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2–12 | Clinical Manual for Management of the HIV-Infected Adult/2006 References ♦ ♦ ♦ ♦ AIDS Project Los Angeles. APLA Nutrition Fact Sheets. Los Angeles: APLA; 2005. Available online at http://www.apla.org/programs/nutrition.html. Accessed June 1, 2006. Association of Nutrition Services Agencies. ANSA Nutrition Guidelines and Fact Sheets. (Select “Resources”, then “ANSA Publications”). Accessed June 1, 2006. Bartlett JG. Introduction. Integrating nutrition therapy into medical management of human immunodeficiency virus. Clin Infect Dis. 2003 Apr 1;36(Suppl 2):S51. Health Resources and Services Administration, HIV/AIDS Bureau. Health Care and HIV: Nutritional Guide for Providers and Clients; 2nd ed. Online manual, also in Spanish. 2002. Available online at http://www.aids-etc.org/aidsetc?page=et- 30-20-01. Accessed June 1, 2006.
Nonoccupational Postexposure Prophylaxis Background Although avoiding exposure to HIV is the only reliable way of preventing HIV infection, postexposure prophylaxis (PEP) can decrease the risk of infection after exposure to HIV. Antiretroviral (ARV) therapy is an important prophylactic intervention in appropriate persons with nonoccupational exposures (eg, sexual contact; sharing of injection drug needles or other equipment), as well as those with occupational exposures (eg, needlesticks). The U.S. Department of Health and Human Services has established guidelines for nonoccupational PEP (nPEP) based on data from animal models, perinatal clinical trials, and observational studies. Overall, the data suggest that nPEP is more likely to be effective when the exposure is a single episode and nPEP is initiated in a timely manner. It is not appropriate for cases of multiple sexual exposures or injection drug use (IDU) exposures over time or for exposures that occurred more than 72 hours before starting nPEP treatment (Figure 1). The model for nPEP is derived in part from protocols for occupational PEP (eg, in terms of risk stratification, pretreatment testing, timing of treatment, treatment regimens, and duration of treatment). However, the recommendations for PEP and nPEP are distinct from each other and should not be confused. The nPEP guidelines exclude exposures to workers in health care, public safety, sanitation, and laboratory settings. Guidelines for the management of these occupational exposures to HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) are available at: http://www. aidsinfo.nih.gov. S: Subjective The patient reports potential exposure to HIV through a sexual encounter or the sharing of needles or other equipment for intravenous drug use. Take a thorough history of the specific sexual or druguse activities and the time the exposure occurred, the HIV status of the source person (if known), and HIV risk factors of the source person (if HIV status is not known). In cases of sexual assault, evidence collection and specific paperwork may be required as well. Section 2—Health Maintenance and Disease Prevention | 2–13 O: Objective Examine for trauma and for signs or symptoms of sexually transmitted diseases (STDs), which may increase the risk of HIV transmission. In injection drug users, examine for abscesses and signs or symptoms of infection. For women who may be pregnant, perform a pregnancy test. A: Assessment Assess potential exposures to HIV, other STDs and bloodborne pathogens. The risk of HIV infection depends on the HIV status of the source and on the characteristics of the exposure. The estimated risk of HIV exposure will determine whether nPEP should be offered. Figure 1 presents an algorithm for risk evaluation and treatment decisions. Figure 1. Algorithm for Evaluation and Treatment of Possible Nonoccupational HIV Exposures Source: Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States, Recommendations from the U.S. Department of Health and Human Services. January 2005. See http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm#fig1 for original image.
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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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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
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Page 51 and 52: Section 2—Health Maintenance and
Page 53: References ♦ ♦ ♦ ♦ ♦ ♦
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 75 and 76: as hepatitis C or another sexually
Page 77 and 78: for treatment is appropriate, and b
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
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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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Patient Education ♦ ♦ ♦ ♦
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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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♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦
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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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♦ ♦ ♦ ♦ ♦ 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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