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Chronic HIV Infection

Chronic HIV Infection. Clinical Manifestations Opportunistic Infections O.I. Prophylaxis. CD4 Count, Viral Load and Clinical Course. Primary Infection. Sero-conversion. Intermediate Stage. AIDS. CD4 Cell Count. Plasma RNA Copies. 1,000. CD4 Cells. 500. 4-8 Weeks. Up to 12 Years.

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Chronic HIV Infection

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  1. Chronic HIV Infection Clinical Manifestations Opportunistic Infections O.I. Prophylaxis

  2. CD4 Count, Viral Load and Clinical Course Primary Infection Sero-conversion Intermediate Stage AIDS CD4 Cell Count Plasma RNA Copies 1,000 CD4 Cells 500 4-8 Weeks Up to 12 Years 2-3 Years

  3. Common Clinical Manifestations of Chronic HIV Infection • Constitutional Symptoms • fever • weight loss/wasting • fatigue • Organ/System Specific • virtually all organ systems can be affected • Consider HIV testing for unexplained syndromes

  4. Wasting By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  5. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  6. http://hivinsite.ucsf.edu

  7. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  8. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  9. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  10. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  11. Oral Manifestations of HIV/AIDS

  12. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  13. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  14. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  15. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  16. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  17. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  18. CNS Lesions

  19. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  20. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  21. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  22. http://www.medinfo.ufl.edu/year2/ophthal/images/35.jpg

  23. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  24. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  25. Prophylaxis against Opportunistic Infections • Pneumocystis carinii pneumonia (PCP) • Toxoplasmosis gondii • Mycobacterium Avium Complex (MAC) • Cryptococcal Meningitis • CMV retinitis • Mycobacterium tuberculosis (TB)

  26. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  27. PCP - Primary Prophylaxis • Initiate at CD4<200 or prior AIDS-defining illness • Best: TMP-SMX • 1 DS qd, 1 SS qd, 1 DS qod or tiw • 1 DS qd also confers protection vs T. gondii and common bacterial infections • consider desensitization if allergic reaction • up to 70% of patients can tolerate reinstitution of therapy

  28. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  29. Toxoplasmic Encephalitis Primary Prophylaxis • Avoid contact with cat feces, raw or undercooked meat, esp. if IgG (-) • Initiate primary prophylaxis at CD4<100 • Options include: • TMP-SMX • dapsone plus pyrimethamine/leucovorin • atovaquone plus pyrimethamine/leucovorin • pyrimethamine-sulfadiazine/leucovorin

  30. MAC Primary Prophylaxis • initiate at CD4<50; R/O dMAC first if symptomatic • options: • clarithromycin 500mg po bid • azithromycin 500mg po qd or 1200mg po qwk • rifabutin 300mg po qd • survival benefit shown for clarithromycin • multiple interactions between rifabutin and antiretrovirals

  31. http://www.medinfo.ufl.edu/year2/ophthal/images/35.jpg

  32. Cytomegalovirus Primary Prophylaxis • Counseling and regular ophthalmological exams for patients with CD4<50 • CMV(-) blood for patients who are CMV(-) at baseline

  33. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  34. Candidal Infections • fluconazole can reduce risk of vaginal, oropharyngeal and esophageal infection • however, generally not recommended: • potential for resistance, cost, possibility of drug interactions • low mortality associated with these infections • acute treatment generally effective

  35. Candidal Infections for which prophylaxis may be warranted: • recurrent esophageal candidiasis: fluconazole 100-200mg qd • recurrent Candida vaginitis: weekly intravaginal clotrimazole tablets or lactobacillus gel capsules reduces frequency by approximately 50%1 1. Abstract 677, 7th Conference on Retroviruses and Opportunistic Infections, 2000.

  36. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  37. Tuberculosis Prophylaxis: Treatment of Latent TB Infection PPD > 5 mm IndurationorRecent Contact with Infectious TB Patient *Rifampin600 mg qd x 2 monthsplusPyrazinamide20 mg/kg/d x 2 months Isoniazid300 mg qd x 9 months or 900 mg 2x/week x 9 months *Use Rifabutin 300 mg qd if patient on PI From: CDC. MMWR 1999;48:No. RR-10. DHS/OI/PP

  38. Consultation Services for Clinicians Caring for Patients with HIV/AIDS • Northwest AETC • (206) 994-8773 pager, (206) 731-1058 VM • University of Washington MEDCON • (800) 326-5300 • National HIV Telephone Consultation Service (Warmline) • (800) 933-3413 • National Clinicians’ Post-Exposure Prophylaxis Hotline (PEPline) • (888) HIV-4911

  39. Extra slides

  40. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  41. By Salvatore Marra, from AIDS imaging http://members.xoom.it/Aidsimaging

  42. Primary Prophylaxis vs Cryptococcal Meningitis? • Fluconazole provides limited protection • resistance can develop • Not routinely recommended

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