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324 HIV/AIDS TREATMENT AND CARE CLINICAL PROTOCOLS FOR THE WHO EUROPEAN REGION 3.2. Interactions of STI/RTI drugs and ARVs If PLHIV are on ART, possible drug interactions with other STI treatment drugs should be considered and discussed with them (see Table 6). Table 6. interactions between other sti/rti drugs and arvs STI/RTI agent STI/RTI agent dosage Azithromycin Ciprofloxacin Co-trimoxazole (TMP/SMX) Erythromycin base (E-Base, Ilosone, E- Mycin, Eryc, Ery-Tab) Famciclovir (Famvir) 600 mg x 1 dose 1200 mg x 1 dose 750 mg Q12H x 3 days 750 mg x 1 dose 160/800 mg Q12H x 1 week ARV ARV dosage EFV 400 mg x 7 days IDV 800 mg TID ddI 200 mg (bufferedformulation) Q12H x 3 days ddI 400 mg (enteric coated capsule) x 1 dose IDV 400 mg Q6H x 1 week Agent effect on ARV levels No significant change No significant change ddI AUC: ↓ 16%; Cmax: ↓ 28% Not studied No significant change — APV — Not studied; may ↑ APV levels 250 mg QID x 7 days 500 mg x 1 dose SQV 1200 mg TID FTC 200 mg x 1 dose SQV AUC: ↑ 99%; Cmax: ↑ 106% No significant change ARV effect on agent levels Azithromycin AUC: no significant change; Cmax: ↑ 22% Potential clinical effects Management — No dose adjustment necessary — — No dose adjustment necessary Ciprofloxacin AUC: ↓ 15-fold (with simultaneous ddI dosing); ↓ 26% when ciprofloxacin is dosed 2 hours before or 6 hours after ddI tablets. No significant change TMP AUC: ↑ 19%; SMX AUC: no significant change Not studied; may increase erythromycin levels ↓ ciprofloxacin effects — ↑ SQV effects — No significant change Consider ddI enteric coated capsule or administer ddI tablets/ suspension 6 hours prior to or 2 hours after ciprofloxacinadministration — No dose adjustment necessary — No dose adjustment necessary — Dose adjustment not established Dose adjustment not established No dose adjustment necessary Suggested alternative agent(s) — — — — — Azithromycin,clarithromycin — —
STI/RTI agent STI/RTI agent dosage Metronidazole (Flagyl) Sufamethoxazole Trimethoprim (Trimpex) ARV ARV dosage — APV Oral solution (containspropylene glycol) — LPV/r Oral solution (contains alcohol) — RTV Oral solution (contains alcohol) and capsules 1000 mg x 1 dose 200 mg x 1 dose ddI 200 mg (bufferedformulation) x 1 dose ddI 200 mg (bufferedformulation) x 1 dose ↑: increase; ↓: decrease; QID: four times daily Source: HIV InSite (19). support for sexual and reproductive health in people living with hiv Agent effect on ARV levels ARV effect on agent levels Potential clinical effects — — Propylene glycol toxicity (acidosis, CNS depression) — — Disulfiram reaction (hypotension headache, nausea, vomiting) — — Disulfiram-like reaction (headache, hypotension, flushing, vomiting) No significant change ddI AUC: no significant change; Cmax: ↑ 17% No significant change TMP AUC: no significant change; Cmax: ↓ 22% Management Do not coadminister with APV oral solution Do not coadminister; consider LPV/r capsules Do not coadminister — No dose adjustment necessary — No dose adjustment necessary Suggested alternative agent(s) Amprenavir capsules 4. Violence related to gender and sexuality Gender- and sexuality-related violence has a detrimental effect on a victim’s physical, emotional and social life. By understanding the range of complications he or she may be experiencing, health care providers are able to offer more effective HIV/AIDS treatment. In many cases the victim, who is most often female, will not only be infected with HIV by the perpetrator, but also, due to feelings of low self-worth, socioeconomic factors or oppressive tactics, she will not be diagnosed until a later stage of the disease (39, 40). Treating PLHIV who have been subjected to violence requires the provider to do the following things (39, 41–44): • Routinely evaluate the possibility of violence for all female (and male when indicated) HIVinfected patients. • Keep the health and welfare of the patient as the first priority. “Safety first” and “do no harm” should be guiding principles. • Avoid retraumatizing the patient with questions that are likely to provoke a strong or emotional reaction, cause distress or insinuate a negative judgement. • Be prepared to respond to distress and highlight the patient’s strengths. • Be prepared to provide appropriate care, follow-up and support services (referrals). • Maintain confidentiality. — — — — 325
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HIV/AIDS TREATMENT AND CARE Clinica
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© World Health Organization 2007 A
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iv Acknowledgements The editors wou
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vi Marco Vitoria (WHO headquarters)
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viii CRP C-reactive protein CS caes
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x LFT liver function test LGE linea
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xii TDM therapeutic drug monitoring
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xiv Introduction HIV is a chronic i
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Annex 7. Glossary .................
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HIV/AIDS TREATMENT AND CARE CLINICA
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HIV/AIDS TREATMENT AND CARE CLINICA
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10 HIV/AIDS TREATMENT AND CARE CLIN
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1 HIV/AIDS TREATMENT AND CARE CLINI
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I. Principles management of opportu
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management of opportunistic infecti
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Table 8. pcp second-line treatment
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Table 12. oesophageal and dissemina
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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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Table 24. Management of cough or di
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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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Page 282 and 283: ManageMent of Hepatitis C and HiV C
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Page 312 and 313: I. Prevention strategies 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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