HIV/AIDS Treatment and Care : Clinical protocols for the European ...

More documents

Recommendations

Info

Contents I. Epidemiology and natural history of HCV in HIV infection .............................................. 229 1. Prevalence, risk factors and transmission ................................................................................. 229 1.1. Prevalence of HCV in HIV infection............................................................................. 299 1.2. Primary modes of transmission...................................................................................... 231 1.3. Genotypes ...................................................................................................................... 231 2. Access of coinfected patients to hepatitis C treatment.......................................................... 232 3. Reciprocal influences of HIV and HCV................................................................................ 232 3.1. Impact of HIV infection on HCV disease progression .................................................. 232 3.2. Impact of HCV infection on HIV disease progression .................................................. 233 II. Identification of HCV/HIV .................................................................................................... 234 1. Assessment of HCV risk and diagnosis of hepatitis C in HIV-infected patients................. 234 1.1. Initial laboratory assessment of HCV status ................................................................. 234 1.2. Evaluation of HCV disease severity.............................................................................. 235 1.2.1. Clinical evaluation of liver disease...................................................................... 235 1.2.2. Biochemical parameters....................................................................................... 235 1.2.3. Child-Pugh score.................................................................................................. 236 1.2.4. Ultrasound............................................................................................................ 236 1.2.5. Histological evaluation ........................................................................................ 236 1.2.6. Non-invasive markers of liver fibrosis................................................................. 237 1.2.7. Clinical situations not requiring histological evaluation ..................................... 237 1.3. Evaluation of comorbidities and co-conditions............................................................. 238 1.3.1. Psychiatric disorders ............................................................................................ 238 1.3.2. Alcohol abuse....................................................................................................... 238 1.3.3. Drug use............................................................................................................... 238 1.3.4. Other comorbidities and co-conditions................................................................ 238 1.4. Evaluation and treatment algorithms for hepatitis C..................................................... 240 1.4.1. Algorithm 1 .......................................................................................................... 240 1.4.2. Algorithm 2 .......................................................................................................... 242 2. Assessment of HIV risk and diagnosis of HIV/AIDS in HCV patients............................... 243 III. Clinical management of HCV/HIV patients ...................................................................... 244 1. Coinfected patients not requiring any treatment ................................................................ 244 2. Coinfected patients requiring only HCV treatment............................................................ 244 2.1. Indications for HCV treatment.................................................................................... 244 2.2. Predictors of sustained virological response probability ............................................ 244 2.3. Contraindications for hepatitis C treatment ................................................................ 245 2.4. Treatment of acute hepatitis C..................................................................................... 245 2.5. Treatment of chronic hepatitis C (doses and schedules) ............................................. 245 2.6. Treatment duration ...................................................................................................... 246 3. Coinfected patients requiring only HIV/AIDS treatment................................................... 246 3.1. Initiation of HAART ................................................................................................... 246 3.2. Considerations in choosing a HAART regimen........................................................... 247 3.3. First-line HAART regimens......................................................................................... 247 3.4. Second-line HAART regimens .................................................................................... 248
