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

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HIV/AIDS TREATMENT AND CARE CLINICAL PROTOCOLS FOR THE WHO EUROPEAN REGION 1.2. Physical examination The physical examination should document presenting symptoms and signs and reproducible results so that other physicians can determine changes in status. A standardized history and examination questionnaire is preferable; see Table 2. Table 2. Initial physical examination General appearance: • height and weight • body morphology (lipodystrophy) • Karnowsky index or other standardized scale for general fitness Vital signs: • blood pressure • temperature • pulse • respiratory rate Lymph nodes Skin (entire body): • in particular, assess for ° active or former herpes zoster ° liver disease ° Kaposi sarcoma ° seborrhoeic dermatitis ° injection sites in injecting drug users (IDUs) The documentation of skin disorders such as discoloured brown or dark patches is best made with photos; other possibilities include drawing the area of a patch on transparent foil, to be able to compare in future in examinations. Oro-pharynx: • oral health and dental status • signs for: ° oral candidiasis ° oral hairy leukoplakia ° primary syphilis Thorax and lungs: • signs (breathing, cough, dyspnoea) • form of thorax • control for risk of emphysema Mamma examination (in female and male patients) to control for risk of carcinoma Cardiac examination for baseline information when there may be higher risk for cardiovascular complications with ART (9, 10) or risk for endocarditis in IDUs Abdominal examination (for baseline information for ART side-effects, especially in cases of chronic hepatitis, alcohol toxicity and cirrhosis): • consistency, size and shape of liver and spleen • bowel movement • tenderness • rigidity • nausea, vomiting, disphagia Genital and anal region examination: • signs for: ° herpes simplex ° cytomegalovirus (CMV) ° syphilis ° Human papilloma virus (HPV), (condylomata acuminatae, anal carcinoma) (11), other STIs ° erectile dysfunction Legs (movement, mobility, lipodystrophy) to provide baseline information for ART side-effects Neurological status (also signs of neuropathy) Mental status Eye and ear functions
1.3. Laboratory and other examinations Table 3. Laboratory testing PATIENT EVALUATION AND ANTIRETROVIRAL TREATMENT FOR ADULTS AND ADOLESCENTS HIV-related testing: • HIV serological testing (typically an enzyme-linked immunosorbent assay (ELISA) or rapid blood test), followed by confirmatory test (typically western blot) (12) • CD4 cell count to determine the severity of immunodeficiency; in pregnant women CD4 % (13, 14) • viral load testing by polymerase chain reaction (PCR), to determine level of viral replication a Other infectious disease testing: Routine testing: • venereal disease research laboratory (VDRL) test for syphilis • serological tests for hepatitis C and B viruses (HCV and HBV) – i.e. HCV antibodies and hepatitis B surface antigen (HBsAg) b • toxoplasma immunoglobulin G (IgG) serological test and information about risk of infection if negative If indicated: • vaginal, penile or anal (as appropriate) swab for gonorrhoea and Chlamydia trachomatis • Cryptococcus antigen titre when CD4 cell count is
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Page 5 and 6: iv Acknowledgements The editors wou
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management of opportunistic infecti
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5.9.1.2. Treatment Table 15. treatm
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palliative care for people living w
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III. Initial evaluation palliative
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IV. Treatment palliative care for p
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Fig. 2. who analgesic ladder for ma
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Type of pain or treatment Usual sta
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Table 5. prevalence of symptoms in
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Type Symptoms Possible causes Disea
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Type Symptoms Possible causes Disea
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Table 22. Management of mania and B
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V. Special advice for terminal care
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Table 27. common manifestations in
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References palliative care for peop
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VI. Suggested minimum data to be co
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136 HIV/AIDS TREATMENT AND CARE CLI
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Contents I. Policy and principles .
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I. Policy and principles HIV/AIDS T
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HIV/AIDS TREATMENT AND CARE FOR INJ
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° bacterial pneumonia ° endocardi
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Social factors are: • homelessnes
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Table 3. Interactions between ARV d
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Other medications Use Rifampicin (R
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Table 5. Interactions of illicit dr
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ANNEX 1 ASI6 C © 2004 University o
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• Cardiovascular Hypertension Tac
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Contents I. Epidemiology and natura
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ManageMent of Hepatitis C and HiV C
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Annex 3. Alcohol screening question
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Table 16. a sample of the drug pipe
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3.2. Considerations regarding treat
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I. Prevention strategies Prevention
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Prevention of HePatitis a, B, C and
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Prevention of HePatitis a, B, C and
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5. Contraceptive methods for women
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I. Policy issues Prevention of Hiv
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III. Initial evaluation Prevention
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Prevention of Hiv transmission from
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6. Fungal infections...............
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• Disseminated non-tuberculous my
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Annex 3. Rabies vaccines ..........
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442 hIv/aIds tReatment and caRe clI
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Contents I. Policy issues .........
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I. Policy issues post-exposure prop
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post-exposure prophylaxis for hiv i
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° condom use ° presence of STIs (
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Table 3. thre- drug arv regimens Pr
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VI. Suggested minimum data to be co
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History of antiretroviral treatment
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Test results: HBV: HCV: HIV: Post-t
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Infection control standard precauti
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The World Health Organization (WHO)
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