0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54
386 Complications of Human Immunodeficiency Virus Type 1Tumors
■Kaposi Sarcoma (HHV8): Topical liquid nitrogen, intralesional vin-
blastine, Radiation (low dose)
■NHL: regiments containing methotrexate, bleomycin, doxorubicin,
cyclophosphamide, Adriamycin, vincristine and corticosteroids
■PCNSL: cranial radiation, intrathecal cytosine arabinoside, chemo-
therapy
■PBCL (HHV8):
■Cervical Cancer (HPV): low-grade intraepithelial lesion (LGSIL or
LSIL) (CIN 1) evaluated by colposcopy and biopsy or follow-up
Pap smears every 4-6 months; high-grade squamous intraepithe-
lial lesions (HGIL or HSIL) (CIN 2 or 3) treated with colposcopy and
biopsy and treated with loop excision or conization; invasive carci-
noma treated with surgery or radiation therapy
■Anal CA (HPV): chemoradiation with 5-FU+cisplatin; surgery for
resistant disease
Side Effects & Contraindications
■See under individual pathogens elsewherefollow-up
Maintenance/suppressive therapy is indicated after treatment for:
■CMV: Valganciclovir, Foscarnet, Ganciclovir, Cidofovir, intraocular
ganciclovir release device q 6 mo+oral ganciclovir
■Cryptococcal meningitis: Fluconazole; alternatives are Ampho-
tericin, Fluconazole and Itraconazole
■Toxoplasmosis: Pyrimethamine+folinic acid+sulfadiazine; alter-
natives are pyrimethamine+folinic acid+clindamycin, pyrime-
thamine+folinic acid+either atoquavone, dapsone or azithro-
mycin
■Isospora: Trimethoprim + sulfamethoxazole; alternatives are
Pyrimethamine+sulfadoxine and Pyrimethamine+folinic acid
■HSV: Acyclovir 400 mg bid, famciclovir 250 mg bid or valacyclovir
500–1,000 mg qd
■VZV: Acyclovir, famciclovir, or valacyclovir With immune reconsti-
tution after therapy for HIV, primary prophylaxis may be stopped in
the following settings:
■Pneumocystis carinii: CD4 >200/mm^3 for 3–6 months regardless of
prior h/o PCP if no thrush or fever
■Toxoplasma gondii: CD4 >100/mm^3 for 3–6 months
■MAC: CD4 >100/mm^3 for 3–6 months and no symptoms of MAC
infection Reinstitute prophylaxis if patient meets criteria again. With