4. Coinfected patients requiring both HCV and HIV/AIDS treatment ................................... 248 4.1. Strategy for initiation of treatment............................................................................... 248 4.2. Considerations of ARVs when treating both HCV and HIV infections....................... 249 4.3. Hepatotoxicity of ARV drugs....................................................................................... 250 4.4. ARV dose adjustment in patients with cirrhosis .......................................................... 250 5. Clinical monitoring ............................................................................................................. 252 5.1. Virological response monitoring.................................................................................. 252 5.2. Histological response monitoring ................................................................................ 252 5.3. Tolerance monitoring................................................................................................... 253 5.4. Management of toxicity and side-effects of PEG-IFN + RBV treatment.................... 253 5.4.1. Anaemia and neutropenia ................................................................................... 253 5.4.2. Dose adjustment of PEG-IFN and RBV............................................................. 253 5.4.3. Influenza-like symptoms..................................................................................... 254 5.4.4. Nausea ................................................................................................................ 254 5.4.5. Depression .......................................................................................................... 254 5.4.6. Dysthyroidism .................................................................................................... 254 5.5. Management of treatment adherence........................................................................... 254 5.6. Management of non-responders................................................................................... 255 5.7. Management of end-stage liver disease....................................................................... 255 5.7.1. Testing for hepatocellular carcinoma.................................................................. 255 5.7.2. Testing for oesophageal varices.......................................................................... 255 5.8. Drug–drug interactions ................................................................................................ 256 5.8.1. Interactions between HIV drugs and HCV drugs............................................... 256 5.8.2. Interactions among recreational drugs, OST, anti-HCV drugs and ARVs.......... 256 5.9. Hepatotoxicity of TB drugs in chronic HCV infection................................................ 256 IV. Suggested minimum data to be collected at the clinical level ........................................... 257 Annex 1. Laboratory assays for HCV ....................................................................................... 258 Annex 2. Alternative biochemical tests to assess hepatic fibrosis ........................................... 260 Annex 3. Alcohol screening questionnaires ............................................................................... 261 Annex 4. Management of end-stage liver disease ..................................................................... 263 Annex 5. Research needs and alternative treatments .............................................................. 265 References .................................................................................................................................... 267
Page 1 and 2:
HIV/AIDS TREATMENT AND CARE Clinica
Page 3 and 4:
© World Health Organization 2007 A
Page 5 and 6:
iv Acknowledgements The editors wou
Page 7 and 8:
vi Marco Vitoria (WHO headquarters)
Page 9 and 10:
viii CRP C-reactive protein CS caes
Page 11 and 12:
x LFT liver function test LGE linea
Page 13 and 14:
xii TDM therapeutic drug monitoring
Page 15 and 16:
xiv Introduction HIV is a chronic i
Page 18 and 19:
��
Page 20 and 21:
Annex 7. Glossary .................
Page 22 and 23:
HIV/AIDS TREATMENT AND CARE CLINICA
Page 24 and 25:
HIV/AIDS TREATMENT AND CARE CLINICA
Page 26 and 27:
10 HIV/AIDS TREATMENT AND CARE CLIN
Page 28 and 29:
Page 30 and 31:
Page 32 and 33:
1 HIV/AIDS TREATMENT AND CARE CLINI
Page 34 and 35:
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 50 and 51:
Page 52 and 53:
Page 54 and 55:
Page 56 and 57:
Page 58 and 59:
Page 60 and 61:
Page 62 and 63:
Page 65 and 66:
��
Page 68 and 69:
I. Principles management of opportu
Page 70 and 71:
management of opportunistic infecti
