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Urologic Complications in HIV and AIDS

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Urological complications are usually the first signs of HIV infection. To know more, read the article below.

Written by

Dr. Kavya

Medically reviewed by

Dr. Shah Sushma Kant

Published At October 26, 2022
Reviewed AtJuly 27, 2023

Introduction

As medical science is growing daily with newer treatment regimes, the survival rate after HIV infection has increased in the coming years. This article will focus on urological complications associated with HIV infection.

What Do We Know About HIV and AIDS?

AIDS (acquired human immunodeficiency syndrome) was described in 1981 and caused by HIV (human immunodeficiency virus), which was described in 1986. It is a lentivirus that causes failure in the immune system leading to life-threatening opportunistic infections. Life expectancy after the infection is around nine to eleven years. HIV particles are transmitted through saliva, breast milk, blood, plasma tears, and urine. It is also transmitted through pre-ejaculate fluid, seminal fluid, and vaginal secretions. The replication of the virus in the blood depends on its concentration, and replication is faster when the concentration is higher and slower when the concentration is low. Most cases of HIV infections are reported through sexual contact (around 75 % to 85 %). There is data about male circumcision that suggests that an uncircumcised male is at 1.5 to 8.4 times more risk than a circumscribed male.

What Are the Complications Caused by Infections?

Urinary Tract Infections:

It is one of the most common infections an individual suffers after contracting HIV. The symptoms involve increased frequency and urgency of urinating, dysuria, and hematuria. Escherichia coli and Pseudomembranous aeruginosa are the main causative agents, and Pseudomembranous aeruginosa accounts for up to 33 % of urinary tract infections in HIV patients. HIV patients with CD4 counts less than 200 are prone to bacterial infections as well as neurological symptoms such as bladder areflexia and hyporeflexia, which causes complications of urinary stasis and infection. Individuals with low CD4 counts also suffer from non-bacterial urinary tract infections such as yeast, viral and fungal. In addition, asymptomatic HIV patients show hematuria after urine analysis.

Prostatitis:

The obstructed or dysfunctional urinary system leads to urinary stasis, causing prostatitis. In an HIV-infected person, the defense mechanism of the prostate glands, such as spermine, spermidine, and prostatic antibacterial factor, fails to resist bacterial infection, leading to bacterial invasion. Escherichia coli is one of the causative agents in 3 % of HIV-infected individuals and 14 % of individuals with AIDS. Other bacterial organisms which may be involved are Klebsiella pneumonia, Staphylococcus aureus, P. aeruginosa, Serratia marcescens, and Salmonella typhi. Mycobacterium tuberculosis and Mycobacterium avium intracellulare are also responsible for causing prostatitis, although they primarily affect the lungs. Fungal organisms such as Cryptococcus neoformans and Histoplasma capsulatum can cause prostatitis. The poor penetration of antimicrobials into the prostate tissue causes relapse and persistent subclinical foci of prostatitis.

Prostatic Abscess:

In the general population, a prostatic abscess is found in individuals with urinary obstruction, diabetes mellitus, and a history of bladder catheterizations. The prostatic abscess in HIV-positive individuals is an emerging problem. The symptoms include fever, dysuria, urinary retention, and perineal pain. Enlarged prostate, prostatic tenderness, and fluctuant mass are the clinical signs. Enterobacteriaceae and gram-negative bacteria are the main causative agents. Secondary manifestations involve fungal abscesses of H. capsulatum and Aspergillus.

Voiding Dysfunction in HIV and AIDS Patients:

AIDS patients suffer from neurological bladder function in the later stages of HIV infection. Bladder hyperreflexia is caused by upper motor neuron injury, which is caused by encephalopathy or AIDS dementia which leads to urgency and urinary incontinence. Anticholinergic drugs treat hyperreflexia. Malignancy or infection causes areflexia resulting from lower motor neuron injury. Areflexia causes urinary tract infection, stasis, and urinary retention. It is treated by foley catheterization or suprapubic cystostomy and clean intermittent catheterization.

Testicular Atrophy:

AIDS patients having testicular atrophy have a chronic illness, cachexia, prolonged fever, and malnutrition. In addition, vascular changes such as intravascular thrombosis and smaller vessel lumen size lead to atrophy and ischemia. HIV has a cytotoxic effect on Sertoli cells and germinal tissue. Cytomegalovirus is the common causative agent along with Toxoplasma and Mycobacterium.

