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

More documents

Recommendations

Info

Linear Gingival Erythema Background Linear gingival erythema is inflammation of the margins of the gingiva. It is characterized by a 2-3 mm band of intense erythema around the necks of the teeth that does not resolve with routine oral hygiene. The erythematous changes usually are generalized, but may be confined to a few teeth. This condition is one of the most common oral manifestations of advanced HIV/ AIDS. It also may be referred to as HIV gingivitis or red-band gingivitis. S: Subjective The patient may complain of bleeding, tender gums, and a bad taste in the mouth. O: Objective Examine the oral cavity carefully for inflamed gingival tissues, which bleed easily upon manipulation (including brushing). This condition is seen most commonly in the buccal area of lower anterior teeth, as a continuous red band around the necks of teeth. A: Assessment The differential diagnosis includes necrotizing gingivitis, periodontitis, and Kaposi sarcoma. (See chapters on Necrotizing Ulcerative Periodontitis and Gingivitis and Kaposi Sarcoma for more information.) P: Plan The diagnosis is based on clinical features; perform additional testing to rule out other causes, as indicated. Recommend patient education and counseling, meticulous home care, frequent dental visits during treatment phase, and regular recall visits. Refer for nutrition counseling as needed. Treatment Section 6—Disease-Specific Treatment | 6–109 Linear gingival erythema should be treated aggressively to prevent progression to necrotizing periodontal disease; referral should be made for prompt dental care and the patient should be educated in oral hygiene techniques. A chlorhexidine gluconate (0.12%) rinse twice daily for 2 weeks will relieve some of the symptoms. Refer to a dentist or dental hygienist for a thorough dental prophylaxis (cleaning). If this combination is not successful, it may be appropriate to add an antibiotic such as: ♦ ♦ ♦ Metronidazole 250 mg orally 4 times daily for 7 days Amoxicillin-clavulanate (Augmentin) 875 mg orally twice daily for 7 days Clindamycin 150-300 mg orally 4 times daily for 7 days Patient Education ♦ ♦ ♦ ♦ Good oral hygiene is essential to management, especially with concomitant periodontitis. Advise patients to brush and floss after every meal. Any rinses prescribed by care providers should be used after brushing. Advise patients not to eat or drink for 30 minutes after rinsing with chlorhexidine gluconate. Urge regular dental checkups and cleaning at least every 3-6 months. Patients should not drink alcohol while taking metronidazole, and for at least 48 hours after the last dose.
6–110| Clinical Manual for Management of the HIV-Infected Adult/2006 References ♦ ♦ ♦ ♦ ♦ Bravo IM, Correnti M, Escalona L, et al. Prevalence of oral lesions in HIV patients related to CD4 cell count and viral load in a Venezuelan population. Med Oral Patol Oral Cir Bucal. 2006 Jan 1;11(1):E33-9. Coogan MM, Greenspan J, Challacombe SJ. Oral lesions in infection with human immunodeficiency virus. Bull World Health Organ. 2005 Sep;83(9):700-6. Kroidl A, Schaeben A, Oette M, et al. Prevalence of oral lesions and periodontal diseases in HIV-infected patients on antiretroviral therapy. Eur J Med Res. 2005 Oct 18;10(10):448-53. Petersen PE. The World Oral Health Report 2003: continuous improvement of oral health in the 21st century—the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2003 Dec;31 Suppl 1:3-23. Reznik DA. Oral manifestations of HIV disease. Top HIV Med. 2005 Dec-2006 Jan;13(5):143-8.
Page 1 and 2:
Clinical Manual for Management of t
Page 3 and 4:
Table of Contents Clinical Manual f
Page 5 and 6:
Clinical Manual for Management of t
Page 7 and 8:
Preface—About this Manual | Clini
Page 9:
Previous Editions Atlanta Contribut
Page 12 and 13:
♦ ♦ ♦ ♦ ♦ | Clinical Manu
Page 14 and 15:
1-2 | Clinical Manual for Managemen
Page 16 and 17:
Page 18 and 19:
Page 20 and 21:
Page 23 and 24:
Initial Physical Examination Backgr
Page 25 and 26:
Genitals/Rectum • Inspect the gen
Page 27 and 28:
Initial and Interim Laboratory and
Page 29 and 30:
Section 1—Testing and Assessment
Page 31:
Patient Education ♦ ♦ ♦ ♦ D
Page 34 and 35:
1-22 | Clinical Manual for Manageme
Page 36 and 37:
Page 38 and 39:
Page 40 and 41:
Page 42 and 43:
Page 44 and 45:
Page 46 and 47:
Page 48 and 49:
Page 51 and 52:
Section 2—Health Maintenance and
Page 53:
References ♦ ♦ ♦ ♦ ♦ ♦
Page 56 and 57:
Page 58 and 59:
Page 60 and 61:
Page 62 and 63:
Page 64 and 65:
Page 67 and 68:
Occupational Postexposure Prophylax
Page 69 and 70:
P: Plan Laboratory Testing Provide
Page 71 and 72:
For hepatitis C, no recommended pro
Page 73 and 74:
Page 75 and 76:
as hepatitis C or another sexually
Page 77 and 78:
for treatment is appropriate, and b
Page 79 and 80:
