Clinical Manual for Management of the HIV-Infected ... - myCME.com

up to 30 mL of CSF to lower the ICP by 50%, if
possible. LP and CSF removal should be repeated daily
as needed for ICP reduction. Ventriculostomy or a
ventriculoperitoneal shunt may be needed if the initial
opening pressure is >400 mm H2O, or in refractory
cases. There is no role for acetazolamide, mannitol, or
steroids in the treatment of elevated ICP.
A repeat LP is not required for patients who did not
have elevated ICP at baseline and are responding to
treatment. If new symptoms develop, a repeat LP
is indicated. Serum CrAg titers are not useful in
monitoring response to treatment.
Cryptococcal pulmonary disease, with negative CSF CrAg and cultures
Treat with fluconazole (200-400 mg orally) if symptoms
are mild or moderate. Otherwise, consider amphotericin
induction, as above. Monitor fungal blood cultures and
CrAg to verify the effectiveness of therapy. Itraconazole
may be used as an alternative (200 mg orally twice daily
capsules; 100-200 mg once daily for oral suspension).
Therapy should be continued for life, unless the patient
has sustained CD4 cell recovery in response to effective
ART (CD4 count >100-200 cells/µL for at least 6
months during ART). Therapy should be restarted if the
CD4 count declines to