Mycoses in AIDS

Abstract

HIV infection associated CD4 depletion is an important defect leading to increased susceptibility to opportunistic as well as endemic fungal infections. Mucosal candidiasis, Pneumocystis jirovecii pneumonia (PJP), and cryptococcal meningoencephalitis were commonest invasive fungal infections identified during early HIV epidemic. Other endemic fungal infections like histoplasmosis and talaromycosis were also increasingly recognized in respective endemic areas after HIV epidemic. Patients with CD4 less than 200/cm3 are at a risk of getting life threatening fungal infections. Understanding of various mycosis in AIDS has improved over last three decades. PJP can be effectively prevented by cotrimoxazole prophylaxis. Advancement in fungal diagnosis and management improved the outcome of patients. Despite this progress in diagnosis and understanding of antifungal therapy, mortality with cryptococcal meningitis is very high especially in sub-Saharan African countries. Access to antiretroviral treatment has improved globally in reducing fungal infection rate. Early initiation of ART dramatically reduces the incidence of opportunistic infections in HIV including mycosis. HIV associated opportunistic and endemic mycosis is discussed in this chapter.