Page 81 and 82:
contact with the patient. Patients
Page 83 and 84:
tablet daily of trimethoprim-sulfam
Page 85 and 86:
Opportunistic Infection Prophylaxis
Page 87 and 88:
Discontinuing Primary Prophylaxis P
Page 89 and 90:
Latent Tuberculosis Background Late
Page 91 and 92:
INH may cause liver toxicity and it
Page 93:
Patient Education ♦ ♦ ♦ ♦
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
Page 117 and 118:
Reducing Maternal-Infant HIV Transm
Page 119 and 120:
Some states require written informe
Page 121 and 122:
contraindicated during pregnancy be
Page 123 and 124:
Section 3—Antiretroviral Therapy
Page 125 and 126:
Nelfinavir (Viracept) Adequate drug
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133:
♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦
Page 136 and 137:
Page 138 and 139:
Page 140 and 141:
Page 142 and 143:
Page 144 and 145:
Page 146 and 147:
Page 148 and 149:
Page 150 and 151:
Page 152 and 153:
Page 154 and 155:
Page 156 and 157:
Page 158 and 159:
Page 160 and 161:
Page 162 and 163:
Page 165 and 166:
Section 4—Complications of Antire
Page 167 and 168:
♦ ♦ ♦ Toronto General Hospita
Page 169 and 170:
Adverse Reactions to HIV Medication
Page 171 and 172:
♦ ♦ ♦ ♦ ♦ Vital signs: No
Page 173 and 174:
egimen, symptoms of fatigue could i
Page 175 and 176:
Recreational Drugs and Antiretrovir
Page 177 and 178:
Section 4—Complications of Antire
Page 179 and 180:
LSD, Mescaline, Psilocin, and Methy
Page 181 and 182:
Immune Reconstitution Syndrome Back
Page 183 and 184:
A: Assessment In the appropriate cl
Page 185 and 186:
♦ ♦ ♦ ♦ ♦ Navas E, Martin
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 202 and 203:
Eye Problems Background The immunos
Page 204:
of
Page 207 and 208:
Page 210 and 211:
Fever Background Although fever may
Page 212 and 213:
Headache Background Headache may ha
Page 214 and 215:
Lymphadenopathy Background Lymphade
Page 216:
Treatment Treatment will depend on
Page 219 and 220:
Page 222 and 223:
Neurologic Symptoms Background The
Page 224 and 225:
♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦
Page 226 and 227:
Pulmonary Symptoms Background Short
Page 228:
Treatment Once the diagnosis is mad
Page 231 and 232:
Page 233 and 234:
Page 235 and 236:
Page 238 and 239:
Candidiasis, Oral and Esophageal Ba
Page 240:
Maintenance therapy Use caution whe
Page 243 and 244:
Page 246 and 247:
Cervical Dysplasia Background Cervi
Page 248:
Patient Education ♦ ♦ ♦ ♦ P
Page 251 and 252:
Page 254 and 255:
Cryptosporidiosis Background Crypto
Page 256:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
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
Page 272 and 273:
♦ ♦ ♦ ♦ ♦ Some patients t
Page 274 and 275:
Hepatitis C Infection Background He
Page 276 and 277:
pregnancy. Ribavirin is teratogenic
Page 278 and 279:
Herpes Simplex, Mucocutaneous Backg
Page 280:
References ♦ ♦ ♦ ♦ ♦ Cent
Page 283 and 284:
Page 285 and 286:
Page 288 and 289:
Kaposi Sarcoma Background Kaposi sa
Page 290 and 291:
Treatment Treatment of KS is not co
Page 292 and 293: Molluscum Contagiosum Background Mo
Page 294 and 295: Mycobacterium avium Complex Backgro
Page 296 and 297: Table 1. Interactions between Rifab
Page 298 and 299: Mycobacterium tuberculosis: Treatme
Page 300 and 301: P: Plan Diagnostic Evaluation Durin
Page 302 and 303: Table 1. Regimens for Treatment of
Page 304 and 305: Rifabutin may be substituted for ri
Page 306: Patient Education ♦ ♦ ♦ ♦
Page 309 and 310: 6-76 | Clinical Manual for Manageme
Page 314 and 315: Non-Hodgkin Lymphoma Background Non
Page 316: Patient Education ♦ ♦ ♦ ♦ S
Page 333 and 334: 6-100| Clinical Manual for Manageme
Page 335 and 336: 6-102| Clinical Manual for Manageme
Page 338 and 339: Toxoplasmosis Background Toxoplasma
Page 340 and 341: ♦ Atovaquone 1,500 mg orally twic
Page 344 and 345: Background Necrotizing ulcerating p
Page 346 and 347: Oral Health Background Examination
Page 348 and 349: Maxillary Tori; Mandibular Tori S:
Page 350 and 351: Periodontal Disease Background The
Page 352 and 353: Oral Hairy Leukoplakia Background O
Page 354 and 355: Oral Ulceration Background Oral ulc
Page 356 and 357: Oral Warts Background Oral warts ar
Page 358 and 359: 7-2 | Clinical Manual for Managemen
Page 369 and 370: Anxiety Disorders Background Anxiet
Page 371: Patient Education ♦ ♦ Behaviora
Page 381 and 382: Insomnia Background Insomnia is a c
Page 383 and 384: Suicidal Ideation Background Transi
Page 385 and 386: Section 8—Neuropsychiatric Disord
Page 387 and 388: P: Plan ♦ ♦ ♦ ♦ ♦ Check t
Page 389 and 390: Correctional Settings Background Ca
Page 391 and 392: Adherence Adherence is one of the m
Page 393:
Karnofsky Performance Scale Backgro
Page 396 and 397:
Page 398 and 399:
Page 400:
show all

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

Create successful ePaper yourself

Delete template?

Save as template?