Hesperian Health Guides
Common Health Problems
People with HIV can get sick easily with many different health problems, especially if they are not taking ART. This section has information about the most common of these problems and how to care for them. People with HIV will have many fewer health problems when they take ART.
Having one of these problems does not mean someone has HIV or AIDS. This information will be helpful to anyone who has any of these signs of illness.
Also see Where There Is No Doctor, or another general health book for more about these problems.
- 1 Fever
- 2 Diarrhea
- 3 Rashes, itching, and skin problems
- 4 Nausea and vomiting
- 5 Cough
- 6 Problems with the mouth and throat
- 7 Wounds and sores
- 8 Mental confusion (dementia)
- 9 Pain
Fevers often come and go. It is hard to know if fever is from an infection that can be treated, like tuberculosis, pelvic inflammatory disease (PID), or malaria, or if it is from HIV itself. If a fever is caused by an infection, make sure to get that infection treated.
To check for fever, use a thermometer, or put the back of one hand on the sick person’s forehead and the other on your own. If the sick person feels warmer, they probably have a fever.
More Informationtaking the temperature
- Remove extra clothing and let fresh air into the room.
- Cool the skin by pouring water over it, wiping the skin with wet cloths, or putting wet cloths on the chest and forehead and fanning the person.
- Give plenty of liquids even if the person is not thirsty. With fever it is easy to become dehydrated (lose too much water).
- Give a medicine like paracetamol, aspirin, or ibuprofen to help reduce fever.
- Keep the skin clean and dry. Use lotion to help prevent sores and corn starch to help prevent rashes.
Get help when:
- the temperature is very high (over 39°C or over 102°F).
- the fever goes on for 2 weeks.
- there is coughing, difficulty breathing, fast breathing, fast heartbeat, or loss of weight.
- there is a stiff neck, severe pain, or sudden, severe diarrhea with the fever.
- the person with the fever is pregnant or recently had a baby, miscarriage, or abortion.
- the person is being treated for malaria, and the fever has not gone away after the first treatment.
- there is discharge from the vagina and pain in the belly with the fever.
Diarrhea is passing 3 or more loose or watery stools in a day. Passing many normal stools is not the same as having diarrhea. Diarrhea may come and go and can be hard to cure. The most common causes of diarrhea in persons with HIV are infections in the intestines from unclean water or food, the HIV infection itself, or the side effects of some medicines.
Diarrhea can cause:
Malnutrition is especially dangerous for someone with HIV.
- malnutrition, because food often passes through the body so quickly that the body cannot use it. Also, someone with diarrhea may not feel hungry.
- dehydration, because people often lose more liquid in their stools than they take in. Dehydration happens faster in hot climates and in people who have a fever.
Signs of dehydration:
- little or no urine
- dry mouth
- feeling dizzy when standing up
- loss of stretchiness of the skin
|Lift the skin between two fingers...||...if the skin fold does not fall right back to normal, the person is dehydrated.|
- Drink more liquids than usual. Fruit juices, coconut water or milk, sweetened weak tea, gruel, soup, rice water, and rehydration drink are good for fighting dehydration. Even someone who does not feel thirsty should sip something every 5 to 10 minutes.
- Keep eating. Try to eat small amounts of foods that are easy to digest. Cook food well, and then mash and grind it. Some good foods are cereals mixed with beans, meat, or fish; dairy products, such as milk, cheese, and yogurt; and bananas. Do not eat uncooked vegetables, whole grains, fruit peels, hot peppers, or foods or drinks with a lot of sugar. These may make diarrhea worse.
|Take medicine only for these kinds of diarrhea:|
|Signs||Medicine||How much||How to use|
|Sudden, severe diarrhea without fever or blood in the stool, if there is cholera in your area||doxycycline||300 mg||by mouth 1 time|
|or ciprofloxacin||1 g (1000 mg)||by mouth 1 time|
|Or if you are pregnant:||azithromycin||500 mg||by mouth 1 time|
|Diarrhea with blood, with or without fever.||ciprofloxacin||500 mg||by mouth 2 times a day for 5 days|
|or metronidazole||500 mg||by mouth 3 times a day for 7 days.|
|Diarrhea that happens on and off continuously for 14 days||cotrimoxazole||1920 mg||by mouth 2 times a day for 14 days|
|then cotrimoxazole||960 mg||by mouth 3 times a day for 7 days.|
|and metronidazole||500 mg||by mouth 3 times a day for 7 days.|
|If you do not start feeling better after 2 days, see a health worker|
Anyone with HIV and diarrhea should be on ART
Someone who has diarrhea for a long time may get a red, sore area around the anus. It may help to put some petroleum gel or zinc oxide cream on the sore area after passing stool. The person may also get piles.
