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National AIDS Coordinating Agency (NACA)
Opportunistic Infections
What are some of the other diseases I could get?
Tuberculosis and HIV and AIDS

HIV weakens the body immune system and when this happens it means the body is not able to fight infection and the tuberculosis germs multiply causing active tuberculosis. That is why it is important for HIV positive people to enroll in the IPT programme. IPT stands for Isoniazid Preventative Therapy and it kills the silent TB before the person becomes ill



Tuberculosis (TB): TB (Kgotlholo e tona in Setswana) is a disease caused by an organism called mycobacterium tuberculosis. These bacteria can attack any part of the body, but they most commonly attack the lungs. A person can have active or inactive tuberculosis. Active TB or TB disease means the bacteria are active in the body and the immune system is unable to stop them from causing illness. People with active TB in their lungs can pass the bacteria on to anyone they come into close contact with. When a person with active TB coughs, sneezes or spits, people nearby may breathe in the TB bacteria and become infected. If TB is left untreated, each person with active TB could infect on average between 10 and 15 people every year.

People can also be infected with tuberculosis that is not active in the body (inactive TB infection or latent TB). If a person has latent TB, it means their body has been able to successfully fight the bacteria and stop them from causing illness. People who have latent TB do not feel sick, do not have symptoms and cannot spread tuberculosis. In some people tuberculosis bacteria remain inactive for a lifetime without becoming active. But in some other people the inactive TB may become active TB if their immune system becomes weakened - for example by HIV. People with inactive TB are also called TB carriers.
Co-infection with TB and HIV markedly increases the mortality and morbidity of both diseases and thus represents a public health challenge in Botswana. Active pulmonary TB and extra-pulmonary TB are WHO clinical stage 3 and 4 conditions, respectively. (Pulmonary and lymph node TB are WHO stage 3 conditions for paediatric patients). At every visit there must be clinical screening for active TB infection, i.e., inquiry into the presence of symptoms of active TB infection, with further investigations as indicated.

Cryptococcal Meningitis
Cryptococcal Meningitis: (Bolwetse jwa letha la boboko) this is a fatal AIDS-defining disease, usually occurring when the CD4+ lymphocyte count falls below 100 cells per mm3 and macrophage function is impaired. Disease onset is often subtle, and classic meningeal signs are absent in up to 50% of the patients. Chronic headache, often initially of low-grade severity, is common, and should raise suspicion of the diagnosis, as should progressive deterioration of mental status, visual disturbances, and/or unexplained fevers in any HIV-infected patient with a low CD4 cell count (< 100 cell/μL) or low CD4% (< 15%).
Kaposi Sarcoma

Kaposi's Sarcoma (KS): KS is an AIDS defining illness in Botswana. Kaposis Sarcoma is a lesion that primarily affects the skin but can affect internal organs and the lining of the mouth as well. When it is located on the skin, KS presents as small bruise-like areas that are not painful and do not itch. Many times they are mistaken for simple bruises. If isolated to the skin, KS is not life threatening. However, if KS forms in the intestinal track, lungs, brain or other internal organs, it can have serious consequences and can even be fatal.
HIV infected people had what many referred to as “molelo wa Badimo” in Botswana or what was referred to as the "AIDS look" in the western world at the beginning of the epidemic. Part of that look is the small darkened lesions scattered on the skin known as Kaposis Sarcoma. HIV and Kaposi ’s sarcoma became synonymous with death.

Do I have KS?

KS lesions on the skin or in the mouth appear as discolored, darkened areas. These are usually not painful and do not itch. Their bruise-like appearance sometimes makes them difficult to identify. An easy test to differentiate a KS lesion from a bruise is to press the area with one finger. A bruise's dark color will go away with finger pressure but a KS lesion's colour will not. However, the only way to absolutely diagnose KS is to perform a biopsy of the lesion. Under no circumstances should anyone try to diagnose any skin lesion on their own. Any new or changing skin lesion should be examined by a doctor as soon as possible. This caution is very important for many Batswana who many of them may find themselves confronted with this situation


Pneumocystis Jiroveci Pneumonia (formerly Pneumocystis Carinii Pneumonia PCP):  PCP is a kind of pneumonia that could give you fever, cough, trouble breathing (especially with exercise) or chest tightness. You are advised to see a doctor right away if you have these symptoms. Most cases are mild, but people with severe PCP may die if the infection isn't treated quickly. PCP is diagnosed by lab tests of fluid or tissue from your lungs.

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