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350 HIV/AIDS TREATMENT AND CARE CLINICAL PROTOCOLS FOR THE WHO EUROPEAN REGION Annex 2. Management of syphilis in PLHIV • Cell-mediated and humoral immunity may modify the natural course of syphilis infection in HIV-coinfected individuals. • The diagnostic and treatment of syphilis-coinfected PLHIV may be different due to a rapid clinical course with unusual manifestations, including increased risk of neurological manifestations and increased treatment failure rates (6). • The recommended treatment for early syphilis does not change for PLHIV. When possible, the cerebrospinal fluid (CSF) should be examined and a more intensive treatment be administered, regardless of the clinical stage of syphilis (92). • Clinical and serological evaluations of syphilis-coinfected patients should occur at 3, 6, 9, 12 and 24 months. • In case of treatment failure, re-treatment should be undertaken as appropriate (6).
support for sexual and reproductive health in people living with hiv Annex 3. Management of vulvovaginal candidiasis in women living with HIV The controversy over whether vulvovaginal candidiasis (VVC), particularly recurrent VVC, is more common in women living with HIV than in matched control HIV-negative women remains largely unresolved (93). Thus, it may be inappropriate to propose HIV testing in women with recurrent VVC. In women living with HIV, candidiasis frequently involves several sites, including the vulva and vagina. It is often severe and frequently relapses. The microbiological spectrum of VVC appears similar in HIV-positive and HIV-negative women (93). Treatment involves topical application of a wide variety of imidazoles (miconazole, clotrimazole, econazole, butoconazole, terconazole, etc.) or nystatin. Although more expensive, imidazoles require shorter courses of treatment and appear to be more effective than nystatin (94). Treatment principles are identical to those for HIV-negative women. There is no evidence of refractory VVC responding to conventional antifungal treatment. Repeated treatment may be required for women living with HIV. It is recommended that any predisposing factors such as antibiotic use, the use of antiseptic/antibiotic vaginal preparations or vaginal douching be reduced or eliminated. Simultaneous treatment of rectal focuses with oral nystatin or fluconazole is useful in preventing recurrences. Although treatment of sexual partners is not recommended, it may be considered for women who have recurrent infection. Table 13. vaginal candidiasis Antifungal agent First-line treatment Dose Frequency Route Duration Fluconazole 100 mg Single dose PO Once Clotrimazole Second-line treatment 500 mg Single dose Vaginal Once Ketoconazole 200 mg BID PO 3 days Ketoconazole Maintenance therapy 200 mg OD PO 7 days Nystatin or: 2–4 million IU BID PO 10 days Fluconazole Third-line treatment 50–200 mg OD PO Every day Ketoconazole 200 mg OD PO Depends on response, usually 7–10 days Itraconazole PO: per os (orally) 100 mg OD PO Depends on response, usually 7–10 days 351
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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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3.2. Considerations regarding treat
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278 hiv/aids tReatment and caRe cLi
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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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