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

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A Guide to Primary Care of People with HIV/AIDS Chapter 9: Management of Opportunistic Diseases 9 MYCOBACTERIUM AVIUM COMPLEX (MAC) What are the symptoms of MAC? Disseminated M. avium complex disease is a multiorgan infection, usually occurring in patients with AIDS who have CD4 counts of 100/mm 3 sustained for at least 6 months. In this setting, antimycobacterial therapy for those who have completed at least 12 months of effective treatment and have no signs or symptoms of disease may be discontinued. Therapy should be re-started if the CD4 cell count again declines to
A Guide to Primary Care of People with HIV/AIDS Chapter 9: Management of Opportunistic Diseases What is the recommended treatment for CMV retinitis? CMV retinitis should be managed in cooperation with an experienced ophthalmologist. For patients with CMV retinitis that is immediately sight-threatening (central lesions approaching or involving the optic nerve or the fovea) systemic therapy with either IV ganciclovir or oral valganciclovir is the preferred initial treatment; many experts would also recommend surgical treatment with a ganciclovir intraocular implant (see Table 9-4). IV ganciclovir or oral valganciclovir is administered in an acute “induction” dose for 14-21 days, followed by a once-a-day chronic maintenance therapy dose. This approach is superior to other alternatives for preventing or delaying disease progression and provides systemic treatment to prevent other organ system involvement. If effective ART is not administered or patients remain immunosuppressed, the ocular implant should be replaced every 7-8 months. For patients with peripheral CMV retinitis that is not immediately sight-threatening, oral valganciclovir is the preferred treatment because of its ease of administration compared with other parenteral alternatives. Table 9-4. Treatment Options for Cytomegalovirus Disease Drug Ganciclovir implant Induction dose Oral valganciclovir 900 mg bid x 14- 21d IV ganciclovir Foscarnet IV cidofovir (+ probenecid) Maintenance therapy dose N/A Replace every 7-8 months 5 mg/kg bid x 14-21d 90 mg/kg bid x 14-21d 5 mg/kg once/w x 2 wks 900 mg/d 5 mg/kg/d 90 mg/kg/d 5 mg/kg every 2 weeks Chronic maintenance treatment for CMV retinitis should be continued for life unless ART results in a sustained increase in CD4 counts to levels of >100 cells/mm 3 for at least 6 months. If the CD4 count again declines to
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