Erectile Dysfunction:

Psychogenic and neurogenic factors cause erectile dysfunction. Individuals suffering from fatigue and depression have decreased libido. The difficulties in maintaining erections and achieving ejaculation were seen in individuals in the studies conducted by Tindall. Low testosterone levels and hypogonadism may cause erectile dysfunction and decreased libido.

What Are the Neoplasms Seen in HIV and AIDS Patients?

Kaposi’s Sarcoma:

It is one of the most common malignancies associated with AIDS. Studies have suggested that 20 % of the individual's affected show genital lesions. The causative agents include cytomegalovirus and herpes virus. Clinical features include purple papular, plaque-like, or ulcerated lesions found on the scrotum or penis. Symptoms include pain and edema and irritating and obstructive voiding symptoms. In addition, urinary retention is seen, and Kaposi's sarcoma may turn into gangrene. Treatment involves the excision of smaller lesions by radiation therapy or laser, whereas larger lesions are treated only by radiation therapy. Chemotherapy is used in cases of dissemination, and the drugs used are Bleomycin, Vincristine, and Doxorubicin.

Testicular Malignancy:

It is the third most common AIDS-associated malignancy after Kaposi's sarcoma and Non-Hodgkin's lymphoma. The incidence rate is higher in black and Hispanic patients. The non-seminomatous type of testicular malignancy is common in HIV patients, and the seminomatous type is seen in the general population. The seminomatous type is treated by radiation therapy, and the non-seminomatous type is treated by chemotherapy. Studies have shown that there may be tumor relapse in immunocompromised individuals.

Lymphoma :

Seen in individuals above 50 years and accounts for 5 % of testicular malignancies. Common symptoms involve bilateral testicular masses and testicular enlargement. It is widely metastatic and shows histopathological features such as diffuse histiocytic lymphoma. Lymphomas are treated with chemotherapy and radiation therapy.

Nephropathy in HIV and AIDS Patients:

Nephropathy in HIV patients was first reported in 1984. Mild to moderate proteinuria and fluid and electrolyte changes, including hyponatremia and hypokalemia. Renal failure and tubular necrosis can be avoided if electrolyte imbalance is maintained. There is a higher incidence seen in black males and intravenous drug abusers. Treatment involves using drugs such as Zidovudine, a Thymidine analog that helps decrease HIV replication.

Conclusion:

The genitourinary system is affected both primarily and secondarily by HIV and AIDS. It involves infectious complications, malignancy, and systemic malignancies. Several treatment modalities involve radiotherapy, chemotherapy, and surgery to reduce mortality and morbidity.

Frequently Asked Questions

1.

What Are the Main HIV Infection Complications?

- Prostatitis: Urinary stasis is brought on by an obstructed or dysfunctional urinary system and results in prostatitis.
- Prostatic Abscess: An growing issue is a prostatic abscess in human immunodeficiency virus-positive people. Fever, dysuria, urine incontinence, and perineal soreness are some of the symptoms.
- Voiding Dysfunction in HIV and AIDS Patients: In the later stages of human immunodeficiency virus infection, acquired immunodeficiency syndrome, patients experience neurological bladder function. Upper motor neuron damage, brought on by encephalopathy or AIDS dementia, causes bladder hyperreflexia.
- Testicular Atrophy: Acquired immunodeficiency syndrome patients with testicular atrophy typically have a chronic disease, cachexia, a high fever, and malnutrition.
- Erectile Dysfunction: It is brought on by neurogenic and psychogenic causes. People who are exhausted and depressed tend to have lower libido.
- Urinary tract Infections: A urinary tract infection is one of the most typical infections after contracting the human immunodeficiency virus. Dysuria, hematuria, and increased frequency and urgency of urination are the symptoms associated with this condition.

2.

Does HIV Lead To Urinary Issues?

One of the most typical infections a person gets after contracting the human immunodeficiency virus is a urinary tract infection. Dysuria, hematuria, and increased frequency and urgency of urination are the symptoms. The two main pathogens are Escherichia coli and Pseudomembranous aeruginosa, with Pseudomembranous aeruginosa being responsible for up to 33 percent of urinary tract infections in human immunodeficiency virus patients.

3.

Is Urinary Retention Linked to HIV?

Yes, human immune virus patients with CD4 counts under 200 are more likely to develop bacterial infections as well as neurological signs, including hypo- and areflexia of the bladder, which can lead to infection and urinary stasis or retention problems.

