0071643192.pdf

INFECTIOUS DISEASE

Cutaneous Complications

KAPOSISARCOMA

More common in men who have sex with men

SYMPTOMS/EXAM

■ Pink, red, or purple

■ Papules or nodules

■ Painless/nonblanching

■ Commonly on lower limbs, face, mouth, and genitals

REACTIVATIONVARICELLAZOSTERVIRUS(VZV)

■ 17 ×higher incidence in HIV

■ Frequently multidermatomal

TREATMENT

■ Oral acyclovir, famciclovir, or valacyclovir

■ IV antiviral therapy if severe, systemic, or ophthalmologic

Ophthalmologic Complications

CMV RETINITIS

■ #1 cause of AIDS-associated blindness

■ Severe necrotic vasculitis and retinitis

SYMPTOMS/EXAM

■ Visual acuity changes, photophobia, floaters, scotoma, redness and/or pain

■ Retina: Fluffy white perivascular lesions

TREATMENT

Ganciclovir

Adverse Medication Reactions

■ Drug fever, rash, nausea, diarrhea, headache, neuropathy, and liver disease

are associated with several different medications.

■ Lactic acidosis can be seen with nucleoside reverse transcriptase inhibitor

(NRTI) HIV drugs.

■ Classically associated with stavudine, zidovudine, didanosine, and

lamivudine

■ Typically present with nausea/vomiting, abdominal pain, muscle weakness

■ Elevated lactate level

■ Untreated mortality rate as high as 50%

■ For specific HIV medication side effects, see Table 8.5.

Other HIV Complications

■ Cardiovascular

■ Pericardial effusion, cardiomyopathy, myocarditis, cardiotoxic medications

■ Renal

■ Prerenal azotemia (secondary to concomitant infection); renal-toxic

medications; HIV-associated nephropathy

Shingles in a

multidermatomal pattern is

suspicious for HIV coinfection

or other immune compromise.

NRTIs can cause a life-

threatening lactic acidosis.