CMEonHIV.com is dedicated to providing online CME presentations (slides with voiceover) on HIV/AIDS for healthcare professionals given by local and international experts to keep you up-to-date on the ongoing developments in the field.
Conference
"New Developments in Opportunistic Infections (OIs)" Dr. Peter Phillips (biography) English - 2002-04-15 - 10 minutes
Summary : Opportunistic infections (OIs) continue to account for significant morbidity and mortality among HIV-infected individuals who either do not respond to or cannot adhere to highly active antiretroviral therapy. New recommendations for preventive immunization strategies include limiting the use of pneumococcal vaccine to those who are most likely to benefit (i.e. CD4 counts are > 200/mm). Hepatitis A vaccine is recommended for those at increased risk (e.g. IDU, MSM) or with chronic liver disease, including hepatitis B or C.
The short course 2 month tuberculosis prophylactic regimen of pyrazinamide and rifampin has occasionally been associated with severe or fatal hepatitis. Consequently, this pyrazinamide-containing regimen is reserved for those patients who seem unlikely to complete the longer 4 month rifamycin or 9 month INH regimens. Increased utilization of rapid diagnostic tests for tuberculosis (e.g. DNA and RNA probes) may help identify sputum smear-negative cases (22% as likely as smear-positive cases to transmit tuberculosis) and thereby facilitate infection control measures and initiation of therapy. Antimycobacterial therapy is complicated by numerous drug interactions, particularly for the rifamycins (with protease inhibitors and NNRTIs) and clarithromycin (with efavirenz). The efficacy of the 6 month tuberculosis treatment regimen for HIV-infected patients remains uncertain and appears to be associated with a higher relapse rate compared to HIV-negative individuals. Some additional therapeutic options are now available for the management of certain OIs including: cytomegalovirus retinitis (valganciclovir); progressive multifocal leukoencephalopathy (PML) (cidofovir); cryptococcal meningitis (liposomal amphotericin B); esophageal candidiasis (caspofungin); and cryptosporidiosis (nitazoxanide; expanded access in USA). Partial immune reconstitution associated with HAART has been associated with atypical manifestations of various Ois, particularly MAC (localized lymphadenitis), tuberculosis (paradoxical reactions), and CMV retinitis (vitritis). The spectrum of immune reconstitution disease continues to expand. Partial immune reconstitution has also allowed the safe discontinuation of primary prophylaxis for MAC (if CD4 >100/mm3 ), PCP and toxoplasmosis (if CD4 >200/mm3). Similarly, longterm suppressive therapy (secondary prophylaxis) can be safely discontinued for PCP (if CD4 >200/mm3 ). There also appears to be a low risk of recurrence after discontinuing suppressive therapy for selected patients with CMV retinitis or toxoplasmosis (if CD4 >100-150/mm3), MAC (if CD4 >100/mm3 ), and cryptococcosis (if CD4 >100-200/mm3).
USER ACKNOWLEDGES AND AGREES THAT ALL DECISIONS MADE WITH THE ASSISTANCE OR USE OF THE SOFTWARE AND/OR THE WEBSITE AND/OR BASED ON CONTENT FOUND HEREIN WILL BE EXCLUSIVELY THE RESPONSIBILITY OF THE USER.
