Internal Medicine

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

Complications of Human Immunodeficiency Virus Type 1 385

Parasitic

■Toxoplasma gondii (encephalitis): Pyrimethamine+folinic acid+

sulfadiazine or trisulfapyrimidine; Pyrimethamine+folinic acid+

clindamycin, Pyrimethamine+folinic acid and one of Azithromycin,

clathromycin or atovaquone, azithromycin

■Cryptosporidia: Paromomycin, Paromomycin + azithromycin

then paromomycin alone, anti-diarrheal agents, Nitazoxanide;

Octreotide, Azithromycin, Atovaquone

■Isospora: Trimethprim+sulfamethoxazole; Pyrimethamine+folinic

acid

■Microsporidia:nutritional supplements and anti-diarrheal agents,

Albendazole shown to work for S. intestinalis, the cause of 10–20%

of microsporidial diarrhea; alternatives include metronidazole, ato-

quavone, thalidomide

Bacteria

■TB: Rifampin-based therapy, Rifabutin-based therapy, Strepto-

mycin-based therapy; usual is to start with rifampin (RIF)/isoniazid

(INH)/pyrazinamide (PZA)/ethambutol (EMB) qd×2 months, then

INH/RIF for 18 wks, provided sensitive to both drugs

■MAC: Clarithromycin+ethambutol+rifabutin; Azithromycin, ami-

kacin or ciprofolxacin

■Bartonella hanselae/quintara (bacillary angiomatoses): Erythromy-

cin; other macrolides

■Rhodococcus equii: Vancomycin, rifampin, ciprofloxacin or imi-

penem; Erythromycin

■Strongyloides: Thiabendazole, albendozole

■Other bacterial infections: see individual pathogens elsewhere

Virus

■CMV: Foscarnet, Ganciclovir, Vitrasert (q 6 mo)+oral ganciclovir,

cidofovir+probenecid, foscarnet and ganciclovir, fomivirsen

■HSV: mild primary/recurrent disease use oral acyclovir or famicy-

clovir or valacyclovir; severe/visceral/refractory disease use IV acy-

clovir or foscarnet

■VZV: Acyclovir or famicyclovir or valacyclovir; severe/refractory/

visceral disease use IV acyclovir or foscarnet

■JC virus (PML): highly active antiretroviral therapy (HAART), cido-

fovir (unclear benefit esp. if already on HAART)

■HCV: alpha interferon+ribavarin; consider PEG-IFN+ribavirin

(more effective, but unclear toxicities)

■HPV: intravaginal 5-fluorouracil