TITLE

Guidelines: Opportunistic Infections and HIV Patients

AUTHOR(S)
Winslow, Dean L.
PUB. DATE
September 2009
SOURCE
Travel Medicine Advisor;Sep2009, Vol. 19 Issue 9, p52
SOURCE TYPE
Periodical
DOC. TYPE
Article
ABSTRACT
THESE GUIDELINES WERE LAST UPDATED FOR ADULTS IN 2002 and for adolescents in 2004. The document (available in pdf format through the link above) is a 209-page file containing 1,391 references that update current recommendations for the prophylaxis and treatment of HIV-related OIs. As with most guidelines published in recent years by professional societies, a well-qualified expert panel has thoroughly reviewed both new and old data and has developed a relatively comprehensive document that will be of use to physicians who treat complicated HIV patients. An attempt has been made to qualify recommendations with both the strength and quality of evidence supporting each recommendation. Obviously, it is not possible to summarize the entire document, but six major changes from previous iterations of the OI guidelines stand out in the March 24, 2009 guidelines: • Emphasis is placed on the importance of antiretrovirals for the prevention and treatment of OIs, especially for those diseases in which specific antimicrobial treatment is minimally effective. • Guidance on the diagnosis and management of immune reconstitution/inflammatory syndrome (IRIS) complicating specific OIs is given. • Recommendations on the use of interferon gamma release assays (IGRAs) for the diagnosis of latent tuberculosis infection (LTBI) are made. (At this point IGRAs are considered to be more specific than tuberculin skin testing for the diagnosis of LTBI, especially in HIV patients who may have received BCG or have been exposed to other mycobacteria. However, they are no more sensitive than tuberculin skin testing, especially in HIV patients with more severe immunosuppression.) • More specific recommendations are made concerning drug/drug interactions, particularly surrounding the use of rifamycins concomitantly with antiretroviral therapy. • Detailed recommendations are made regarding the treatment of hepatitis B virus/HIV co-infected patients, including the recommendation to avoid HBV antiviral monotherapy with agents such as entecavir due to the risk of selecting M184V HIV reverse transcriptase substitutions. • A section on the bi-directional effects of malaria and HIV co-infection has been added, which is of great significance in the developing world where both of these infections are endemic. Lastly, it was interesting to note that these latest guidelines contain a well-reasoned discussion regarding the controversies surrounding routine screening for HPV-related anal intraepithelial neoplasia in men who have sex with men. This latest update to the OI guidelines is an important document that will be of value to all physicians who treat HIV-infected patients.
ACCESSION #
43901323

 

Related Articles

  • THE IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME. Bosamiya, Sanjay S. // Indian Journal of Dermatology;Sep/Oct2011, Vol. 56 Issue 5, p476 

    A paradoxical clinical worsening of a known condition or the appearance of a new condition after initiating antiretroviral therapy in HIV-infected patients is defined as immune reconstitution inflammatory syndrome (IRIS). Because of wide variation in clinical presentation and the still...

  • The changing spectrum of rheumatic disease in HIV infection. Lawson, Edwina; Walker-Bone, Karen // British Medical Bulletin;Sep2012, Vol. 103 Issue 1, p203 

    Background Rheumatic manifestations were described soon after human immunodeficiency virus (HIV) was discovered. Since however, combination anti-retroviral therapy (cART) has revolutionized the course of the infection. Less clear is what effect cART has had on rheumatic manifestations. Sources...

  • What's New in ...  // JAAPA: Journal of the American Academy of Physician Assistants (;Dec2009, Vol. 22 Issue 12, p54 

    The article explains what physician assistants (PAs) should know about the immune reconstitution inflammatory syndrome (IRIS) or immune restoration disease. It describes the pathogenesis of the disease. It presents a case study of a 30-year-old woman with HIV/AIDS and pulmonary M avium infection...

  • Proposed Clinical Case Definition for Cytomegalovirus–Immune Recovery Retinitis. Ruiz-Cruz, Matilde; Alvarado-de la Barrera, Claudia; Ablanedo-Terrazas, Yuria; Reyes-Terán, Gustavo // Clinical Infectious Diseases;Jul2014, Vol. 59 Issue 2, p298 

    A standardized clinical case definition for active cytomegalovirus retinitis occurring in the context of immune reconstitution inflammatory syndrome is needed. Therefore, here we propose the case definition and a new term for this condition, namely, cytomegalovirus–immune recovery...

  • Lymphoma Immune Reconstitution Inflammatory Syndrome in the Center for AIDS Research Network of Integrated Clinical Systems Cohort. Gopal, Satish; Patel, Monita R.; Achenbach, Chad J.; Yanik, Elizabeth L.; Cole, Stephen R.; Napravnik, Sonia; Burkholder, Greer A.; Mathews, W. Christopher; Rodriguez, Benigno; Deeks, Steven G.; Mayer, Kenneth H.; Moore, Richard D.; Kitahata, Mari M.; Richards, Kristy L.; Eron, Joseph J. // Clinical Infectious Diseases;Jul2014, Vol. 59 Issue 2, p279 

    In a multicenter cohort, unmasking immune reconstitution inflammatory syndrome (IRIS) was observed in 12% of HIV-associated lymphomas. Presentation and survival for lymphoma IRIS were similar to non-IRIS, with possibly increased early mortality among IRIS cases.Background. Lymphoma incidence is...

  • Crusted scabies-associated immune reconstitution inflammatory syndrome. Fernández-Sánchez, Mónica; Saeb-Lima, Marcela; la Barrera, Claudia Alvarado-de; Reyes-Terán, Gustavo // BMC Infectious Diseases;2012, Vol. 12 Issue 1, p1 

    Background: Despite the widely accepted association between crusted scabies and human immunodeficiency virus (HIV)-infection, crusted scabies has not been included in the spectrum of infections associated with immune reconstitution inflammatory syndrome in HIV-infected patients initiating...

  • Antiretrovirals/enfuvirtide.  // Reactions Weekly;1/16/2010, Issue 1284, p10 

    The article describes the case of a 33-year-old man with HIV infection who developed immune reconstitution syndrome (IRIS) manifesting as acute appendicitis during treatment with antiretrovirals and enfuvirtide. He was hospitalised after 26 days of taking the treatment due to vomiting and...

  • Antiretrovirals.  // Reactions Weekly;1/9/2010 Part 1 of 2, Issue 1283, p15 

    The article describes the case of a 37-year-old woman who developed immune reconstitution syndrome (IRS) while receiving antiretrovirals for human immunodeficiency virus (HIV) infection. The patient complained of skin lesions, dry cough and fever. The administration of antiretrovirals on the...

  • Antiretrovirals/BCG vaccine.  // Reactions Weekly;8/8/2009, Issue 1264, p7 

    The article describes the case of three HIV-infected infants who developed localised Bacillus Calmette-Guérin (BCG)-related disease after receiving BCG vaccination and antiretrovirals. It is stated that the disease was a manifestation of immune reconstitution inflammatory syndrome (IRIS) in...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics