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Infectious Diseases · Viral Hepatitis and HIV

Treatment of HIV infection

HIV therapy involves not only antiretroviral drugs, but also the management of multiple opportunistic infections and neoplasms. Severe immunosuppression triggers severe lesions of the nervous system, gastrointestinal tract, respiratory tract, and skin, requiring a specific approach.

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JC virusCauses progressive multifocal leukoencephalopathy (PML) at CD4+ counts of 35–100 cells/µL
HHV-8The causative agent of Kaposi sarcoma, occurring 20,000 times more frequently in HIV-infected individuals
PneumocystisPneumocystis is the cause of 85% of pneumonia cases in patients with HIV
AcyclovirFirst-line drug for the treatment of Herpes zoster, dose 800 mg 5 times a day
4 min readFor medical studentsUpdated 09/24/2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesReviewed by medical editor: Aulov A. A., general practitioner · 09/24/2026

Infectious complications and their treatment

Treatment of shingles (Herpes zoster) depends on the severity of the process.

  • Uncomplicated forms: oral administration of acyclovir (800 mg 5 times daily) or famciclovir (500 mg 3 times daily). The course lasts 7–10 days until the rashes crust over.
  • Disseminated forms (involving the eyes, internal organs): acyclovir is administered intravenously (10 mg/kg 3 times daily); if ineffective, the reserve drug foscarnet is used.

Postherpetic neuralgia often develops as a specific complication in HIV-positive patients, and NSAIDs are used as a baseline treatment for pain relief.

Special attention is required for progressive multifocal leukoencephalopathy (PML) — a CNS disorder caused by the JC polyomavirus. The process starts when CD4+ lymphocytes drop below 100 cells/µL and leads to white matter demyelination. There is no specific therapy, and the prognosis is extremely poor. The main way to improve the condition is prescribing ART to restore immunity.

Oncological diseases in HIV

Immunosuppression is a powerful oncogenic factor. About 40% of patients develop malignant tumors. AIDS-defining conditions include Kaposi sarcoma, B-cell lymphomas, and cervical cancer.

Kaposi sarcoma (KS) is caused by human herpesvirus type 8 (HHV-8). The virus encodes cytokine-like proteins which, together with HIV proteins, stimulate vascular growth. The tumor affects the skin (painless purplish patches and nodules), mucous membranes, lymph nodes, lungs, and the gastrointestinal tract. The main treatment is ART; local treatments include radiation therapy, chemotherapy, and topical agents.

Non-Hodgkin lymphomas are of B-cell origin in 85% of cases. The trigger is Epstein-Barr virus co-infection against a background of CD4+ counts falling below 100 cells/µL. It is characterized by painless lymph node enlargement unresponsive to antibiotic therapy, as well as systemic involvement (lungs, CNS, GI tract).

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Gastrointestinal disorders

The gastrointestinal tract is most vulnerable in HIV. The main manifestations are chronic diarrhea and weight loss.

  1. Oral cavity and esophagus: frequent stomatitis (HSV), candidiasis, oral hairy leukoplakia.
  2. Stomach: rarely affected primarily; KS or lymphoma are possible.
  3. Intestines:
  4. HIV enteropathy: direct cell damage by the virus; diagnosis is made by exclusion.
  5. Opportunistic infections: cryptosporidia, microsporidia, CMV, mycobacteria (cause 40% of severe intestinal complications).

The hepatobiliary system suffers from viral hepatitis B and C, as well as drug toxicity from ART and antituberculous drugs.

Briefly: answers to topical questions

How is postherpetic neuralgia treated in HIV-infected patients?

Symptomatic, local, and systemic therapy is used to treat postherpetic neuralgia in HIV-infected patients.

  • Nonsteroidal anti-inflammatory drugs are used as a baseline to relieve severe pain.
  • Local anesthetics — lidocaine patches are applied topically.
  • Antidepressants — amitriptyline is prescribed.
  • Anticonvulsants — pregabalin, gabapentin, or carbamazepine are used.
  • Opioids — tramadol is used as a reserve drug when first-line agents are ineffective.

Which viruses and fungi cause oral and esophageal lesions in HIV?

According to sources, oral and esophageal lesions in HIV infection are associated with the following pathogens:

  • Candidiasis as a fungal infection — may manifest as candidal stomatitis/oral candidiasis and candidal esophagitis.
  • Epstein–Barr virus (EBV) — causes oral hairy leukoplakia due to active replication in the epithelial cells of the tongue.
  • Herpes simplex virus (HSV) — in an AIDS-defining presentation, it may be accompanied by deep ulcers and esophageal involvement.

Which infection is the main cause of pneumonia in HIV, and what drugs are used to treat it?

The sources indicate two contexts for pneumonia in HIV infection:

  • Bacterial respiratory tract infections: the leading pathogen is pneumococcus (Streptococcus pneumoniae).
  • Opportunistic pneumonia: a classic manifestation in patients with severe immunodeficiency is Pneumocystis pneumonia (Pneumocystis jirovecii), which manifests when CD4+ counts drop below 200 cells/µL.

In the clinical case, Pneumocystis pneumonia was resistant to standard antibiotics but sensitive to biseptol (co-trimoxazole).

Class and exam questions

Which oncological diseases are AIDS-defining?

These include Kaposi sarcoma (in individuals under 60), B-cell non-Hodgkin lymphomas, and squamous cell cervical carcinoma.

What are the features of pulmonary involvement in HIV?

The human immunodeficiency virus does not directly affect the respiratory tract. Pneumonias are secondary (opportunistic) in nature. In 85% of cases, the causative agent is Pneumocystis, with CMV taking second place.

How is Kaposi sarcoma treated?

Baseline therapy consists of prescribing ART to restore immunity. Topically, local gels, intralesional chemotherapy, and radiation therapy are used.

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What else to study on this topic

  • Pathogenesis of polyclonal B-cell activation in HIV infection.
  • Features of anogenital squamous cell carcinoma and the role of HPV.
  • Differential diagnosis of HIV enteropathy and opportunistic intestinal infections.
  • Mechanisms of peritonitis development in HIV and surgical management.

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Other topics in the section "Viral Hepatitis and HIV"

Epidemiology and prevention of HIV infectionEtiology and pathogenesis of HIV infectionClinical presentation and stages of HIV infectionOpportunistic diseases in HIV infectionDiagnosis of HIV infectionPrevention of mother-to-child transmission of HIVPost-exposure prophylaxis of HIV infectionLichenHIV infection and AIDSStomatitisStevens-Johnson syndromeGenital herpesCandidiasisUrethritis in womenTuberculosisInfectious diseases of the respiratory system
The entire section "Viral Hepatitis and HIV"

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