A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

A Guide to Primary Care of People with HIV/AIDS
Chapter 8: Symptom Management
What are the best options for managing
nausea?
If nausea is due to medications, stopping the
medication or removing an interacting drug is the best
option. Symptomatic therapy with prochlorperazine or
metoclopramide may help. A natural product option
is ginger, at a dose of 2 grams daily (no more than
4 grams/day). Switching the time of the dose of the
offending drug to be taken with food may be helpful.
PULMONARY SYMPTOMS
What are the possible causes of cough in an
HIV-infected patient?
The CD4 cell count is crucial information in determining
the cause of cough. In patients with CD4 cell counts
>200/mm 3 , viral upper respiratory infections,
bacterial pneumonia (caused by S. pneumoniae or H.
influenzae most commonly), tuberculosis (TB), and
sinusitis with post-nasal drip are all important causes
of cough. Bacterial bronchitis is more common in
patients with HIV than in non-HIV-infected patients.
In patients with low CD4 cell counts (200/mm 3 the history
and physical exam should determine what testing to
do. If the patient has a cough but no fever or productive
sputum, no dyspnea, and a normal pulmonary exam,
then chest x-ray is not necessary. A patient at high
risk for TB should have an x-ray if there is a prolonged
cough (>2-3 weeks) regardless of CD4 cell count. In
a patient with a low CD4 cell count (