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7–8 | Clinical Manual for Management of the HIV-Infected Adult/2006 Table 1. Common Symptoms in Patients with AIDS and Possible Disease-Specific and Palliative Interventions Symptom Possible Causes Disease-Specific or Curative Treatment CONSTITUTIONAL Fatigue, weakness • AIDS • Opportunistic infections (OIs) • Anemia Weight loss/ anorexia • HIV • Malignancy Fevers, sweats • Disseminated MAC and other infections • HIV lymphoma, and other malignancies PAIN Nociceptive, somatic, visceral • Opportunistic infections • HIV-related malignancies, nonspecific Neuropathic • HIV-related peripheral neuropathy • Cytomegalovirus (CMV) • Varicella zoster virus (VZV) • Medications (eg, dideoxynucleosides: didanosine, zalcitabine, stavudine), isoniazid, vincristine • • • • • • ART Treat specific infections Erythropoietin, transfusion ART Chemotherapy Nutritional support/enteral feedings • Specific treatment of OIs or malignancy • ART Specific treatment of disease entities Palliative Treatment* • • • • • • • • • • • • • • NSAIDS • • • ART Discontinue offending medication; Change antiretroviral or other regimen • • Psychostimulants (methylphenidate, pemoline, dextroamphetamine, modafinil) Testosterone/androgens Corticosteroids (prednisone, dexamethasone) Testosterone/androgens Oxandrolone Megestrol acetate Dronabinol Recombinant growth hormone Corticosteroids Nonsteroidal anti-inflammatory drugs (NSAIDs, ibuprofen, naproxen, indomethacin) Anticholinergics (hyoscine, thioridazine) H2-antagonists (cimetidine) Opioids Corticosteroids • NSAIDS • Neuropathic pain medications: • tricyclics (amitriptyline, imipramine) • benzodiazepines (clonazepam) • anticonvulsants (gabapentin, lamotrigine) • Opioids (eg, methadone) and adjuvants • Corticosteroids • Acupuncture
GASTROINTESTINAL Nausea, vomiting • Antiretroviral medications • Esophageal candidiasis • CMV Diarrhea • MAC • • • • • Cryptosporidiosis CMV microsporidiosis Other intestinal infections Malabsorption Medications (eg, protease inhibitors) Constipation • Dehydration RESPIRATORY • • Dyspnea • PCP • • • • Malignancy Anticholinergic medications Opioids Bacterial pneumonia Anemia Pleural effusion, mass, or obstruction Decreased respiratory muscle function Cough • PCP, bacterial Increased secretions (“death rattle”) • • • • • • • • pneumonia TB Acid reflux Postnasal drip Fluid shifts Ineffective cough Sepsis Pneumonia • Specific treatment of disease entities • Change antiretroviral regimen • Specific treatment of disease entities • Discontinue offending medication • • • • • • Hydration Radiation and chemotherapy Medication adjustment Specific treatment of disease entities Erythropoietin, transfusion Drainage, radiation, or surgery • • • • • • • • • • • • • • • • • • • • • • • • • • • Section 7—Pain and Palliative Care | 7–9 Dopamine antagonists (prochlorperazine, haloperidol) Prokinetic agents (metoclopramide) Antihistamines (diphenhydramine, promethazine) Anticholinergics (hyoscine, scopolamine) Serotonin antagonists (granisetron, ondansetron, dolasetron) H2 blockers (cimetidine) Proton pump inhibitors (omeprazole) Somatostatin analogues (octreotide) Benzodiazepines (lorazepam) Marijuana, dronabinol Bismuth, methylcellulose Psyllium Kaolin Diphenoxylate + atropine Loperamide Calcium carbonate Ferrous sulfate Octreotide Tincture of opium Activity/diet Prophylaxis for patients taking opioids Peristalsis-stimulating agents: • • • anthracenes (senna) polyphenolics (bisacodyl) Softening agents: –surfactant laxatives (docusate) –bulk-forming agents (bran, methylcellulose) –osmotic laxatives (lactulose, sorbitol) –saline laxatives (magnesium hydroxide) Use of fan, open windows, oxygen Opioids Bronchodilators Methylxanthines Benzodiazepines (eg, lorazepam) • Specific treatment • Cough suppressants (dextromethorphan, codeine, other opioids) of disease entities • Decongestants, expectorants (various) • Antibiotics as • Atropine, hyoscine, transdermal scopolamine, glycopyrrolate indicated • Fluid restriction, discontinue intravenous fluids
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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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Recreational Drugs and Antiretrovir
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Section 4—Complications of Antire
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LSD, Mescaline, Psilocin, and Methy
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Immune Reconstitution Syndrome Back
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A: Assessment In the appropriate cl
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♦ ♦ ♦ ♦ ♦ Navas E, Martin
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Eye Problems Background The immunos
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of
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Fever Background Although fever may
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Headache Background Headache may ha
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Lymphadenopathy Background Lymphade
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Treatment Treatment will depend on
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Neurologic Symptoms Background The
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Pulmonary Symptoms Background Short
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Treatment Once the diagnosis is mad
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Candidiasis, Oral and Esophageal Ba
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Maintenance therapy Use caution whe
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Cervical Dysplasia Background Cervi
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Patient Education ♦ ♦ ♦ ♦ P
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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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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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Page 314 and 315: Non-Hodgkin Lymphoma Background Non
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Page 338 and 339: Toxoplasmosis Background Toxoplasma
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Page 342 and 343: Linear Gingival Erythema Background
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Page 346 and 347: Oral Health Background Examination
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