Hesperian Health Guides
Common Medical Problems
A person with HIV can get sick very easily from many different medical problems, especially if they are not taking ART. The rest of this chapter has information about the most common of these problems and how an individual or family may care for them.
Just because someone has one of these problems does not mean she has AIDS. This information will be helpful to anyone suffering from one of these illnesses.
- 1 Fever
- 2 Diarrhea
- 3 Skin rashes and itching
- 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 the 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 the fever is caused by an infection, then make sure the infection itself is also 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, she probably has a fever.
- 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 them.
- Give plenty of liquids even if the person is not thirsty. With fever it is easy to become dehydrated (lose too much water).
- Take a medicine like paracetamol, aspirin, or ibuprofen to help reduce fever.
- Keep the skin clean and dry. Use lotion or corn starch to help prevent sores and rashes.
Get help when:
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, infection because of HIV, or the side effects of some medicines.
Diarrhea can cause:
A person with HIV and diarrhea lasting more than 1 month may need to start ART.
- malnutrition, if the food passes through the body so quickly that the body cannot use it. Also, people with diarrhea often do not eat because they are not hungry.
- dehydration, if the body loses more liquid in the stools than the person takes in. Dehydration happens faster in hot climates and in people who have fever.
Signs of dehydration:
|Lift the skin between two fingers||...if the skin fold does not fall right back to normal, the person is dehydrated.|
- Prevent dehydration by drinking more than usual. Fruit juices, coconut water or milk, sweetened weak tea, gruel, soup, rice water, and rehydration drink are good for fighting dehydration. Even if the person does not feel thirsty, she 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 make diarrhea worse.
Take medicine only for these kinds of diarrhea:
If you are pregnant or breastfeeding, do not take norfloxacin. For more information about these medicines, see the “Green Pages.”
- Sudden, severe diarrhea with fever (with or without blood in the stool). Take ciprofloxacin 500 mg by mouth 2 times a day for 7 days. Or try cotrimoxazole 960 mg 2 times a day for 7 days. If you are not better after 2 days, see a health worker.
- Bloody diarrhea without fever, which can be caused by amoebas (tiny animals that live in water or in the intestines).Take metronidazole 500 mg, 3 times a day for 7 days. If you are not better after 2 days, see a health worker.
If a woman with HIV has diarrhea for more than a month, she probably needs ART.
- When someone has diarrhea for a long time, she may get a red, sore area around the anus. It may help to apply petroleum gel or zinc oxide cream each time after passing stool. The person may also get piles (hemorrhoids).
Get help if the person:
- has the signs of dehydration.
- cannot eat or drink as usual.
- does not seem to be getting better no matter what she does.
- has a high fever (over 39°C or over 102°F).
- passes many watery stools in a day.
- passes bloody stools that do not go away with medicine.
- is also vomiting.
- Drink clean water. Purify your water before using it in food or drink.
- 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.
- 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.
Skin rashes and itching
It is often difficult to know what causes skin rashes and itching. Many skin problems can be helped by keeping the body clean. Try to wash once a day with mild soap and clean water.
If the skin becomes too dry, wash less often and do not use soap. Try rubbing glycerin or vegetable oils into the skin after bathing. Wear loose cotton clothing.
Allergic reactions, which often cause an itchy rash, are more common in people with HIV. Medicines that contain sulfa (like cotrimoxazole) may cause especially bad reactions for a few people. If you are using these medicines and you get an itchy rash, itchy eyes, vomiting or dizziness, stop taking them immediately and see a health worker. She may be able to give you a non-sulfa medicine that will work.
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. Women 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:
- If you have red, itchy patches, keep the area clean and dry. If possible, keep the area uncovered and open to the air and sunlight.
- Apply nystatin cream 3 times a day or gentian violet 2 times a day until the rash is completely gone.
- If you have a bad fungal infection, take ketoconazole, one 200 mg tablet by mouth each day for 10 days, or 100 to 200 mg of fluconazole by mouth each day for 7 to 14 days. Do not take either of these medicines if you are pregnant. (Also see information on thrush, a fungal infection 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. Medicines are not helpful. If you are having problems, like difficulty eating because of patches in your mouth, see a health worker.
Treatment without medicines:
- Cool the skin or fan it.
- Avoid heat and hot water on the skin.
- Avoid scratching, which causes more itching and sometimes infection. Cut the fingernails short and keep them clean to avoid infection.
- Use cool cloths soaked in water from boiled and strained oatmeal, or plant medicines from local healers.
Treatment with medicines (use any one of these):
Antihistamines should be used with caution by women who are pregnant or breastfeeding (see the “Green Pages”).
- Apply calamine lotion with a clean cloth as needed.
- Apply small amounts of 1% hydrocortisone cream or ointment 3 times a day.
- Take an antihistamine, such as diphenhydramine or hydroxyzine, by mouth. Take 25 mg, 4 times a day. Antihistamines may make you sleepy.
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.
- Apply calamine lotion 2 times a day to help with pain and itching.
- Keep sores dry. Cover with a loose bandage if clothing rubs the sores.
- To prevent infection, apply gentian violet liquid. If the sores do become infected, see 'Treatment of open wounds and sores that are infected'.
- Strong pain medicine is often needed.
