Cryptococcal Meningitis: A Deadly Opportunistic Infection

The Project Red Ribbon Care Management Foundation (TRR) has been helping a lot of patients who have opportunistic infections, who are confined in the hospitals all over the country. The Foundation helps in alleviating the burden of medical treatment and one of the biggest challenges it faces is one infection that is deadly and very costly. Cryptococcal meningitis.

In the recent months, in the Research Institute for Tropical Medicine - AIDS Research Group (RITM-ARG) in Alabang, Muntinlupa City, there is an increasing rate of admission for cryptococcal meningitis. In this month alone, TRR has handled 5 cases of cryptococcal meningits. Shortened as "crypto-meningitis", this infection is very rare but affects those with lowered immune system, those with HIV. This is very costly as usually fluconazole is prescribed, an antifungal medication which costs around P400.00. The treatment is daily, and most of the time treatment lasts for 2 years to prevent recurrence. The diagnostics needed also demand high cost of laboratory tests, including lumbar tap and CT scan or MRI which are very burdensome to individuals especially the indigent.

In the Philippines, with minimum wage of about P460+, the treatment for crypto-meningitis is really hard to maintain. TRR had economically challenged clients who had to choose between food and medicine. Thus, the increase in cases of re-admission to wards. Let's note the fact here that crypto-meningitis is a life threatening disease and mortality rate is high, and TRR had been a witness to this.

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Email 441: The New Year Smoke

New Year's eve is just around the corner. So as the smoke and powder from firecrackers.  What risks do PLHIV get from smoke? Could long exposure cause cold, cough, pneumonia? Should PLHIV (especially with low CD4) just stay indoor during New Year's eve?

Dennis

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What's Wrong with my Mouth?

(Source: 100 Questions & Answers About HIV and AIDS, 2nd Edition, by Joel Gallant, MD, MPH)

The most common cause of mouth and throat problems is oropharyngeal candidiasis ("thrush"), a buildup of Candida (a common yeast or fungus). Thrush is easy to diagnose with a mirror and a flashlight. You'll see whitish-yellow curd-like patches, especially on the roof and sides of the mouth, the back of the throat, and the gums. These patches can be easily scraped off. Don't confuse a white coating on the tongue with thrush. The tongue is usually the last part of the mouth to be infected, and a white coating on the tongue, with no other evidence of thrush is usually just ... a white coating on the tongue.

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Email 538: Have TB and Expects HIV Positive

I am getting TB treatment for almost 3 weeks already after being diagnosed. Alam ko how associated it is with HIV.  Knowing my experiences and doing research on the net, I came to a point that even if am not get tested, am already claiming na ako'y positive. Tanggap ko n sa sarili ko tho di ko lang alam kung paano na kung actual nasa harap ko n ang result. Isang friend ko lang ang sinabihan ko nito. Di ko rin inopen sa doctor ko ung possibility though di niya rin nadiscuss sa akin.

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Email 524: Needs Help!

Hi pozzie,

I was diagnozed as PLHIV last June, along with that I have pneumonia and TB. Also i have Hepa B. RITM Alabang is my hub. 

I started first with my TB medicines on July 12. After 2 weeks I was allowed to take ARV meds. Im taking: 

Tenofovir

Efavirenz

Lamivudine (2 pcs) 

So my routine is 

TB MEDS - before i eat in the morning

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What is CMV?

(Source: 101Questions and Answers About HIV and AIDS, 2nd Ed., by Joel Gallant, MD, MPH)

Cytomegalovirus (CMV) means "big cell virus", because cells infected with CMV are big. CMV is a type of herpesvirus, and like all herpesviruses, you don't get rid of it once you've got it. Since it's common and easily transmitted sexually, most people with HIV infection have already been exposed to it and have been infected.

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Email 509: Will I Be on Cotrimoxazole For Life?

good day pozziepinoy! I have a question. Do I really need to take antibiotic (cotrimoxazole) as prophylaxis for lifetime just like ARVs even with a CD4 count beyond 350?

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Email 369: Treatment of OI's

good evening..

sir pozzie. ask ko lng po pag po ba nag take n ng gamot yung mga symptoms po na nkikita mawawala napo?? like yung white spots sa tongue and yung guhit sa kuko po? sir im planning to go back in the philippines this end of june para mag pa test po..

thanks and God bless.

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Kaposi's Sarcoma and HIV

Kaposi sarcoma (KS) also known as Kaposi’s cancer, is a tumor caused by Human herpesvirus 8 (HHV8), also known as Kaposi sarcoma-associated herpesvirus (KSHV).  Kaposi's sarcoma creates tumors below skin surfaces and in membranes of the mouth, nose, anus, or eyes. It can spread to the lungs, liver, stomach, intestines, or lymph nodes. This involves a process called angiogenesis, where tiny new blood vessels form.  

There are four main types of Kaposi’s sarcoma.  

1)  Classic Kaposi’s sarcoma, seen mainly in elderly Mediterranean and Eastern European men, more especially, in Italian and Jewish men, and rarely, in elderly women. 
2)  Endemic Kaposi’s sarcoma, seen mainly in young adult males in sub Saharan Africa. One form is also common in young African children. 
3)  Transplant Kaposi’s sarcoma, is contracted when a HHV-8 infected organ is transplanted into a patient who has not had a history of the disease Endemic Kaposi’s cancer.
Among these first 3 groups, the tumors developed slowly. 
4)  HIV related Kaposi’s sarcoma, is self explanatory but the cancers here develop very rapidly due to the persons weakened immune system.  Occasionally they will appear on a HIV+ person with a high CD4 count as well.  The KS that appears in this instance is most frequently the same type as Transplant KS.  Kaposi's Sarcoma is considered to be AIDS defining illnesses by both The United States Center for Disease Control (CDC) and The World Health Organization. (WHO) regardless of the CD4 count.  Kaposi's sarcoma can be deadly for a HIV+ person with a low CD4 count.

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Email 184: A PLHIV Shares his Story

Hello!  

I’m XXX, and I chanced upon your blog while browsing through the net.  I, too, am positive – HIV-1 stage 4.  I'm the one who commented about the latest makati med fees and the tetanus toxoid vaccination. 

Normally, I am nonchalant about it and I take it quite lightly unlike most people who are in the same predicament.  After reading your blog though, I thought, why not send this person an email?  Perhaps we could compare notes.  So here goes....

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What is CMV Retinitis?

We have been assisting patients in RITM-ARG for CMV Retinitis Treatment. PLHIV's usually come to us for medical assistance because the lab tests and treatment are quite expensive. The Love Fund can only assist PLHIV's initially, however because treatment is long, we always refer them to the Philippine Charity Sweepstakes Office (PCSO) for prolonged medical assistance.

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HIV and Toxoplasmosis

These past weeks I have been assisting PLHIV's with toxoplasmosis. I remembered having tested a year ago on it and the result showed that I am not immune to it, meaning I am not exposed to it. When I was still a patient of PGH-SAGIP, the doctor resident said that almost all Filipinos are exposed to it because she said that we are used to playing in dirt or soil or we eat raw food or we love playing with cats. Well even though I don't have it, I am pretty careful so I won't acquire it even with my rebounded immune system.

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Email 69: Nevirapine and Hepa B

Hi Pozzie Pinoy,

Good day! How are you? I'm XXX and I came across your blog a couple of days before getting myself diagnosed on the last week of September to date. Actually, this blog served as the only guide I had to get HIV test at RITM, Malate. I say that this blog is very helpful and I would like to thank you for that.

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