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close this bookNational Guidelines for the Clinical Management of HIV/AIDS - Tanzania (NACP; 2005; 131 pages)
View the documentLIST OF ABBREVIATIONS
View the documentACKNOWLEDGEMENTS
View the documentFOREWORD
Open this folder and view contentsCHAPTER 1: INTRODUCTION
Open this folder and view contentsCHAPTER 2: ORGANIZATION OF HIV/AIDS CARE AND TREATMENT
Open this folder and view contentsCHAPTER 3: HIV/AIDS PREVENTION
Open this folder and view contentsCHAPTER 4: PROTECTIVE MEASURES AGAINST HIV TRANSMISSION
Open this folder and view contentsCHAPTER 5: LABORATORY TESTS IN HIV/AIDS
Open this folder and view contentsCHAPTER 6: HIV/AIDS AND PREGNANCY
Open this folder and view contentsCHAPTER 7: PEDIATRIC HIV/AIDS AND RELATED CONDITIONS
Open this folder and view contentsCHAPTER 8: COMMUNITY AND HOME BASED CARE FOR PEOPLE LIVING WITH HIV/AIDS (PLHA)
Open this folder and view contentsCHAPTER 9: COUNSELLING RELATED TO HIV-TESTING AND TREATMENT ADHERENCE
close this folderCHAPTER 10: MANAGEMENT OF COMMON SYMPTOMS AND OPPORTUNISTIC INFECTIONS IN HIV/AIDS
View the document10.1 Introduction
Open this folder and view contents10.2 Clinical features commonly encountered in patients with HIV/AIDS
Open this folder and view contents10.3 Prophylactic treatment of common opportunistic infections in HIV/AIDS
close this folder10.4 Treatment of Opportunistic Infections:
View the document10.4.1 Viral infections
View the document10.4.2 Bacterial infections
View the document10.4.3 Fungal infections
View the document10.4.4 Protozoa
Open this folder and view contentsCHAPTER 11: MANAGEMENT OF MENTAL HEALTH PROBLEMS IN HIV/AIDS
Open this folder and view contentsCHAPTER 12: MANAGEMENT OF HIV INFECTED PATIENTS USING ANTIRETROVIRAL DRUGS
Open this folder and view contentsCHAPTER 13: ARV THERAPY IN INFANTS AND CHILDREN
Open this folder and view contentsCHAPTER 14: USE OF ARVS IN SPECIAL CIRCUMSTANCES
Open this folder and view contentsCHAPTER 15: HIV/AIDS AND NUTRITION
Open this folder and view contentsCHAPTER 16: MANAGEMENT OF ANTIRETROVIRAL MEDICINES
Open this folder and view contentsCHAPTER 17: CERTIFICATION OF HEALTHCARE FACILITIES AS CARE AND TREATMENT SITES
 

10.4.3 Fungal infections

Fungal infections commonly found in association with HIV/AIDS include: Cryptococcus neoformans, Pneumocystic jivoreci, Candida species, Histoplasma capsulatum and several others.

Cryptococcus neoformans

Major cause of meningitis in HIV infected persons and disseminated disease may occur. Contrary to bacterial meningitis, fever may be absent in these cases. Diagnosis depends on demonstration of positive CSF Indian Ink preparation.

Treatment

The preferred regimen is Amphotericin B 0.7mg/kg/day IV + 5 Fluorocytosine 100m/kg/day orally fr 14 days, for induction phase, then Fluconazole 400mg/kg/day for 8 weeks until CSF is sterile (consolidation phase)

Maintenance therapy is Fluconazole 200mg per day (suppressive phase)

Fluconazole I.V. 400mg/day x 10 days until the patient can take orally then continue with the same dose for 10 weeks. Thereafter maintain 200 mg daily on alternate days as secondary chemoprophylaxis (is this WHO regime??)

Candidiasis

Is the most common fungal infection in HIV/AIDS.

Clinical manifestations depend on the site of disease which include oral, pharynx, esophagus, vagina, etc.

NB. Candidiasis in the esophagus, trachea, bronchi or lungs is diagnostic of AIDS

Diagnosis:

The diagnosis is mainly based on clinical findings.

Treatment

The following drugs are recommended:-

Miconazole nitrate

Clotrimazole

2% sodium benzoate solution

Nystatin oral suspension

Fluconazole 150mg/day or 200mg/day for 2-3 weeks (for oro-pharyngeal candidiasis and others).

NB. Treatment is continued until symptoms resolve

Pneumocystis jiroveci pneumonia (PCP)

Quite common in Tanzania especially among HIV infected children.

Clinical presentation

Typically patients with PCP present with:

Non-productive cough, fever, chest tightness and shortness of breath that has evolved over 2-4 weeks.

Chest signs may be minimal despite severe shortness of breath

CXR may show diffuse and symmetrical increased interstitial markings to diffuse alveolar pattern with infiltrations characterized by asymmetry, nodularity or cavitations. Chest radiograph may appear normal in 10-30% of patients.

Diagnosis

In our circumstances diagnosis is based on clinical presentation and exclusion of other common causes of severe dyspnoea.

Treatment of PCP

Trimethoprim 12-15 mg/kg/day + Sulphamethoxazole 75 mg/kg/day - PO/IV for 21 days in 3 divided doses, or cotrimoxazole 1920 mg 3 times/day for 21 days

For those allergic to sulpha:

Trimethoprim 12-15mg/kg/day + Dapsone 100mg/day for 21 days

Prophylaxis therapy for PCP

Give Trimethoprim-sulphamethoxazole (TMP-SMX) as shown above.

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