Prognosis

Tuberculosis (TB)

The outcome of treatment of TB in people living with HIV (PLWH) 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 patients. However, after initial clinical improvement, paradoxical worsening of disease has been observed in patients who are started on antiretroviral treatment (ART). High failure and mortality rates have been observed in PLWH infected with extensively drug-resistant TB.[144][246][247]

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 patients with more extensive disease or advanced immunosuppression, clinical response might be delayed.[1]​​[248]

Pneumocystis jirovecii pneumonia (PCP)

The mortality rate is high for patients presenting with acute respiratory failure. In patients with PCP who require ventilatory support, survival at 12 months approaches 50%.[219] 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.[215]

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 patients.[249][250] Rarely, widespread disseminated disease may develop.[251]

Cryptococcal meningitis

Significant cryptococcal meningitis-associated mortality persists, despite the administration of amphotericin B and ART.[252]​ 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.[150][253]

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.[254]

Mucocutaneous candidiasis

Most patients 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 patients typically have a CD4 count below 50 cells/microliter and have received multiple courses of azoles.[1][255]

Coccidioidomycosis

Lack of viral suppression and CD4 counts <250 cells/mm³ are associated with increased disease severity in patients with HIV.[1]

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