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Headache Background Headache may have many causes in HIV-infected persons, particularly those with low CD4 counts. Possible causes include infections (opportunistic and other) and central nervous system malignancies, HIVrelated systemic illnesses, and medication toxicity. In addition, of course, headache may be caused by any of the processes that cause headaches in HIV-uninfected individuals. New or severe headache should be evaluated carefully. S: Subjective The patient complains of a new type of headache. Determine the following during the history: ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ History of headaches or migraines Characteristics of the headache (location, quality of pain, timing, duration, etc) Recent head trauma Allergies History of sinusitis Fevers Visual changes Dizziness, vertigo, nausea Mental status changes Seizures Focal or other neurologic symptoms (see chapter Neurologic Symptoms) New rashes or ulcerations Other symptoms Usual versus recent caffeine intake New medications (eg, zidovudine) Relief of headache by any medication Unprotected sex, new sex partner O: Objective Section 5—Complaint-Specific Workups | 5–27 Perform a physical examination as follows: ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ Check vital signs. Look for fever, orthostasis, and hypertension. Examine the head and neck for trauma, sinus tenderness, and neck mobility; check lymph nodes. Check the eyes, including funduscopic examination, for lesions or papilledema. Look for oral lesions, dental abscess, thrush, and pharyngeal drainage. Examine the lungs for abnormal sounds. Check the skin, including palms and soles, for rashes or lesions. Perform a complete neurologic examination, including mental status examination. Review recent CD4 measurements, if available, to determine the patient’s risk for opportunistic illnesses as a cause of headache. A: Assessment A partial differential diagnosis includes the following: ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ Cryptococcal meningitis Neurosyphilis Tuberculous meningitis; other meningitis Progressive multifocal leukoencephalopathy (PML) Toxoplasmic encephalitis Cytomegalovirus (CMV) meningoencephalitis or retinitis Other encephalitis Central nervous system lymphoma Systemic infection Sinusitis Anemia Fever Depression, anxiety disorder Medication adverse effect Stress or tension headache
5–28 | Clinical Manual for Management of the HIV-Infected Adult/2006 ♦ ♦ ♦ ♦ Migraine or cluster headache Caffeine withdrawal Hypertension Dehydration Other causes of headache unrelated to HIV should be considered. P: Plan Diagnostic Evaluation Evaluation should include the following: ♦ ♦ ♦ ♦ ♦ ♦ CD4 count (if not done recently), to help with risk stratification for opportunistic illnesses Complete blood count (CBC) with differential (if fever or suspected anemia); see chapters Anemia and Fever Blood chemistries, including liver function tests, electrolytes, creatinine, glucose Serum cryptococcal antigen (if fever is present and CD4 count is
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Clinical Manual for Management of t
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Table of Contents Clinical Manual f
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Clinical Manual for Management of t
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Preface—About this Manual | Clini
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Previous Editions Atlanta Contribut
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♦ ♦ ♦ ♦ ♦ | Clinical Manu
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1-2 | Clinical Manual for Managemen
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Initial Physical Examination Backgr
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Genitals/Rectum • Inspect the gen
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Initial and Interim Laboratory and
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Section 1—Testing and Assessment
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Patient Education ♦ ♦ ♦ ♦ D
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Section 2—Health Maintenance and
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References ♦ ♦ ♦ ♦ ♦ ♦
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Occupational Postexposure Prophylax
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P: Plan Laboratory Testing Provide
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For hepatitis C, no recommended pro
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as hepatitis C or another sexually
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for treatment is appropriate, and b
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contact with the patient. Patients
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tablet daily of trimethoprim-sulfam
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Opportunistic Infection Prophylaxis
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Discontinuing Primary Prophylaxis P
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Latent Tuberculosis Background Late
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INH may cause liver toxicity and it
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Patient Education ♦ ♦ ♦ ♦
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Reducing Maternal-Infant HIV Transm
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Some states require written informe
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contraindicated during pregnancy be
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Section 3—Antiretroviral Therapy
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Nelfinavir (Viracept) Adequate drug
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Page 202 and 203: Eye Problems Background The immunos
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Page 210 and 211: Fever Background Although fever may
Page 214 and 215: Lymphadenopathy Background Lymphade
Page 216: Treatment Treatment will depend on
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Page 226 and 227: Pulmonary Symptoms Background Short
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Page 240: Maintenance therapy Use caution whe
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Page 248: Patient Education ♦ ♦ ♦ ♦ P
Page 254 and 255: Cryptosporidiosis Background Crypto
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Gonorrhea and Chlamydia Background
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Treatment of Gonorrhea Treatment op
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Hepatitis B Infection Background He
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♦ ♦ ♦ ♦ ♦ Some patients t
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Hepatitis C Infection Background He
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pregnancy. Ribavirin is teratogenic
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Herpes Simplex, Mucocutaneous Backg
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References ♦ ♦ ♦ ♦ ♦ Cent
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Kaposi Sarcoma Background Kaposi sa
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Treatment Treatment of KS is not co
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Molluscum Contagiosum Background Mo
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Mycobacterium avium Complex Backgro
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Table 1. Interactions between Rifab
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Mycobacterium tuberculosis: Treatme
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P: Plan Diagnostic Evaluation Durin
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Table 1. Regimens for Treatment of
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Rifabutin may be substituted for ri
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Non-Hodgkin Lymphoma Background Non
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Patient Education ♦ ♦ ♦ ♦ S
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Toxoplasmosis Background Toxoplasma
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♦ Atovaquone 1,500 mg orally twic
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Linear Gingival Erythema Background
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Background Necrotizing ulcerating p
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Oral Health Background Examination
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Maxillary Tori; Mandibular Tori S:
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Periodontal Disease Background The
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Oral Hairy Leukoplakia Background O
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Oral Ulceration Background Oral ulc
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Oral Warts Background Oral warts ar
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Anxiety Disorders Background Anxiet
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Patient Education ♦ ♦ Behaviora
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Insomnia Background Insomnia is a c
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Suicidal Ideation Background Transi
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Section 8—Neuropsychiatric Disord
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P: Plan ♦ ♦ ♦ ♦ ♦ Check t
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Correctional Settings Background Ca
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Adherence Adherence is one of the m
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Karnofsky Performance Scale Backgro
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