Clinical Manifestations of Chronic HIV

Posted by e-Medical PPT
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

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


PCP - Primary Prophylaxis
Initiate at CD4<200 or prior AIDS-defining illness
Consider desensitization if allergic reaction
up to 70% of patients can tolerate reinstitution of therapy

Toxoplasmic Encephalitis Primary Prophylaxis
Avoid contact with cat feces, raw or undercooked meat, esp. if IgG (-)
Initiate primary prophylaxis at CD4<100

MAC Primary Prophylaxis   
initiate at CD4<50; R/O dMAC first if symptomatic
survival benefit shown for clarithromycin
multiple interactions between rifabutin and antiretrovirals

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

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