HIV Related Disease

132 132 137 138 139 141 145 146 147 148 149 GENERAL GUIDELINES

Approximately 5-15% of adults with latent TB infection (LTBI) develop active TB disease during their life. Provision of preventive treatment has proven itself as an effective intervention to avert the development of active TB disease, with efficacy ranging from 60% to 90%. The likelihood of progression of TB infection to active disease depends on bacterial, host, and environmental factors. In high TB prevalence and resource-limited settings such as Zimbabwe, the following four target populations

DEFINITION: Lymph nodes >1.5 cm in two or more areas, not due to another cause such as TB and persisting for 1 month or more.

DEFINITION: Three or more liquid stools daily for 2 to 14 days in patients with symptomatic HIV infection.

DEFINITION: Weight loss of more than 10%, plus either unexplained chronic diarrhea for more than one month, or unexplained prolonged fever for more than one month. This places the patient in WHO Clinical Stage 4 HIV disease and hence patient should be considered for ART.

A multitude of different manifestations of respiratory complications may occur in patients with HIV infection. These include bacterial pneumonias, pulmonary tuberculosis, Pneumocystis jiroveci pneumonia (PCP) and pulmonary Kaposi's sarcoma. All HIV infected patients should be screened for TB at every visit using the standard TB screening tools.

An opportunistic infection caused by Pneumocystis jiroveci. Patients present with progressive shortness of breath and possibly cyanosis with few or no chest signs.

The symptom of headache is commonly encountered in patients with HIV infection. Careful evaluation and follow up is required to exclude meningitis and other CNS infections. Rule out a serum cryptococcal antigenaemia (CrAg) especially is CD4 count is less than 100. If CrAg positive refer for lumbar puncture (LP). Also refer for LP if the headache is associated with fever, vomiting, neck stiffness, seizures, confusion as all these are “danger” symptoms and signs. Also refer to Section on Neurologi

Characterized by progressive impairment in cognitive function that is accompanied by behavioural changes and motor abnormalities. Note: Other causes of dementia must be excluded

Skin manifestations of HIV infection may be the result of opportunistic infections or HIV itself. Start ART as soon as possible as restoration of immunity tends to result in a resolution in most instances. Refer to a Skin Specialist if not getting better.

HIV-infected individuals have an increased incidence of several malignancies, including both AIDS-defining malignancies (Kaposi sarcoma [KS], cervical cancer, and non-Hodgkin lymphoma [NHL] including systemic NHL, CNS lymphoma, primary effusion lymphoma, and multicentric Castleman disease [MCD]), as well as a number of non-AlDS-defining cancers (NADCs) including lung, breast, prostate, colorectal.

Patients with KS are in WHO clinical stage 4 and will require ART. Assess the KS stage (limited or mild, moderate or severe/extensive). Also assess for signs and symptoms of visceral involvement. Most patients present late with a high burden of tumour and hence chemotherapy is required. If possible, refer patients for specialist opinion prior to starting ART (this might avoid IRIS which may occur with extensive KS especially pulmonary KS) and should submit a biopsy for tissue diagnosis before re