Prognosis

Tuberculosis (TB)

The outcome of treatment of TB in people living with HIV is relatively good after 6-9 months of treatment, but there is increased risk for relapse. Directly observed therapy improves the outcome and is strongly recommended in these individuals. However, after initial clinical improvement, paradoxical worsening of disease has been observed in individuals who are started on antiretroviral treatment (ART). High failure and mortality rates have been observed in people living with HIV infected with extensively drug-resistant TB.[154][272]​ One systematic review and meta-analysis of data in Ethiopia (where the mortality rate among individuals coinfected with TB/HIV is higher than other countries in Africa) identified risk factors for death in people coinfected with TB/HIV to be:​ advanced stages of the disease (WHO clinical stages III & IV), missed trimethoprim/sulfamethoxazole or isoniazid preventive therapy, and low hemoglobin levels.[273]

Disseminated Mycobacterium avium complex

The use of combination schemes, including 2 or more antimicrobial agents followed by secondary prophylaxis and ART, have improved the survival and reduced mortality rates. For individuals with more extensive disease or advanced immunosuppression, clinical response might be delayed.[1]​​[274]

Pneumocystis jirovecii pneumonia (PCP)

The mortality rate is high for individuals presenting with acute respiratory failure. In individuals with PCP who require ventilatory support, survival at 12 months approaches 50%.[236] Use of ART is an independent predictor of decreased mortality in severe PCP and may represent a potential therapy to improve outcome in this disease.[232]

Toxoplasmosis

ART improves treatment outcomes and survival, and prevents relapses. Signs of neurologic deterioration predict an unfavorable response to the treatment. Persistent neurologic deficits are often present in surviving individuals.[275][276]​ Rarely, widespread disseminated disease may develop.[277]

Cryptococcal meningitis

Significant cryptococcal meningitis-associated mortality persists, despite the administration of amphotericin-B and ART.[278]​ Abnormal mental status and high organism load, measured by quantitative cerebrospinal fluid (CSF) culture or CSF antigen titer, are the most important determinants of death. Furthermore, elevated CSF opening pressure and low CSF white cell count are also associated with poor outcome.[160][279]

Cytomegalovirus (CMV)

Widespread use of ART has reduced the incidence and complications of CMV retinitis. However, CMV retinitis and uveitis associated with immune recovery remain causes of vision loss in this population.[280]

Mucocutaneous candidiasis

Most individuals respond to treatment within 48-72 hours. Refractory oral or esophageal candidiasis is reported in approximately 4% to 5% of individuals living with HIV. These individuals typically have a CD4 count below 50 cells/microliter and have received multiple courses of azoles.[1][281]

Coccidioidomycosis

Lack of viral suppression and CD4 counts <250 cells/microliter are associated with increased disease severity in individuals with HIV.[1]

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