Fungal infections are common in people living with HIV and can present at different stages of the disease, from the earliest acute phase to later stage AIDS-defining conditions. Four of the most common fungal illness are known as candidiasis, cryptococcosis, histoplasmosis, and coccidiomycosis.
Candidiasis is caused by a type of yeast called Candida. The infection most commonly presents in the mouth and vagina, although people living with untreated HIV can have more invasive infections.
When it presents in the mouth as thrush, it is typically characterized by thick, white patches on the tongue and other parts of the mouth and throat. When it presents in the vagina as a yeast infection, it is distinguished by a thick cottage-cheese-like” discharge.
When the disease spreads to the esophagus, bronchi, trachea, or lungs, the infection is considered serious and officially classified as an AIDS-defining condition in people with HIV.
Symptoms of candidiasis include:
- White patches inside the mouth, the upper throat or tongue.
- Sore throat and changes in taste are common.
- Chest pain and difficulty swallowing accompany esophageal candidiasis.
- Vaginal itching, burning, and a thick white discharge characterizes vaginal candidiasis.
Cryptococcosis is a potentially fatal fungal disease affecting more than one million people around the world each year. In people with HIV, it can often progress to a condition known as cryptococcal meningitis, which affects the central nervous system and is today the third most common complication in people with AIDS.
The causal fungi, C. neoformans or C. gatti, are found in soil that contains bird droppings. Generally speaking, the route of infection is through the inhalation of fungal spores. Ingestion of spores is not considered an effective form of transmission, while human-to-human transmission is considered rare.
Extrapulmonary cryptococcosis (which includes cryptococcal meningitis) is classified by the Centers for Disease Control and Prevention (CDC) as an AIDS-defining condition in people with HIV.
Symptoms of cryptococcal meningitis include:
- Blurred vision with photophobia (profound sensitivity to light)
- Mental confusion
- Stiff, painful neck
Histoplasmosis is caused by a common fungus called H. capsulatum, which can be regularly found in solid droppings, bird dropping, and bat guano. Infection is known to be widespread in eastern and central U.S. (as well as Africa, Southeast Asia, southern Europe, and Central and South America), although most people affected will only experience mild, flu-like symptoms with no long-lasting impact.
However, in people with advanced HIV, histoplasmosis can develop into a chronic lung infection similar to tuberculosis. It can spread well beyond the lungs and affect multiple major organs, most often in people with HIV with CD4 counts under 150.
As such, histoplasmosis has been classified by the CDC as an AIDS-defining condition in people living with HIV.
Symptoms of histoplasmosis include:
- Swollen lymph glands
- Shortness of breath
- Severe weight loss
Coccidioimycosis is a caused by the fungus C. immitis or C. posadaii, and is commonly referred to as Valley Fever. It widely affected populations in the Southwestern U.S., including Texas and southern California, as well as northern Mexico, Central America, and South America.
Like cryptococcosis, coccidiomycosis is transmitted by fungal spores found in soil, which go airborne and are inhaled into the lungs. Symptoms are usually short-lasting and relatively mild.
However, when the infection spreads from the lungs to other organ systems it is considered an AIDS-defining condition, resulting in a range of serious illnesses from skin ulcers, meningitis, bone lesions, and heart inflammation.
Symptoms of coccidiomycosis include:
- Shortness of breath
- Muscle pain