Get help if the person:
- has signs of dehydration.
- passes bloody stools that do not go away with medicine.
- cannot eat or drink as usual.
- does not seem to be getting better.
- has a high fever (over 39°C or over 102°F).
- has many watery stools in a day.
- is also vomiting.
- Drink clean water. Purify water before drinking or cooking with it.
- Eat clean, safe food. Make sure raw foods are washed or peeled, and that meat is well cooked. Protect food from dirt, flies, insects, and animals, which can spread germs.
- Always wash your hands:
- after using or helping someone use the latrine or toilet.
- after cleaning soiled children or sick people.
- before making food or drink.
- Protect your community’s water source.
- Take daily cotrimoxazole
Rashes, itching, and skin problems
Skin problems happen more as the immune system weakens. When HIV is untreated, visible and uncomfortable problems can upset a person and make them avoid seeking out friends or even health care. ART is the main treatment for most skin problems from HIV.
Keep areas with skin problems clean, and for dry skin, rub glycerin or vegetable oil into the skin after bathing. Try putting a spoon of that oil in the water you wash with.
Allergic reactions often cause an itchy rash and are common in people with HIV. Medicines with sulfa (including cotrimoxazole) cause allergic reactions in some people. If you get an itchy rash, itchy eyes, vomiting, or dizziness after taking a medicine, stop taking it immediately. See a health worker to get a non-sulfa medicine you can use instead.
Fungal infections (yeast, candida)
Fungal infections are difficult to describe because they can look like many different things. Some fungal infections look like round, red, or scaly patches that itch. Someone with HIV can also get frequent yeast infections in the vagina.
You may have a fungal infection if you have a skin problem in one of these areas:
- Keep skin with red, itchy patches clean and dry. If possible, leave it uncovered, open to air and sunlight.
- Put miconazole cream or nystatin cream on the area 2 times a day for 5 to 7 days.
Also see below for information on fungal infections in the mouth.
Brown or purple patches on the mouth or skin
These patches are caused by a cancer of the blood vessels or lymph nodes called Kaposi’s sarcoma, or KS, so start ART as soon as possible. If you are having problems, like difficulty eating because of patches in your mouth, see a health worker.
Use antihistamines with caution if you are pregnant or breastfeeding).
Antihistamines may make you sleepy.
Treatment with medicines (use any one of these):
- Put calamine lotion on the rash with a clean cloth as needed.
- Put small amounts of 1% hydrocortisone cream or ointment on the patches 2 times a day.
- Take an antihistamine, such as diphenhydramine or hydroxyzine, by mouth. Take 25 mg, 4 times a day.
Herpes zoster (shingles)
Shingles is an infection caused by the chicken pox virus. It usually begins as a painful rash with blisters, which may then break open. It is most common on the face, back, and chest. The area may burn and be very painful. The rash may start to heal in a few weeks, but the pain may last longer.
- Put calamine lotion on the rash 2 times a day.
- Keep the rash dry. Cover with a loose bandage if clothing rubs the rash.
- To prevent infection, bathe each day with soap and clean water and then put 0.05% chlorhexidine liquid on the rash. If it still becomes infected, see below.
- Strong pain medicine is often needed.
- Take acyclovir.
IMPORTANT! Do not touch your eyes. Shingles can harm yoursight or even cause blindness.
Nausea and vomiting
If nausea and vomiting prevent people from eating or drinking, they can become weak, malnourished, and dehydrated. For some people, nausea or vomiting may go on day after day. Nausea and vomiting may be caused by:
- some medicines.
- problems with the stomach and intestines.
- HIV infection itself.
- Take small bites of dry food (bread, crackers, chapati, tortilla) when you wake up in the morning.
- Try to avoid the smell of food as it cooks. If a food or smell seems to cause nausea, avoid that food.
- Drink small amounts of mint, ginger, or cinnamon tea.
- Lick a lemon.
- Clean your teeth and rinse your mouth well to get rid of the bad taste after vomiting.
- Let fresh air into the house or room often.
- Soak a cloth in cool water and put it on your forehead.
- If the problem is caused by a medicine, see if you can use a different medicine instead.
If vomiting is severe:
- Do not drink or eat for 2 hours.
- Then, for the next 2 hours, sip 3 tablespoons of water, rehydration drink, or other clear liquid every hour. Slowly increase the amount of liquid to 4 to 6 tablespoonfuls every hour. If you do not vomit, keep increasing the amount of liquid.
- If you cannot stop vomiting, use metoclopramide 10 mg every 8 hours as needed by mouth or in the vein.
