TB/HIV: a clinical manual - libdoc.who.int - World Health Organization

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11.4 Principles of a public health approach to ART . . . . . . . . 13911.5 Initiation of ART. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13911.5.1 Adults and adolescents with documented HIV infection 14011.5.2 Infants and children . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14011.6 Recommended doses of ARV drugs . . . . . . . . . . . . . . . . 14111.6.1 Adults and adolescents . . . . . . . . . . . . . . . . . . . . . . . . . 14111.6.2 Children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14211.7 Choice of ART regimen . . . . . . . . . . . . . . . . . . . . . . . . . 14911.7.1 Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14911.7.2 Children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15011.8 Monitoring the efficacy of ART. . . . . . . . . . . . . . . . . . . . 15111.9 Adverse effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15111.10 Interactions between ARV drugs and drugs used toprevent or treat opportunistic infections . . . . . . . . . . . . 15311.11 Antiretroviral drugs and TB treatment . . . . . . . . . . . . . 15311.11.1 Drug interactions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15311.11.2 Treating TB and HIV together . . . . . . . . . . . . . . . . . . . . 15311.11.3 Immune reconstitution syndrome . . . . . . . . . . . . . . . . . 15411.11.4 Options for ART in patients with TB . . . . . . . . . . . . . . . 15412 Treatment and prevention of other HIV-relateddiseases in TB/HIV patients . . . . . . . . . . . . . . . . . . . 15712.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15712.2 Clinical spectrum of HIV-related disease . . . . . . . . . . . . 15712.3 Sexually transmitted infections. . . . . . . . . . . . . . . . . . . . 15812.3.1 Syndromic management . . . . . . . . . . . . . . . . . . . . . . . . . 15812.3.2 Treatment regimens for common STIs. . . . . . . . . . . . . . 15912.4 Skin and mouth problems . . . . . . . . . . . . . . . . . . . . . . . 16112.5 Respiratory problems . . . . . . . . . . . . . . . . . . . . . . . . . . 16512.5.1 Respiratory problems in adults . . . . . . . . . . . . . . . . . . . 16512.5.2 Respiratory problems in children. . . . . . . . . . . . . . . . . . 16712.6 Gastrointestinal problems . . . . . . . . . . . . . . . . . . . . . . . 16712.6.1 Dysphagia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16712.6.2 Diarrhoea in adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16812.6.3 Diarrhoea in children. . . . . . . . . . . . . . . . . . . . . . . . . . . 170TB/HIV:A CLINICAL MANUAL7
12.7 Neurological problems in adults. . . . . . . . . . . . . . . . . . . 17112.7.1 Acute confusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17112.7.2 Chronic behaviour change . . . . . . . . . . . . . . . . . . . . . . . 17212.7.3 Persistent headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17212.7.4 Difficulty in walking . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17412.7.5 Poor vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17512.7.6 Burning sensation in the feet . . . . . . . . . . . . . . . . . . . . . 17512.8 Neurological problems common in children . . . . . . . . . 17512.9 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17612.9.1 Approach to management . . . . . . . . . . . . . . . . . . . . . . . 17612.9.2 Disseminated infection. . . . . . . . . . . . . . . . . . . . . . . . . . 17612.10 Other HIV-related problems . . . . . . . . . . . . . . . . . . . . . 17712.11 Prevention of HIV-related opportunistic infections. . . . . 17912.11.1 General measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17912.11.2 Immunizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17912.11.3 Primary chemoprophylaxis in adults. . . . . . . . . . . . . . . . 18012.11.4 Primary chemoprophylaxis in children . . . . . . . . . . . . . . 18112.11.5 Secondary chemoprophylaxis in adults. . . . . . . . . . . . . . 18113 Coordinated care in different settings . . . . . . . . . . 18513.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18513.2 The expanded scope of a new approach to decreasethe burden of TB/HIV . . . . . . . . . . . . . . . . . . . . . . . . . . 18513.3 Referral to local HIV/AIDS care services . . . . . . . . . . . . 18613.4 Benefits of support from local HIV/AIDS care services . 18613.5 A framework for HIV/AIDS care that incorporatesinterventions to address TB . . . . . . . . . . . . . . . . . . . . . . 18713.5.1 Home and community care . . . . . . . . . . . . . . . . . . . . . . 18713.5.2 Primary care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18813.5.3 Secondary care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18913.5.4 Tertiary care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18913.6 The private sector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19113.6.1 Private medical practitioners . . . . . . . . . . . . . . . . . . . . . 19113.6.2 Traditional practitioners. . . . . . . . . . . . . . . . . . . . . . . . . 19113.7 Operational research aimed at improving integratedTB and HIV/AIDS prevention and care . . . . . . . . . . . . . 1928 CONTENTS
Page 1 and 2: WHO/HTM/TB/2004.329TB HIVA CLINICAL
Page 3 and 4: WHO Library Cataloguing-in-Publicat
Page 5 and 6: 2.2.4 Key operations for DOTS imple
Page 7: 9.4 TB treatment regimens: question
Page 12 and 13: FOREWORD TO SECOND EDITIONWHO is co
Page 14 and 15: PREFACE TO SECOND EDITIONRecognitio
