organs inside the body, such as the lung, lymph nodes, or intestines.1y,2k

Tuberculosis (TB)

Bacterial infection

This infection is caused by the bacteria Mycobacterium tuberculosis. Inhaling the bacteria can lead to an infection in the lungs.2l Classis symptoms include cough, fever, night sweats and weight loss.1z,2l Although the disease usually occurs in the lungs, it may also affect and present in other parts of the body, especially if left untreated.2l,3e

Mycobacterial diseases or infections


Mycobacteria live in our environment, including in the soil and dust particles. In people with severely damaged immune systems, infections with these bacteria spread throughout the body and can be life-threatening.2m


Bacteria, virus or fungus2n

Pneumonia is a severe infection of one or both of the lungs. Symptoms include a cough (with mucus), fever, chills and trouble breathing. Pneumonia occurs in people with weakened immune systems and can be life-threatening. Vaccines are effective against some types of pneumonia.2n



Carried by animals, this parasite is spread through inhaling dust or eating food contaminated with animal excretions. Cats are often the cause.2o

Varicella zoster and herpes zoster

Viral infection

Varicella zoster is commonly known as chickenpox and Herpes zoster is commonly known as shingles. Shingles is more common in the elderly or immunocompromised such as in HIV. Severe complications of shingles can include blindness and other nerve-related damage.1h,i


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More information on some of the above conditions

Cervical cancer

Cervical cancer is a preventable disease and is curable if diagnosed and treated early.3b

The best way to prevent this infection is by vaccination HPV in girls and women.3b  

Women living with HIV have a higher risk of cervical cancer. Early detection of precancerous and cancerous cells in the cervix can prevent serious illness and death from cervical cancer.3c

All women living with HIV should be screened, with a PAP smear, every three years for evidence of precancerous changes in the cervix, regardless of age or whether they are taking antiretrovirals or their CD4 count or viral load.3d


Bacterial lung diseases, including sinusitis, bronchitis, otitis (ear infection), and pneumonia, are among the most common respiratory complications in patients with HIV.1j

HIV patients with the following are at increased risk factors of getting a bacterial lung infection:1k

  • lack of HIV treatment (ARVs), or intermittent use
  • low CD4 count
  • tobacco, alochol and injection drug use
  • lung, liver, heart or kidney disease
  • obesity

Bacterial pneumonia can recur; if a patient gets 2 or more infections in a 1-year period, it is called an AIDS-defining condition.1l

Diarrhoeal disease

Lowering the risk of diarrhoeal disease is achieved by practicing good hygiene measures in general. Wash hands regularly with soap and water especially after:1s,t

  • before preparing food and eating
  • before and after sex
  • after going to the toilet
  • after changing babies nappies
  • handling pets and other animals
  • after gardening

People suffering from diarrhoea need to drink plenty of fluids, consume a bland diet avoiding fat and dairy and take prescribed medicines where necessary. 1n,o

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What is ‘Wasting syndrome’ due to HIV?

Wasting is a clinical term for the loss of more than 10 % of one’s body weight while having diarrhoea or weakness and fever for more than 30 days. Wasting refers to the loss of muscle mass and fat.2p

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Preventing opportunistic infections

The best way to prevent getting an opportunistic infection is to get proper care for HIV, and:2q,

To prevent bacterial pneumonia, getting vaccinated for certain types of pneumonia and flu, antiviral therapy (ART) and lifestyle changes can decrease the risk.

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Treatment of opportunistic infections

If a person living with HIV develops an opportunistic infection, there are treatments available such as antibiotics, antifungal and antiviral drugs.2q,r

The most important intervention for prevention of opportunistic infections is the use of HIV medications to control the viral load. By controlling the virus, the number of CD4 cells can increase and the body is more equipped to handle and fight off other infections.1q,2q



Speak to your healthcare professional so that you are familiar with the most common opportunistic infections, know how to prevent them or oin treatment for them as early as possible.2c

Medical References

  1. Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at Accessed September 2020.
  2. Centers for Disease Control (CDC). HIV. AIDS and Opportunistic infections. Available at: Last accessed September 2020.
  3. National Consolidated Guidelines for the management of HIV in adults, adolescents, children and infants and prevention of mother-to-child transmission. South African National Department of Health, February 2020.


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