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HIV/AIDS – CLINICAL ISSUES

HIV/AIDS – CLINICAL ISSUES. Classification of HIV infection Clinical category A. acute (primary)HIV illness persistent generalized lymphadenopathy asymptomatic HIV infection. Acute HIV illness. Fever > 95% Lymphadenopathy 74%

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HIV/AIDS – CLINICAL ISSUES

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  1. HIV/AIDS – CLINICAL ISSUES

  2. Classification of HIV infection Clinical category A • acute (primary)HIV illness • persistent generalized lymphadenopathy • asymptomatic HIV infection

  3. Acute HIV illness • Fever > 95% • Lymphadenopathy 74% • Pharyngitis 70% • Rash 70% • Arthralgia, myalgia 54% • Diarrhoea 32% • Headache 32% • Nausea, vomits 29% • Hepatomegaly, splenomegaly 14%

  4. Classification of HIV infection Clinical category B • candidiasis, oropharyngeal • hairy leukoplakia • shingles (2 episodes) • peripheral neuropathy • cervical carcinoma in situ • idiopathic thrombocythopenia • constitutional symptoms > 1 month - fever 38,5o C - diarrhoea • pelvic inflammatory disease

  5. Classification of HIV infection Clinical category C (AIDS defining conditions) 1 • Pulmonary and extrapulmonary tuberculosis • MAC • Recurrent pneumonia (2 episodes in 1 year) • PCP (Pneumocystis jirovesi pneumonia) • Cerebral toxoplasmosis

  6. Classification of HIV infection Clinical category C (AIDS defining conditions) 2 • Candidiasis: esophageal, trachea, bronchi • Cryptococcosis, extrapulmonary (meningitis) • Non-Hodgkin lymphoma • Kaposi`s sarcoma • Cervical cancer, invasive • Progressive multifocal leukoencephalopathy

  7. Classification of HIV infection Clinical category C (AIDS defining conditions) 3 • CMV retinitis • HSV with mucocutaneous ulcer >1month • HIV encephalopathy • Wasting syndrome due to HIV • Salmonella bacteremia, recurrent

  8. Management of HIV+ patient • Fighting focal infections (teeth) • Treating of opportunistic infections • Prophylaxis of opportunistic infections • Antiretroviral therapy

  9. Management of opportunistic infections (1) • Tuberculosis - antimycobacterial drugs for 6 –12 months • PCP - cotrimoxazole iv 8-12 amp/d + corticosteroids • Cerebral toxoplasmosis Pyrimethamine 200mg 75mg/d Sulfadiazine 4 g/d Folinic acid 15 mg/d • CMV retinitis - Ganciclovir (Cymevane)

  10. Management of opportunistic infections(2) • Mycoses Fluconazole (up to 400mg/d) Ketokonazole Itraconazole Amphotericin B • Varicella-zoster, herpes Aciclovir (Zovirax)

  11. Primary prophylaxis of opportunistic infections Tuberculosis - tuberculine skin test (PPD*)>5 mm, or Interferon Gamma Release Assay (IGRA) chest x-ray normal, sputum smear for AFB (-) INH 300mg/d for 6 months CD4 count <200 cells/mm3 PCP Toxoplasmosis Cotrimoxazole 480 1 tabl/d or 960mg 3 times a week CD4 <50 cells/mm3 MAC Clarithromycin 500mg b.i.d or Azitmomicine 1,2g once a week *purified protein derivative

  12. The role of a general practitioner • Suspicion of HIV infection - refer to an out-patient setting for consultation) • Suspicion of AIDS - refer to the hospital • HIV positive patient, symptoms not HIV related Management like in HIV negative patient • Cooperation with HIV/AIDS specialist in the field of drug-drug interactions Opportunistic reactivation is very uncommon in patient with CD4 count >200 cells/mm3

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