0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54
Complications of Human Immunodeficiency Virus Type 1 373well as in other settings identified as high risk by local health author-
ities; skin inoculation and venereal transmission have been reported
■Mycobacterium Avian Complex (MAC): fairly ubiquitous in environ-
mental sources such as food, water, and soil
■Other atypical mycobacteria: M. kansasii occurs in the south and
midwest with outbreaks among HIV+patients primarily in the south
and midwest esp. among urban IDUs and among those with under-
lying chronic pulmonary disease; other atypical mycobacteria occur
sporadically
■Bartonella hanselae/quintara: can be transmitted from cats; esp.
<1 yr old by bite, scratch.
■Syphilis: transmission can be sexual, congenital, or by kissing/close
content w/active lesions, transfusions, accidental direct inoculation
■Other bacterial infections: streptococcus pneumonia (common at
al stages of HIV ), Haemophilus influenzae (100-fold higher than
healthy controls); uncommon agents include Staphylococcus aur-
eus, Legionella species, Rhodococcus equii and Nocardia asteroides
Viruses
■Cytomegalovirus (CMV): ubiquitous; risk groups with relatively low
rates of seropositivity include persons who have not had male homo-
sexual contact or used injection drugs; CMV is shed in semen, cervi-
cal secretions, and saliva; child-care providers or parents of children
in child-care facilities are at increased risk; risk of CMV infection can
be diminished by good hygienic practices and safe sex practices
■Herpes Simplex Virus (HSV): use latex condoms during every act of
sexual intercourse to reduce the risk for exposure to herpes simplex
virus (HSV ) and to other sexually transmitted pathogens; specifically
avoid sexual contact when herpetic lesions (genital or orolabial) are
evident
■Varicella-Zoster Virus (VZV): HIV+children and adults who are sus-
ceptible to VZV (i.e., those who have no history of chickenpox or shin-
gles or are seronegative for VZV ) should avoid exposure to persons
with chickenpox or shingles; household contacts (especially chil-
dren) of susceptible HIV+persons should be vaccinated against VZV
if they have no history of chickenpox and are seronegative for HIV,
so that they will not transmit VZV to their susceptible HIV-infected
contacts
■JC Virus: cause of progressive multifocal leukoencephalopathy
(PML)
■Hepatitis C Virus (HCV): main route of transmission in the United
States is injection drug use (also snorting of drugs has been