Page 72 and 73:
Page 74 and 75:
Page 76 and 77:
Table 8. pcp second-line treatment
Page 78 and 79:
Page 80 and 81:
Table 12. oesophageal and dissemina
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
5.9.1.2. Treatment Table 15. treatm
Page 88 and 89:
Page 90 and 91:
Page 92 and 93:
Page 94 and 95:
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
��
Page 103 and 104:
palliative care for people living w
Page 105 and 106:
Page 107 and 108:
III. Initial evaluation palliative
Page 109 and 110:
IV. Treatment palliative care for p
Page 111 and 112:
Fig. 2. who analgesic ladder for ma
Page 113 and 114:
Type of pain or treatment Usual sta
Page 115 and 116:
Page 117 and 118:
Table 5. prevalence of symptoms in
Page 119 and 120:
Type Symptoms Possible causes Disea
Page 121 and 122:
Type Symptoms Possible causes Disea
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Table 22. Management of mania and B
Page 135 and 136:
Table 24. Management of cough or di
Page 137 and 138:
V. Special advice for terminal care
Page 139 and 140:
Table 27. common manifestations in
Page 141 and 142:
Page 143 and 144:
References palliative care for peop
Page 145 and 146:
��
Page 147 and 148:
VI. Suggested minimum data to be co
Page 149 and 150:
136 HIV/AIDS TREATMENT AND CARE CLI
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Contents I. Policy and principles .
Page 175 and 176:
I. Policy and principles HIV/AIDS T
Page 177 and 178:
HIV/AIDS TREATMENT AND CARE FOR INJ
Page 179 and 180:
° bacterial pneumonia ° endocardi
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188: HIV/AIDS TREATMENT AND CARE FOR INJ
Page 197 and 198: Social factors are: • homelessnes
Page 199 and 200: Table 3. Interactions between ARV d
Page 203 and 204: Other medications Use Rifampicin (R
Page 205 and 206: Table 5. Interactions of illicit dr
Page 209 and 210: ANNEX 1 ASI6 C © 2004 University o
Page 225 and 226: • Cardiovascular Hypertension Tac
Page 235: HIV/AIDS TREATMENT AND CARE FOR INJ
Page 240 and 241: ManageMent of Hepatitis C and HiV C
Page 272 and 273: Annex 3. Alcohol screening question
Page 278 and 279: Table 16. a sample of the drug pipe
Page 284 and 285: ��
Page 286 and 287: 3.2. Considerations regarding treat
Page 288 and 289:
278 hiv/aids tReatment and caRe cLi
Page 290 and 291:
Page 292 and 293:
Page 294 and 295:
Page 296 and 297:
Page 298 and 299:
Page 300 and 301:
Page 302 and 303:
Page 304 and 305:
Page 306 and 307:
Page 309 and 310:
��
Page 312 and 313:
I. Prevention strategies Prevention
Page 314 and 315:
Prevention of HePatitis a, B, C and
Page 316 and 317:
Prevention of HePatitis a, B, C and
Page 318 and 319:
��
Page 320 and 321:
5. Contraceptive methods for women
Page 322 and 323:
Page 324 and 325:
Page 326 and 327:
Page 328 and 329:
Page 330 and 331:
Page 332 and 333:
Page 334 and 335:
Page 336 and 337:
Page 338 and 339:
Page 340 and 341:
Page 342 and 343:
Page 344 and 345:
Page 346 and 347:
Page 348 and 349:
Page 350 and 351:
Page 352 and 353:
Page 354 and 355:
Page 356 and 357:
Page 358 and 359:
Page 360 and 361:
Page 362 and 363:
Page 364 and 365:
Page 366 and 367:
Page 368:
��
Page 372 and 373:
I. Policy issues Prevention of Hiv
Page 374 and 375:
III. Initial evaluation Prevention
Page 376 and 377:
Prevention of Hiv transmission from
Page 378 and 379:
Page 380 and 381:
Page 382 and 383:
Page 384 and 385:
Page 386 and 387:
Page 388 and 389:
Page 390 and 391:
Page 392 and 393:
Page 394 and 395:
Page 396 and 397:
��
Page 398 and 399:
6. Fungal infections...............
Page 400 and 401:
Page 402 and 403:
Page 404 and 405:
Page 406 and 407:
Page 408 and 409:
Page 410 and 411:
Page 412 and 413:
Page 414 and 415:
Page 416 and 417:
Page 418 and 419:
Page 420 and 421:
Page 422 and 423:
Page 424 and 425:
Page 426 and 427:
Page 428:
Page 431 and 432:
• Disseminated non-tuberculous my
Page 434 and 435:
Page 436 and 437:
Page 438 and 439:
Page 440 and 441:
Page 443 and 444:
��
Page 445 and 446:
Annex 3. Rabies vaccines ..........
Page 447 and 448:
442 hIv/aIds tReatment and caRe clI
Page 449 and 450:
Page 451 and 452:
Page 453 and 454:
Page 455 and 456:
Page 457 and 458:
Page 459 and 460:
Page 461 and 462:
Page 463 and 464:
Page 465 and 466:
Page 467 and 468:
Page 469 and 470:
Page 471 and 472:
Contents I. Policy issues .........
Page 473 and 474:
I. Policy issues post-exposure prop
Page 475 and 476:
post-exposure prophylaxis for hiv i
Page 477 and 478:
Page 479 and 480:
° condom use ° presence of STIs (
Page 481 and 482:
Page 483 and 484:
Table 3. thre- drug arv regimens Pr
Page 485 and 486:
Page 487 and 488:
Page 489 and 490:
VI. Suggested minimum data to be co
Page 491 and 492:
Page 493 and 494:
History of antiretroviral treatment
Page 495 and 496:
Test results: HBV: HCV: HIV: Post-t
Page 497 and 498:
Infection control standard precauti
Page 499 and 500:
Page 501:
The World Health Organization (WHO)
show all

HIV/AIDS Treatment and Care : Clinical protocols for the European ...

Create successful ePaper yourself

Delete template?

Save as template?