Internal Medicine

0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54

384 Complications of Human Immunodeficiency Virus Type 1

avoid purchasing a dog or cat aged <6 months (otherwise have

veterinarian examine stools for cryptosporidium, etc.; >1 year

old better in avoiding Bartonella), and avoid adopting stray pets.

Cat litter box should be changed daily, preferably by an HIV-

negative, nonpregnant person or should wash hands thoroughly

after changing litter box; should try to keep cats inside and should

not adopt or handle stray cats (cats should be fed only canned

or dried commercial food or well-cooked table food, not raw

or undercooked meats). Also, avoid raw or undercooked meat,

particularly undercooked pork, lamb, or venison; wash hands

after contact with raw meat and after gardening or other con-

tact with soil. In addition, wash fruits and vegetables well before

eating them raw; avoid exposure to calves and lambs and to

premises where these animals are raised. HIV+persons should

be aware of occupational risks and take appropriate precautions

and hygeine measures, but no recommendations to avoid certain

forms of employment. Appropriate precautions including any

necessary vaccinations or chemoprophylaxis (e.g., for malaria)

should be taken when traveling. Intravenous drug users should

be encouraged to enter rehabilitation programs; if they continue

to use drugs, education regarding cleaning equipment used and

not sharing needles should be reviewed. CMV negatives should

receive CMV-negative leukopore-filtered blood.

specific therapy

Indicated for any evidence of active disease (as indicated in “Tests”

section); see also primary and secondary prophylaxis

Fungal

■PCP: Trimethoprim+sulfamethoxazole; alternative are Trimetho-

prim, Pentamidine, Clindamycin, Atovaquone, Trimetrexate

■Candida: Fluconazole, Clotrimazole oral troches, Nystatin; Ampho-

tericin B, Itraconazole

■Cryptococcus (meningitis): Amphotericin B+flucytosine then flu-

conazole; alternatives include Fluconazole, Itraconazole, Flucona-

zole plus flucytosine

■Aspergillosis: Amphotericin B; Itraconazole, Amphotec, Abelcet,

AmBisome

■Histoplasmosis: Amphotericin B, Itraconazole; Fluconazole

■Cocciodioidomycosis: Amphotericin B; Fluconazole, Itraconazole

■Penicillium marneffei: Amphotericin B; Itraconazole