4.

What Are Urethritis’s Three Most Common Causes?

The two main causes are Escherichia coli and Pseudomembranous aeruginosa, with Pseudomembranous aeruginosa being responsible for up to 33 percent of urinary tract infections in human immunodeficiency virus patients. Yeast, viral, and fungal infections of the urinary system are non-bacterial.

5.

What Are the Consequences of Infections?

The following are the consequences of human immunodeficiency virus infections:
- Pneumocystis: The disease brought on by this fungus can be very serious. Despite the fact that it has greatly decreased thanks to human immunodeficiency virus/AIDS therapies today.
- Candidiasis (Thrush): A typical human immunodeficiency virus-related infection is candidiasis. Your mouth, tongue, esophagus, or vagina becomes inflamed, and there is a thick, white covering.
- Tuberculosis (TB): A typical opportunistic infection linked to the human immunodeficiency virus is tuberculosis (TB). TB is the primary cause of death for acquired immunodeficiency syndrome patients globally.
- Cytomegalovirus:  Body fluids such as saliva, blood, urine, semen, and breast milk can spread the common herpes virus. The virus is rendered inactive by a robust immune system, whereupon it remains latent in the body. If the immune system deteriorates, the virus reemerges and damages the lungs, digestive system, eyes, and other organs.
- Cryptococcal Meningitis:  An inflammation of the membranes and fluid surrounding the brain and spinal cord is known as meningitis (meninges). A fungus present in soil can cause cryptococcal meningitis, a frequent central nervous system infection linked to human immunodeficiency syndrome.
- Toxoplasmosis:  Toxoplasma gondii, a parasite predominantly spread by cats, is the source of this potentially fatal infection. Cats with parasite infestations convey the parasites to other animals and people through their feces. When toxoplasmosis spreads to the brain, seizures and heart damage occur.

6.

What Causes Death From HIV/AIDS?

Human Immuno virus and tuberculosis are very prevalent opportunistic infections. Tuberculosis is a major global cause of death for acute immunodeficiency syndrome patients.

7.

What Kind of Illness Is AIDS?

The human immune virus (HIV) is the primary cause of the chronic, potentially fatal illness known as acquired immunodeficiency syndrome (AIDS). HIV interferes with the body's capacity to fight disease and infection by weakening the immune system. Saliva, breast milk, blood, plasma tears, and urine can all spread human immune virus particles.

8.

What Malignant Neoplasms Are Linked to HIV/AIDS?

- Kaposi Sarcoma: It is among the most frequently occurring cancers linked to acquired immunodeficiency syndrome. The cytomegalovirus and herpes virus are the causal causes. Clinical signs include lesions on the scrotum or penis that are purple, papular, plaque-like, or ulcerated.
- Testicular Malignancy: Ranks third among cancers linked to acquired immunodeficiency virus, behind Kaposi's sarcoma and Non-Hodgkin lymphoma. Black and Hispanic patients have a greater incidence rate.
- Lymphoma: Lymphoma accounts for 5 percent of testicular cancers and is more common in people over 50. Testicular enlargement and bilateral testicular masses are frequent signs.
- Nephropathy in HIV and AIDS Patients: In 1984, the first case of nephropathy in human immunodeficiency virus patients was described. fluid and electrolyte abnormalities, including mild to moderate proteinuria, hyponatremia, and hypokalemia.

9.

Which Abnormality Is the First to Appear in HIV Patients?

Early signs of the human immunodeficiency virus (HIV) infection include persistent generalized lymphadenopathy, which is frequently the first sign of the primary infection; oral lesions like thrush and oral hairy leukoplakia; hematologic issues like hypoproliferative anemia, thrombocytopenia; and neurologic are the most common symptoms of human immunodeficiency virus patients.

10.

What Does Neoplasm Mean?

A mass of tissue that develops abnormally when cells grow and divide more frequently than is normal or when they do not die when they need to die. Malignant or benign neoplasms are both possible (cancer). Despite having the potential to become enormous, benign neoplasms do not infiltrate or spread to surrounding tissues or other body regions. A malignant neoplasm may invade or spread to neighboring tissues. Through the lymphatic and circulatory systems, they can also spread to different areas of the body. Also known as a tumor.
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Dr. Shah Sushma Kant
Dr. Shah Sushma Kant

HIV/AIDS specialist

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