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MANAGEMENT
OF OPPORTUNISTIC INFECTIONS
IN
HIV-POSITIV PATIENTS
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FACT
SHEETS
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Tuberculosis
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A
bacterial infection
Causative organism
Mycobacterium tuberculosis
Symptoms of active infection
May be pulmonary or extra-pulmonary, such as lymphadenitis,
meningitis, etc. Cough, weight loss, night sweats, fever,
swollen lymph nodes, or organ-specific symptoms.
Diagnostic procedures
Chest X-ray, sputum smear, culture and sensitivity, blood,
bone marrow or liver cultures, PCR. Ultrasonography or
CT scan for extra-pulmonary TB.
Treatment
Treat with 4 oral drugs: isoniazid, pyrazinamide, rifampin
and ethambutol; if treatment failure or intolerant, streptomycin
or amikacin and/or ofloxacin or sparfloxacin or ciprofloxacin.
Most HIV-positive patients clear their sputum rapidly,
and a 6-month regimen is considered adequate.
Rifampin is a strong inducer of the cytochrome P450 enzyme
system in the liver, and has the potential to cause significant
drug interactions. For example, concomitant administration
of rifampicin may result in sub-therapeutic levels of
protease inhibitors
.
If the patient is already on antiretrovirals, or requires
initiation of antiretroviral therapy, recommended antituberculous
treatment regimes are depicted in the following algorithm: |
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WHO recommended dosage
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Drug
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Mean dose (mg/kg/day)
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Rifampicin
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10
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Isoniazid
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5
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Pyrazinamide
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25
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Ethambutol
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15
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Prophylaxis
The Technical Resource Group of the National AIDS Control
Organisation of India has deferred recommendations on
TB chemoprophylaxis in HIV patients. Various issues, including
efficacy and toxicity of prophylaxis, as well as emergence
of drug resistance, were cited.
Prophylaxis
The Technical Resource Group of the National AIDS Control
Organisation of India has deferred recommendations on
TB chemoprophylaxis in HIV patients. Various issues, including
efficacy and toxicity of prophylaxis, as well as emergence
of drug resistance, were cited.
Drug interactions / Precautions
Isoniazid
Avoid antabuse, ketoconazole; monitor liver function
Ethambutol
Avoid co-administration with aluminium salts; check visual
acuity.
Rifampin
Affects many drugs metabolized by the liver, including
protease inhibitors; may also affect methadone metabolism;
monitor liver function
Amikacin
Avoid amphotericin B, diuretics, penicillins; monitor
for vestibular and auditory toxicity
Ciprofloxacin
Avoid theophylline, antacids, anticoagulants, cyclosporine,
caffeine
Rifabutin
Monitor for toxicity (e.g. arthralgias, uveitis, leukopenia)
when co-administered with indinavir, nelfinavir, amprenavir
or efavirenz, especially if fluconazole or clarithromycin
is being used concurrently. |
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