Page 16 and 17: GLOSSARY AND ABBREVIATIONSThis glos
Page 18 and 19: HIV-negativeHIV-positiveHIV-related
Page 20: RNARTISCCscrofulasensitivity testse
Page 24 and 25: BACKGROUND INFORMATION ONTUBERCULOS
Page 26 and 27: dead, 25% will be healthy (self-cur
Page 28 and 29: smear; upper lobe involvement; usua
Page 30 and 31: About one-third of children born to
Page 32 and 33: important cells in the cell-mediate
Page 34 and 35: AdultsWHO clinical staging system f
Page 36 and 37: 1.2.8 Epidemiological surveillance
Page 38 and 39: 1.3.2 HIV infection and risk of TBH
Page 40 and 41: HIV-related TB in childrenAs in adu
Page 42 and 43: AN EXPANDED FRAMEWORK FOR EFFECTIVE
Page 44 and 45: 2.2.3 TB control policy package (th
Page 46 and 47: º Undertake economic analysis and
Page 48 and 49: 2.5 DOTS-PLUSHigh levels of multidr
Page 50 and 51: DIAGNOSIS OF PULMONARY TUBERCULOSIS
Page 52 and 53: 3.3 DIAGNOSTIC SPUTUM SMEAR MICROSC
Page 54 and 55: Sensitivity of sputum smear microsc
Page 56 and 57: PRACTICAL POINTIf the patient is br
Page 58 and 59:
cavitationunilateral infiltrationbi
Page 60 and 61:
Clinical and CXR features of PCP an
Page 62 and 63:
DIAGNOSIS OF PULMONARY TUBERCULOSIS
Page 64 and 65:
disease to other parts of the body,
Page 66 and 67:
(3) Respiratory symptoms such as co
Page 68 and 69:
º evidence of wasting (i.e. under
Page 70 and 71:
In the past, some doctors have advo
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productive of copious purulent and
Page 74 and 75:
distinguishing TB-infected from non
Page 76 and 77:
DIAGNOSIS OF EXTRAPULMONARYTUBERCUL
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Practical approach to investigation
Page 80 and 81:
Clinical differentiation of miliary
Page 82 and 83:
malignancy, post-pneumonic effusion
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Therapeutic pericardiocentesis is n
Page 86 and 87:
Clinical featuresThe patient may pr
Page 88 and 89:
5.6 OTHER FORMS OF EXTRAPULMONARY T
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SUGGESTIONS FOR FURTHER READINGCrof
Page 93 and 94:
PRACTICAL POINTFull blood count (FB
Page 95 and 96:
countries for staging and monitorin
Page 97 and 98:
provides support. Counselling is a
Page 99 and 100:
SUGGESTIONS FOR FURTHER READINGUNAI
Page 101 and 102:
Lesscommonextensive fungal skin, na
Page 103 and 104:
positive. These include the poor ou
Page 106 and 107:
STANDARDIZED TUBERCULOSIS CASEDEFIN
Page 108 and 109:
Pulmonary TB - sputum smear-negativ
Page 110:
The table below shows the severe an
Page 113 and 114:
First-line Mode of Potency Recommen
Page 115 and 116:
growing bacilli and the killing of
Page 117 and 118:
Recommended treatment regimens for
Page 119 and 120:
9.4 TB TREATMENT REGIMENS: QUESTION
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9.5 USE OF ANTI-TB DRUGS IN SPECIAL
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PRACTICAL POINTRecording treatment
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indicators are treatment completion
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SCCAmong TB patients who complete S
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SIDE-EFFECTS OF ANTI-TUBERCULOSIS D
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PRACTICAL POINTRifampicin reduces t
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10.7.1 Treatment regimen includes t
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not a severe reaction) to isoniazid
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ANTIRETROVIRAL THERAPY FOR THETREAT
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eplication and functioning of HIV.
Page 142 and 143:
18 HIV antibody º WHO Paediatric S
Page 144 and 145:
Name of drug Formulations Pharmacok
Page 146 and 147:
Stavudine Maximum dose: Needs to be
Page 148 and 149:
Efavirenz 25 to 33 kg: 350 mg(EFZ)
Page 150 and 151:
11.7 CHOICE OF ART REGIMENWHO recom
Page 152 and 153:
Recommended first-line ARV combinat
Page 154 and 155:
11.10 INTERACTIONS BETWEEN ARV DRUG
Page 156:
SUGGESTIONS FOR FURTHER READINGBart
Page 159 and 160:
worldwide. There has also been rece
Page 161 and 162:
chlamydia doxycycline 100 mg orally
Page 163 and 164:
º Fungal infectionsInfection Local
Page 165 and 166:
Ichthyosis(dry scalyskin)PsoriasisE
Page 167 and 168:
sputuminductionusing 3-5%hypertonic
Page 169 and 170:
Where available, barium swallow sho
Page 171 and 172:
Isospora bellitrimethoprim 80 mg/su
Page 173 and 174:
Always check a blood film for malar
Page 175 and 176:
It is unlikely, but possible, that
Page 177 and 178:
a variety of neurological problems
Page 179 and 180:
section 12.4 on skin problems), a b
Page 181 and 182:
ChildrenIn children with known or s
Page 183 and 184:
PathogenPneumocystis cariniiDrug re
Page 186 and 187:
COORDINATED CARE IN DIFFERENT SETTI
Page 188 and 189:
º access to voluntary counselling
Page 190 and 191:
13.5.3 Secondary careMeasures appli
Page 192 and 193:
Secondary care As for primary As pe
Page 194:
SUGGESTIONS FOR FURTHER READINGGilk
Page 197 and 198:
PRACTICAL POINTIn wards, outpatient
Page 199 and 200:
14.3.2 BCG protection against TB in
Page 201 and 202:
) Aimed at decreasing risk of a rec
Page 203 and 204:
to exclude active TB and to ensure
Page 205 and 206:
SUGGESTIONS FOR FURTHER READINGHarr
Page 207 and 208:
Childrenapproach to TB diagnosis .
Page 209 and 210:
Kaposi sarcoma . . . . . . . . . .3
Page 211 and 212:
Target groups for preventive treatm
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