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

management of opportunistic infections and general symptoms of hiv/aids
• Dissemination can also occur at the same time, with involvement of skin, nervous system, lungs
and mucous membranes.
• In immunosuppressed patients, zoster is often multidermatomal in distribution, persistent, extensive
and associated with severe pain and debility.
5.9.3.1. Diagnosis
The diagnosis is usually made on clinical grounds.
5.9.3.2. Treatment
Table 20. treatment of dermatomal zoster
Antiviral agent Dose Frequency Route Duration
First-line treatment
Aciclovir 800 mg 5 times a day PO 7–10 days
or until lesions crust
or:
Famciclovir 500 mg TID PO 7–10 days
Table 21. treatment of disseminated, visceral or ophthalmic zoster
Antiviral agent Dose Frequency Route Duration
First-line treatment
Aciclovir 10 mg/kg TID IV 7–10 days
or:
Famciclovir 500 mg TID PO 7–10 days
Second-line treatment
Foscarnet 60 mg/kg
or 40 mg/kg
BID
TID
IV 7–10 days
• Post-herpetic neuralgia is a common and seriously debilitating problem. It causes severe pain in
dermatomal distribution, usually at the site of the lesions.
• Pain control is often necessary and may be achieved with non-steroidal anti-inflammatory drugs
(NSAIDs).
• If pain control is not achieved, amitryptiline, carbamazepine or phenytoin may be tried.
5.9.4. Cytomegalovirus (CMV) infection
CMV may affect multiple systems and organs in immunosuppressed individuals. Symptoms may
include:
• fever and diarrhoea from CMV colitis
• dyspnoea from CMV pneumonitis
• blindness caused by CMV retinitis
• the appearance of painful ulcers in the mouth, resulting in difficulty eating.
5.9.4.1. Diagnosis
• The most frequent localization is the retina and is diagnosed by a specialized ophthalmologist.
• Other localizations require sophisticated equipment and costly tests, such as tissue biopsies and
deoxyribonucleic acid (DNA) hybridization studies.
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