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infection and AIDS
Monitoring of ARV treatment
C D 4 coun ts are useful in the in itiation an d follow -up of treatm en t. C B C , haem oglobin
an d A L A T are n ot essen tial, but can be useful in d etectin g treatm en t ad verse effects.
V iral load (rarely available) is useful for d etection of treatm en t failures.
Treatment of opportunistic and other infections
W ith p rogressive im m un osup p ression , H I V in fected p atien ts w h o are n ot receivin g
trip le th erap y (or p atien ts w ith p oor ad heren ce) becom e in creasin gly suscep tible to
in fection s. F or con d ition s of clin ical stages 2 an d 3 , stan d ard treatm en ts are usually
effective an d th e d iagn osis of H I V in fection d oes n ot m uch alter th e clin ical
m an agem en t. P atien ts in th ese stages m ay ben efit from p rim ary p rop h ylaxis ( see
primary prophylaxis, p age 2 1 1 ).
S evere op p ortun istic in fection s often req uire sop histicated d iagn ostic an d therap eutic
m ean s rarely available. H ow ever, w ith im p rovin g h ealth services, m ost of th ese
d iseases can be treated .
F or treatm en t of op p ortun istic in fection s, see tables, p ages 2 1 3 to 2 1 9 .
Treatment of pain
T reat all p atien ts for associated p ain (see Pain, p age 2 9 ).
Prevention of HIV infection
– Sexual transmission
T he on ly reliable m ethod of p reven tion is the use of m ale or fem ale con d om s.
I n ad d ition , early d iagn osis an d treatm en t of sexually tran sm itted in fection s is
essen tial as they in crease the tran sm ission of H IV (see C hap ter 9 ).
Post-exposure prophylaxis (P E P ): e.g. in the even t of rap e, A R V treatm en t begun w ithin
4 8 hours after p ossible exp osure an d given for a d uration of 1 m on th m ay red uce the
risk of in fection .
– Transmission through blood and blood products
•tran sfusion : strict resp ect of in d ication s for tran sfusion an d system atic serological
screen in g of th e d on or‟s blood are th e tw o in d isp en sable p recaution s in th e
p reven tion of H IV tran sm ission through tran sfusion s.
•I V d rug use: n eed le an d syrin ge exch an ge p rogram m es w ith d isp osable n eed les
an d syrin ges for users.
– Occupational transmission ( accid en tal n eed le stick in juries or in juries w ith
con tam in ated objects, con tact betw een a p atien t‟s blood an d un p rotected brok en sk in
or m ucous m em bran es).
P reven tion is based on use of un iversal p recaution s to avoid con tam in ation w ith
soiled m aterial or p oten tially in fected bod y fluid s.
Post exposure prophylaxis (P E P ): e.g. in the even t of an accid en t, A R V treatm en t
begun
w ithin 4 8 hours after the accid en t an d given for a d uration of 1 m on th red uces the
risk of in fection .
210
Monitoring of ARV treatment
C D 4 coun ts are useful in the in itiation an d follow -up of treatm en t. C B C , haem oglobin
an d A L A T are n ot essen tial, but can be useful in d etectin g treatm en t ad verse effects.
V iral load (rarely available) is useful for d etection of treatm en t failures.
Treatment of opportunistic and other infections
W ith p rogressive im m un osup p ression , H I V in fected p atien ts w h o are n ot receivin g
trip le th erap y (or p atien ts w ith p oor ad heren ce) becom e in creasin gly suscep tible to
in fection s. F or con d ition s of clin ical stages 2 an d 3 , stan d ard treatm en ts are usually
effective an d th e d iagn osis of H I V in fection d oes n ot m uch alter th e clin ical
m an agem en t. P atien ts in th ese stages m ay ben efit from p rim ary p rop h ylaxis ( see
primary prophylaxis, p age 2 1 1 ).
S evere op p ortun istic in fection s often req uire sop histicated d iagn ostic an d therap eutic
m ean s rarely available. H ow ever, w ith im p rovin g h ealth services, m ost of th ese
d iseases can be treated .
F or treatm en t of op p ortun istic in fection s, see tables, p ages 2 1 3 to 2 1 9 .
Treatment of pain
T reat all p atien ts for associated p ain (see Pain, p age 2 9 ).
Prevention of HIV infection
– Sexual transmission
T he on ly reliable m ethod of p reven tion is the use of m ale or fem ale con d om s.
I n ad d ition , early d iagn osis an d treatm en t of sexually tran sm itted in fection s is
essen tial as they in crease the tran sm ission of H IV (see C hap ter 9 ).
Post-exposure prophylaxis (P E P ): e.g. in the even t of rap e, A R V treatm en t begun w ithin
4 8 hours after p ossible exp osure an d given for a d uration of 1 m on th m ay red uce the
risk of in fection .
– Transmission through blood and blood products
•tran sfusion : strict resp ect of in d ication s for tran sfusion an d system atic serological
screen in g of th e d on or‟s blood are th e tw o in d isp en sable p recaution s in th e
p reven tion of H IV tran sm ission through tran sfusion s.
•I V d rug use: n eed le an d syrin ge exch an ge p rogram m es w ith d isp osable n eed les
an d syrin ges for users.
– Occupational transmission ( accid en tal n eed le stick in juries or in juries w ith
con tam in ated objects, con tact betw een a p atien t‟s blood an d un p rotected brok en sk in
or m ucous m em bran es).
P reven tion is based on use of un iversal p recaution s to avoid con tam in ation w ith
soiled m aterial or p oten tially in fected bod y fluid s.
Post exposure prophylaxis (P E P ): e.g. in the even t of an accid en t, A R V treatm en t
begun
w ithin 4 8 hours after the accid en t an d given for a d uration of 1 m on th red uces the
risk of in fection .
210