- As nausea gets better, start to eat small amounts of food. Start with plain foods such as bread, rice, cassava, or porridge.
When to get help:
- The person cannot keep any food or drink down for 24 hours.
- The person vomiting also has pain in the belly or a high fever.
- The vomiting is very strong, it is dark green or dark brown, it smells like stool, or has blood in it.
- The person has signs of dehydration.
DO NOT smoke if you have a cough.
Coughing is the body’s way of cleaning the breathing system and getting rid of mucus. Coughing is also a common sign of lung problems, such as pneumonia or tuberculosis. Any person with HIV who has a cough for more than 2 weeks should be seen by a health worker to be tested for TB.
When a cough produces mucus, do not take medicine to stop the cough. Instead, do something to help loosen and bring up the mucus. This makes a cough heal faster. Cover your mouth when you cough.
- Drink lots of water—it is better than any cough medicine. It loosens mucus so you can cough it up more easily.
- Keep active by walking or by turning in bed and sitting up. This helps the mucus come out of the lungs.
- Soothe the throat by drinking tea with lemon and honey or your own herbal remedy. Cough syrups that you buy are more expensive and not more helpful.
- If the cough is very bad and keeps you awake at night, take 30 mg of codeine or codeine cough syrup.
Tuberculosis (TB) is a serious infection that mostly affects the lungs. The signs of TB and advanced HIV disease (AIDS) are similar, but they are different diseases. Most people with TB do not have HIV or AIDS. See the TB chapter.
But someone with HIV can get TB very easily because their immune system is so weak. Unfortunately, having both infections makes each disease worse. TB is the main cause of death for people living with HIV.
TB can be cured, even in people who are very ill, so it is important to get treatment quickly—both treatment for TB and also ART. See a health worker or find an HIV care and treatment program. Someone with HIV who lives in an area with a lot of TB can take the medicine isoniazid to prevent illness.
People with HIV and pneumonia should be on ART.
Pneumonia is caused by germs that infect people deep in the lungs. Old people and very sick or weak people get pneumonia more easily.
Pneumonia is serious for people with HIV. Treat it right away. Sometimes it must be treated in the hospital with medicines in the vein (IV)
- Breaths are small and fast (more than 30 breaths a minute in an adult). Nostrils may open wide with each breath.
- You feel as if you cannot get enough air.
- You have a sudden, often high, fever.
- You cough up mucus that is green, rust-colored, or bloody.
- You feel very weak and ill.
- Take cotrimoxazole for 21 days.
- Drink plenty of liquids.
- Try to bring the fever down.
- If you are no better in 24 hours or if you are getting worse, get medical help right away.
Problems with the mouth and throat
Mouth problems are common for people with HIV, but much less common if you are taking ART. Some problems can be treated by rinsing daily with a mouthwash that kills germs, such as 0.12% or 0.2% chlorhexidine gluconate. Or mix equal parts hydrogen peroxide and water. Do not swallow these mouthwashes.
Problems with the mouth or throat can keep people from eating normally, making them sicker. They should try to:
- eat smaller amounts of food, but more often.
- add vegetable oil to foods to give more energy.
- avoid uncooked vegetables. They are harder to chew and digest and may have germs.
- drink a lot of liquids and watch for dehydration.
Soreness in the mouth and throat
Many people with HIV have soreness in the mouth, and problems with their teeth and gums. Try to:
- eat soft, plain foods—not hard, crunchy, spicy, or salty foods.
- try cold foods, drinks, or ice to help ease pain
Cracks and sores in the corner of the mouth can also be caused by malnutrition.
Sores, cracks, and blisters around the mouth
Painful blisters and sores (also called cold sores or fever blisters) on the lips can be caused by the herpes virus. Like a person who does not have HIV, someone with HIV can get these sores at any time. The sores may last a long time, but they usually go away on their own. To help prevent infection, put antibiotic ointment, such as mupirocin, on the sores. A medicine called acyclovir may also help. Wash your hands after touching the sores.
White patches in the mouth (oral thrush)
Thrush is a fungal infection that causes white patches and soreness on the skin inside the mouth, on the tongue, and sometimes down the throat. This can cause pain in the chest.
The patches look like milk curds stuck to the cheek or tongue. If the patches can be scraped off, it is probably thrush. A person with HIV who gets oral thrush should start taking ART.
If mouth problems are painful, take paracetamol.
Gently scrub the tongue and gums with a soft toothbrush or clean cloth 3 or 4 times a day. Then rinse the mouth with salt water or lemon water and spit it out (do not swallow). In addition, use any ONE of these remedies:
- Put 1 ml (⅕ teaspoon) of nystatin solution (100,000 U) in your mouth, hold it there for 2 minutes, and then swallow it. Do this 4 times a day for 7 days. Or,
- Suck one 500,000 U nystatin tablet, 4 times a day. Keep the tablet in your mouth as long as possible and continue using nystatin for at least 2 days after signs go away.
