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

2. Plasma RNA Copies CD4 Cells 4-8 WeeksUp to 12 Years2-3 Years CD4 Cell Count 1,000 500 Intermediate StageAIDS Primary Infection Sero- conversion CD4 Count, Viral Load and Clinical Course

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

6. http://hivinsite.ucsf.edu

7. 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

18. CNS Lesions

19. 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

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 DHS/OI/PP Isoniazid 300 mg qd x 9 months or 900 mg 2x/week x 9 months PPD > 5 mm Induration or Recent Contact with Infectious TB Patient *Rifampin 600 mg qd x 2 months plus Pyrazinamide 20 mg/kg/d x 2 months *Use Rifabutin 300 mg qd if patient on PI From: CDC. MMWR 1999;48:No. RR-10.

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

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