AIDSassociated

AIDS-associated refers to diseases and manifestations that occur with AIDS, the most advanced stage of HIV infection. The term is used to describe conditions that take advantage of severe immune suppression, particularly CD4+ T-cell depletion, and are either AIDS-defining illnesses or infections and malignancies seen more commonly in people with AIDS. AIDS can be diagnosed when an individual with HIV infection develops an AIDS-defining illness or when CD4 count falls below 200 cells per microliter, regardless of symptoms.

AIDS-associated illnesses are commonly divided into opportunistic infections, malignancies, and various neurologic, metabolic, and systemic disorders. Opportunistic infections include Pneumocystis jirovecii pneumonia, esophageal candidiasis, cryptococcal meningitis, cytomegalovirus disease, Toxoplasma encephalitis, Mycobacterium avium complex, tuberculosis, and others. AIDS-associated cancers include Kaposi sarcoma, non-Hodgkin lymphoma, and invasive cervical cancer. Other conditions such as AIDS-related neurocognitive disorders, wasting, and certain bacterial infections are also described in association with advanced HIV.

Pathophysiology centers on CD4+ T-cell depletion and impaired cell-mediated immunity, which allow opportunistic pathogens to cause disease. AIDS-defining illnesses are defined by CDC criteria and include several infections and cancers. Diagnosis of AIDS involves confirmed HIV infection plus either the presence of an AIDS-defining condition or sustained CD4 count below 200 cells/µL.

Management centers on antiretroviral therapy to restore immune function, reduce the risk of AIDS-defining illnesses, and improve survival. In addition, prevention and targeted treatment of opportunistic infections rely on prophylaxis guided by CD4 count and local epidemiology (for example, Pneumocystis jirovecii pneumonia prophylaxis with TMP-SMX when CD4 <200; MAC prophylaxis with azithromycin or clarithromycin if CD4 <50 in some settings). Treatment of AIDS-associated conditions follows guidelines for each infection or cancer, with ART continued as the foundation.