Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

734 Human Immunodeficiency Virus Type 1 (HIV-1)

Special Situations

■Efavirenz contraindicated during pregnancy; nevirapine should be

avoid in liver disease esp. HCV coinfected individuals

follow-up

During Treatment

■CD4, VL, LFTs every 4 weeks for first 6 months to assess Rx success

and need for intensification (addition of another antiretroviral) or

treatment changes; adherence should be emphasized; evaluation

for adverse events important; baseline lipids and at 3 months and 12

months on HAART

Routine

■CD4, VL at baseline with confirmatory test 2–4 weeks later then

q3months if stable (all major changes require confirmatory testing);

annual PPD, annual pap smear (some indicate anal pap smear for

all q 1–2 years), baseline lipids

complications and prognosis

Complications

■Possible complications correlate with degree of immunosuppression

■CD4>500: acute HIV syndrome, candida vaginitis, persistent gen-

eralized lymphadenopathy (PGL), polymyositis, aseptic meningitis,

Guillain-Barre syndrome

■CD4 200–500: pneumococcal and other bacterial pneumonias, pul-

monary TB, Kaposi sarcoma, herpes zoster, thrush, cryptosporidio-

sis, oral hairy leukoplakia, cervical cancer, anal cancer, lymphocytic

interstitial pneumonitis, mononeural multiplex, anemia, idiopathic

thrombocytopenic purpura

■CD4<200: Pneumocystis carinii pneumonia, candida esophagitis,

disseminated/chronic herpes simplex, toxoplasmosis, cryptococco-

sis, disseminated coccidioidomyocosis, cryptosporidiosis, chronic,

progressive multifocal leukoencephalopathy, microsporidiosis, mil-

iary/extrapulmonary TB, CMV disease, disseminated M. avium com-

plex, wasting, B-cell lymphoma, cardiomyopathy, peripheral neu-

ropathy, HIV-associated dementia, CNS lymphoma, HIV-associated

nephropathy

Prognosis

■Median incubation time (HIV to AIDS) is 7–11 years.

■Median survival (HIV to death) without HAART is 8–12 years.