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Pulmonary Symptoms Background Shortness of breath or cough may be common manifestations of acute or chronic respiratory diseases, but also may be symptoms of HIV-related opportunistic infections. Further, these symptoms may indicate nonpulmonary conditions such as anemia, cardiovascular disease, and sinusitis, or adverse effects of medications such as angiotensin-converting enzyme (ACE) inhibitors. The onset and duration of symptoms, and the presence or absence of other factors such as sputum production, fever, and weight loss, will guide the evaluation. In addition, the patient’s CD4 cell count will establish a context for the evaluation, because it will help to stratify the risk of opportunistic infections. S: Subjective The patient complains of dyspnea or cough. Determine the following factors relating to the patient’s history. Recent History ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ Onset and duration of symptoms: rapid (hours to days), subacute, chronic Progression or stability of symptoms Dyspnea at rest or with exertion? Cough: productive (character of sputum), hemoptysis? Associated symptoms (chest pain, pleuritic pain, etc) Constitutional symptoms: fever, night sweats, unintentional weight loss Sinus congestion, facial tenderness, postnasal discharge, sore throat Orthopnea, paroxysmal nocturnal dyspnea (PND), peripheral edema Wheezing Past History ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ Section 5—Complaint-Specific Workups | 5–41 CD4 nadir (lowest documented CD4 cell count), current CD4 count If the CD4 count is
5–42 | Clinical Manual for Management of the HIV-Infected Adult/2006 A: Assessment The differential diagnosis of pulmonary symptoms is broad (Table 1). Both HIV-related and HIV-unrelated causes should be considered; the patient’s risk of HIVrelated causes is strongly influenced by the CD4 count. More than 1 cause of symptoms may be present. Table 1. Partial Differential Diagnosis of Pulmonary Symptoms CD4 Cell Count Possible Cause Any Count • Upper respiratory tract illness • • • • • • • • • • • • • • • • • • • Upper respiratory tract infection (URI) Sinusitis Pharyngitis Acute or chronic bronchitis Bacterial pneumonia TB Influenza Chronic obstructive pulmonary disease Reactive airway disease, asthma Non-Hodgkin lymphoma Pulmonary embolus Congestive heart failure Pulmonary hypertension Pneumothorax Bronchogenic carcinoma Anemia Gastroesophageal reflux (may cause cough) Lactic acidosis Medication adverse effect
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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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Section 4—Complications of Antire
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♦ ♦ ♦ Toronto General Hospita
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Adverse Reactions to HIV Medication
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♦ ♦ ♦ ♦ ♦ Vital signs: No
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egimen, symptoms of fatigue could i
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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
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Page 214 and 215: Lymphadenopathy Background Lymphade
Page 216: Treatment Treatment will depend on
Page 222 and 223: Neurologic Symptoms Background The
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Page 228: Treatment Once the diagnosis is mad
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Page 240: Maintenance therapy Use caution whe
Page 246 and 247: Cervical Dysplasia Background Cervi
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Page 254 and 255: Cryptosporidiosis Background Crypto
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Page 266 and 267: Gonorrhea and Chlamydia Background
Page 268 and 269: Treatment of Gonorrhea Treatment op
Page 270 and 271: Hepatitis B Infection Background He
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Page 274 and 275: 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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