0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54
Complications of Human Immunodeficiency Virus Type 1 383management
What to Do First
■Thorough history & physical (including pap smear, if not done in
past year) with attention to history of CD4 counts, AIDS-defining
illnesses, TB exposure or risk, prior chicken pox/shingles, sexu-
ally transmitted diseases, hepatitis A/B/C, and review of symptoms
(weight loss, fever, night sweats, fatigue, anorexia, dysphagia, nau-
sea, vomiting, diarrhea, abdominal pain, chest pain, dyspnea, cough,
headaches, weakness, painful extremities, mental status changes,
paresthesias or dysesthesias, rashes, insomnia, adenopathy, visual
changes)
■Screening laboratory evaluations should include CBC, CD4 count,
toxoplasma IgG, PPD (unless history of positive PPD or TB treat-
ment), hepatitis serologies (HBsAb, HBcAb, HBsAg, HCV IgG, and
some advocate HAV IgG), RPR/VDRL; some suggest VZV Ab (if no
history of chicken pox or shingles) and CMV serology (if low risk)General Measures
■Vaccinate as needed with Pneumovax, influenza vaccine, HBV vac-
cine, HAV vaccine, & tetanus booster.
■Review role of pets (sources of diarrhea such as cryptosporidium,
salmonella, and campylobacter; also, cats are a source of bartonella
and toxoplasma; healthy birds may be a source of cryptococcus or
histoplasma; reptiles may carry salmonella), food and water (sources
of diarrhea esp. salmonella in eggs and poultry; toxoplasma in
uncooked meats, and cryptosporidia in lakes and rivers), travel (con-
taminated food and water esp. in developing countries; penicillium
marneffii in endemic ares), and occupational exposures (esp. TB in
healthcare settings, homeless shelters, correctional facilities; cryp-
tosporidia, CMV, HAV, Giardia in child care settings; cryptosporidia,
toxoplasma, bartonella, salmonella, and campylobacter in settings
requiring animal contact) in risks of acquiring opportunistic infec-
tions. In particular:
➣HIV+persons should avoid contact with human and animal
feces and wash hands after contact with human feces (e.g., dia-
per changing), after handling pets, and after gardening or other
contact with soil. Avoid sexual practices that might result in oral
exposure to feces (e.g., oral-anal contact), and use latex con-
doms during sexual intercourse to reduce risk of sexually trans-
mitted diseases as well (HSV, syphilis, etc.) as CMV and HHV8.
Avoid bringing any animal that has diarrhea into households,