December 2001 OI Guidelines 11/28/01 2001 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected With Human Immunodeficiency Virus Module 1: Prophylaxis Core A Training Slide Set Prepared by the AETC National Resource Center
48
Embed
December 2001OI Guidelines 11/28/01 2001 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected With Human Immunodeficiency.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
December 2001 OI Guidelines 11/28/01
2001 USPHS/IDSA Guidelines for the Prevention of
Opportunistic Infections in Persons Infected With Human
Immunodeficiency Virus
Module 1:
Prophylaxis Core
A Training Slide Set Prepared by the AETC National Resource Center
December 2001 OI Guidelines 11/28/01
Disclaimer
These slides were developed using the most recent treatment guideline information at the time of production. However, in the rapidly changing field of HIV care this information could become out of date quickly. The user is encouraged to compare the date of this slide set with the date of the most recent guidelines. Also, it is intended that these slides be used, as prepared, without changes in either content or attribution. Users are asked to honor this intent.
AETC National Resource Center
December 2001 OI Guidelines 11/28/01
Summary of OIs for Which Prevention Is Recommended
When to restart: patients previously treated for TB infection or TB disease do not require retreatment based upon diminished immune function alone. Patients with known exposure or suspected of acquiring TB infection may need retreatment. In these instances consultation with experts is strongly recommended.
December 2001 OI Guidelines 11/28/01
Rifabutin Dose Modifications With ART Agents
PI/NNRTI
Rifabutin
Daily 2-3 X / Wk
IDV 1000 mg q 8h 150 300
NFV 1250 mg bid 150 300
APV 1200 mg bid 150 300
RTV/SQV 400/400 mg - 150
LPV/RTV 400/100 - 150 qod
NVP 200 mg bid 300 -
EFV 600 hs 450 600
December 2001 OI Guidelines 11/28/01
Tuberculosis Prophylaxis Therapeutic Monitoring
Drug Clinical Laboratory Intervention
INH Review monthly for sx hepatitis
LFTs at baseline & 3 mo
D/C if ALT > 5 x ULN
RIF/
PZA
Clinical evaluation at wk 2, 4, 6 & 8
ALT & Bili at 2, 4 & 6 wks or with sx
D/C if:•sx + abn ALT/ AST, or
•ALT/AST > 5 x ULN, or Bilirubin
December 2001 OI Guidelines 11/28/01
Varicella-Zoster Virus Disease
Varicella vaccine contraindicated in HIV-infected adults.
Varicella zoster immune globulin (VZIG) for susceptible HIV-infected children and adults. Give ASAP but 96 hours after close contact with a person who has chickenpox or shingles.
No preventive measures are currently available for shingles.
December 2001 OI Guidelines 11/28/01
VACCINES: ROUTINE USE
Agent Indication
Hepatitis B Anti-HBc neg
Hepatitis A Risk * + neg anti-HAV
S. pneumoniae CD4 > 200
Influenza Annually, Oct – Nov
* Risk = IDU, MSM, hemophilia, chronic HBV or HCV
December 2001 OI Guidelines 11/28/01
VACCINES: OTHER
Give if indicated:
Cholera, Japanese encephalitis, Lyme disease, Tetanus-diptheria, Typhoid inactivated (Typhim V1)
December 2001 OI Guidelines 11/28/01
VACCINES: OTHER
Contraindicated (live virus):
Varicella, Yellow Fever, Typhoid live (Ty21a), Measles, Vaccinia
December 2001 OI Guidelines 11/28/01
OI Guidelines November, 2001
OIs for Which Only Secondary Prevention Is Generally Recommended
December 2001 OI Guidelines 11/28/01
Cytomegalovirus Disease
Chronic maintenance therapy following inductionPreferred Regimen:• Ganciclovir IV or PO• Foscarnet IV• Ganciclovir implant + PO (for retinitis)Alternative Regimen:• Cidofovir IV + probenecid PO• Fomivirsen injection in vitreous• Valganciclovir PO
When to stop: CD4 >100-150 X 6 mo + no active disease + negative ophthal exam.
When to restart: CD4 < 100-150
December 2001 OI Guidelines 11/28/01
* Consider if CD4 < 100 + endemic area (>10 cases/100 pts-yrs)** CD4 > 100-200 X 6 mo + complete initial therapy + asymptomatic