- If thrush is very bad, take 100 to 150 mg fluconazole by mouth for 7 to 14 days.
If you are pregnant or breastfeeding, do not take fluconozole.
Do not take ketoconazole if you are taking the ART medicines nevirapine (NVP) or lopinavir/r (LPV/R).
Difficulty swallowing (esophageal thrush)
Thrush can move down into the tube that goes from the mouth to the stomach (the esophagus). Swallowing may become so painful the person cannot eat or drink. If this happens, the person needs urgent hospital care. A person who can still swallow medicine should take 100 to 200 mg fluconozole by mouth each day or 200 to 400 mg ketoconazole each day for 14 to 21 days.
Wounds and sores
Wounds are caused by an injury that breaks the skin. Sores are often caused by bacteria or constant pressure on the skin (pressure sores). They can happen very easily to people who are mostly in bed or who use wheelchairs. Take special care of any cut, wound, or open sore so that it does not become infected.
General care of open wounds and sores:
- Wash the wound or sore with clean water and mild soap at least once a day. Wash around the edge of the wound first, then wash from the center out to the edges. If possible, use separate pieces of cloth for each wipe.
- If the wound has pus or blood in it, cover the area with a clean piece of cloth or bandage. Leave the bandage loose and change it every day. If the wound is dry, it can be left open to the air. It will heal more quickly that way.
- If the wound is on the legs or feet, raise the legs above the level of the heart. Do this as often as possible during the day. During the night, sleep with the feet raised. Avoid standing or sitting for a long time. Some walking is helpful.
- Wash soiled cloth and bandages in soap and water, then put them in the sun to dry. Or boil them for a short time and hang them to dry. If the cloths and bandages will not be used again, burn them or throw them in a pit latrine.
Be careful: If you use too much potassium permanganate or very hot water, you will burn the skin.
Someone with HIV and skin infections or fevers should be taking ART.
Treatment of open wounds and sores that are infected:
Wounds and sores are infected if they:
- become red, swollen, hot, and painful.
- have pus in them.
- begin to smell bad.
Follow the general care advice (steps 1 through 4) on the previous page, and also:
- Put a hot compress over the wound 4 times a day for 20 minutes each time. Or try to soak the wound in a bucket of hot water with soap or potassium permanganate in the water. Use one teaspoon of potassium permanganate to 4 or 5 liters (or quarts) of water. When you are not soaking the infected part, keep it raised up above the level of the heart.
- If part of the wound looks gray or rotten, rinse it with hydrogen peroxide after soaking it. Try to pick off the gray parts with a clean piece of gauze or tweezers that have been cleaned.
- Cover the wound with gauze soaked in saline solution. (To make saline solution, add 1 teaspoon of salt to 2 cups of boiled water. Only use for 24 hours, then throw it away and make more if needed.) Otherwise, cover the wound with a clean covering.
- Use cephalexin for 5 to 7 days.
Mental confusion (dementia)
Some confusion or other mental changes are common among people with advanced HIV disease, especially if a person has been sick for a long time. Confusion with a headache that does not go away, stiff neck, and fever can be signs of brain infection. Seek help immediately. Confusion can also be a side effect of ART or other medicines.
We all have pain sometimes—from injury, illness, or even health care—but no one should have pain that can be treated or prevented. When someone has HIV, starting ART as soon as possible can prevent a lot of pain, such as mouth or skin sores, nerve or joint pain, and severe pain from cancer or other serious illnesses.
To help someone in pain:
- Try relaxation exercises, meditation, or prayer.
- Try to take their mind off the pain—talk with the person, play music, watch TV, share community news, or read aloud.
- For pain from swelling in the hands and feet, try raising the swollen part.
- For a burning feeling in the hands and feet caused by nerve pain, put the body part in water.
- For skin that hurts to touch, line the bed with soft covers and pillows or animal skins. Be gentle when touching the person.
- For headache, keep the room dark and quiet.
- Acupressure may help some kinds of pain.
Pain medicines work best if you take them before the pain gets very bad.
Medicines for pain:
The following medicines may be used to control pain that comes day after day (chronic pain). Take the medicines regularly, according to instructions. If you wait until the pain has become very bad, the medicines will work less well. Medicines used to control pain should be taken as needed, according to instructions. Take care not to use too much in a day.
- first try a lower-cost medicine such as paracetamol, aspirin, or ibuprofen
- codeine if you need something stronger
- morphine if the pain is very bad