- Take acyclovir.
Do not touch your eyes, because shingles can damage your eyesight and can cause blindness.
Nausea and vomiting
If nausea and vomiting prevent a person from eating or drinking, she 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 the teeth and rinse the mouth often, 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 the forehead.
- If the problem is caused by a medicine, see if another medicine can be used 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 the person does not vomit, keep increasing the amount of liquid.
- If the person cannot stop vomiting, use promethazine 25 mg to 50 mg every 6 hours as needed by mouth or in the rectum. When vomiting starts to improve, the person will probably prefer to continue taking the medicine only by mouth.
- As nausea gets better, start to eat small amounts of food again. Start with plain foods such as bread, rice, cassava, or porridge.
When to get help:
- The person cannot keep any food or drink in her body for 24 hours.
- The person vomiting 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 will make the cough heal faster.
- Drink lots of water. Water is better than any cough medicine. It loosens the mucus so you can cough it up more easily.
- Cough several times during the day to clear the lungs. Be sure to cover your mouth.
- 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 no more helpful.
- If the cough is very bad and keeps you awake at night, take codeine, 30 mg, or codeine cough syrup.
Tuberculosis (TB) is a serious infection caused by a germ that usually affects the lungs. The signs of AIDS and TB are similar, but they are different diseases. Most people with TB do not have AIDS.
But someone with HIV can get TB very easily because the person’s body is too weak to fight it. TB is actually the leading cause of death for people with HIV and AIDS.
TB can be cured, even in persons with AIDS, so it is important to get treatment early. Once a person with HIV starts taking treatment for TB, she or he should also start ART. Help the person find an HIV care and treatment program.
People with HIV and pneumonia probably need to start ART.
Pneumonia is caused by germs that infect the small breathing tubes deep in the lungs. Old people and very sick or weak people often get pneumonia.
Pneumonia can be very serious for people with HIV. It should be treated with antibiotics right away. Sometimes pneumonia 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). Sometimes the nostrils 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 ill.
- Take cotrimoxazole for 10 to 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. Some problems can be treated by rinsing daily with a mouthwash that kills germs, such as gentian violet. Or one made with equal parts hydrogen peroxide and water (do not swallow these mouthwashes).
|Using a straw to drink can help with painful mouth problems.|
Problems with the mouth or throat can keep a person from eating normally. She may then become weak, malnourished, and sicker. She should try to:
- eat small amounts of food often.
- add vegetable oil to foods to give more energy.
- avoid uncooked vegetables. They are hard for the body to digest and may have germs.
- drink a lot of liquids and watch for dehydration.
Cracks and sores in the corner of the mouth can also be caused by malnutrition.
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.
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. A healthy person can get these sores after a cold or fever. 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, apply gentian violet to 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 may need to start taking ART.
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:
- Suck a lemon if it is not too painful. The acid slows the growth of the fungus. Or,
- Rinse the mouth with 1% gentian violet liquid 2 times a day. Do not swallow. Or,
- Put 2.5 ml of nystatin solution in the mouth and hold it there 2 minutes and then swallow it. Do this 5 times a day for 14 days. Or,
- If thrush is very bad ketoconazole may help. Take one 200 mg tablet, once a day with food for 14 days (but do not take this medicine if you are pregnant).
Difficulty swallowing (esophageal thrush)
Thrush can move down into the tube that goes from the mouth to the stomach (the esophagus), and swallowing becomes so painful the person cannot eat or drink. If this happens, the person needs urgent hospital care. If the person can still swallow medicine, she should take fluconozole 400 mg at once, then 200 mg daily for 14 days. If the person is no better in 3 to 5 days, double the dose to 400 mg daily. But if she is pregnant or breastfeeding, she should not take fluconazole.
Wounds and sores
Wounds are caused by an injury that breaks the skin. Sores are often caused by bacteria or pressure on the skin (pressure sores). They can happen very easily to people who stay in bed a long time. 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 leg 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.
A person with severe skin infection and fever may need to start 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.
Treat the infected area as in steps 1 through 4 on the previous page, and also do the following:
- 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 properly cleaned.
- If you can, put gentian violet on the wound before putting on the dressing.
- If there are many infected sores at the same time, especially with a fever, treat with antibiotics. Use erythromycin, dicloxacillin, or penicillin for 10 days.
Mental confusion (dementia)
Some mental confusion or other mental changes are common among people with AIDS, especially if a person has been sick for a long time. Mental confusion with a headache that does not go away, stiff neck and fever can be signs of a brain infection. Seek help immediately. Confusion can also be a side effect of ART or other medicines.
With some illnesses, and in the later stages of AIDS (and other serious illnesses like cancer), pain may be severe. It may become a part of daily life. Pain can be caused by many things, such as:
- not being able to move.
- infections, like herpes.
- pressure sores.
- swelling of the legs and feet.
- nerve pains.
Treatment for pain, without medicines:
- Try relaxation exercises, meditation, or prayer.
- Try to think about other things.
- Play music, or have someone read aloud or tell stories.
- 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.
Treatment for pain, with medicines:
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.
- mild pain medicine, like paracetamol
- ibuprofen or codeine — if you need something stronger
- oral morphine — if the pain is very bad