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management of opportunistic infections and general symptoms of hiv/aids 5.9.5.2. Lymphocytic interstitial pneumonitis (LIP) • LIP occurs primarily in children, but it also occurs in adult PLHIV. • It is characterized by diffused interstitial pulmonary infiltrates that may be confused with TB or PCP. However, patients with LIP often do not have signs of severe respiratory illness. • No specific treatment is available for LIP. 75
76 HIV/AIDS TREATMENT AND CARE CLINICAL PROTOCOLS FOR THE WHO EUROPEAN REGION III. General symptoms 1. Persistent generalized lymphadenopathy (PGL) in adults • The most common clinical manifestation of HIV infection is symmetric generalized lymph node enlargement. • Enlarged lymph nodes are generally painless, firm, mobile and rubbery and are most easily palpated in the neck, submental area, axillae and the groin. • The patient may or may not have other associated symptoms of HIV infection. • PGL is defined as the presence for more than one month of lymph nodes measuring more than 1 cm in diameter in more than one area of the body other than the groin. • PGL is a very common feature of HIV infection. In most cases a lymph node histology only reveals “reactive hyperplasia” or “follicular hyperplasia”. A lymph node biopsy is necessary to establish a cause. 1.1. Diagnosis It is important to palpate lymph nodes specifically in the following areas: • anterior and posterior triangles of the neck • submental area • suboccipital area • anterior and posterior auricular areas • both axillae • epitrochlear areas • both inguinal regions. Patients with PGL caused by HIV infection may have other features of HIV infection, including: • oral thrush • oral hairy leukoplakia • pruritic skin rash • hyperpigmented nails • oral or genital herpes • involuntary weight loss • unexplained fever. PGL may be caused by a number of conditions other than HIV infection, including TB, leukaemia, lymphoma, KS, syphilis, Chlamydia trachomatis (lymphogranuloma venereum), CMV, toxoplasmosis, EBV, cryptococcosis, histoplasmosis and septic skin conditions, bubonic plague and hepatitis B. 1.2. Criteria for performing a lymph node biopsy A patient with PGL should be referred for a lymph node biopsy if presenting with any of the following: • asymmetrical lymph node enlargement • massive lymph node enlargement (at least one lymph node >3 cm in diameter) • lymph node enlargement over a period of observation • evidence of TB on a chest X-ray • evidence of hilar lymph node enlargement on a chest X-ray • evidence of KS elsewhere • fever, night sweats and weight loss for more than one week. A diagnosis of HIV-related lymphadenopathy does not rule out other serious diseases like lymphoma in unbiopsied lymph nodes. Therefore, with any change in condition, persistent fever or other suspicious circumstance, a biopsy or lymphadenectomy should be repeated.
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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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palliative care for people living w
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References palliative care for peop
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VI. Suggested minimum data to be co
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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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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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History of antiretroviral treatment
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Test results: HBV: HCV: HIV: Post-t
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The World Health Organization (WHO)
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