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Dx: HIV RNA > 10,000 copies + indeterminate or negative HIV serology or recent seroconversion
Case definition of HIV infection C3 B3 A3 < 200 mm 3 (<14%) C2 B2 A2 200-499 mm 3 (14 to 28%) C1 B1 A1 > 500 mm 3 (>29%) AIDS indicator condition (Category C) Symptomatic, but not with AIDS indicator condition (Category B) Asymptomatic (Category A) CD4 cell categories
Class and specific adverse effects Discontinue medication Never rechallenge Abacavir Hipersensitivity Discontinue medication Didanosine, zalcitabine, stavudine Peripheral neuropathy Discontinue medication Didanosine, zalcitabine Pancreatitis Erythropoietin, switch agent Zidovudine Bone marrow supression, especially anemia Discontinue medication NNRTI Rash including Steven Johnson’s syndrome Symptomatic PI, NRTI GI toxicity Treatment Agents Toxicity
Class and specific adverse effects Actually not adverse effects, but some physicians and patients get excited about them (they are “markers” of adherence) Reassure patient Atazanvir Indirect hyperbilirrubinemia (Gilbert’s syndrome) Reassure patient Zidovudine Macrocytosis without anemia Good hydration Avoid other nephrotoxic agents Indinavir (stones), tenofovir Nephrotoxic Avoid during pregnancy Efavirenz Teratogenicity Consider switching agent Efavirenz CNS toxicity Treatment Agents Toxicity
CSF: do not forget opening pressure. Other findings are similar to aspetic meningitis, but cells may be low or zero
India ink is rarely used any longer
Antigen is not useful for follow up, cultures are
Tx: amphotericin B + 5FC x 14 days followed by high dose of fluconazole for 1o weeks, followed by chronic supression. Premedicate patients and monitor Cr, K, Mg, LFT Repeat LP as needed or use lumbar drain.
Darkfield and DFA test are useful in primary disease
For late syphilis use non-treponemal tests (VDRL or RPR) and confirm with treponemal tests (FTA)
Non-treponemal tests behave atypically in HIV
LP is indicated if there is evidence of neurologic , ocular or auditory findings; treatment failure, late latent syphilis (> 1 year duration), non-penicillin treatment for VDRL > 1:32, but some recommend it in everybody with HIV
Neurosyphilis is diagnosed by pleocytosis, elevation of protein or positive VDRL