DOCSLIB.ORG

Recurring and Emerging Questions Related to Management of HIV-Related Opportunistic Infections

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Recurring and Emerging Questions Related to Management of HIV-Related Opportunistic Infections Opportunistic Infections Volume 26 Issue 3 September 2018 Perspective Recurring and Emerging Questions Related to Management of HIV-Related Opportunistic Infections The incidence of HIV-related opportunistic infections (OIs) has dramatically Society of America (IDSA) OI guide- declined with the ability to achieve viral suppression and immune recon- lines are accessed online. During the stitution with potent antiretroviral therapy. However, a large number of period from March 1, 2017, to Feb- patients remain at risk for OIs because they are diagnosed at late stages of ruary 28, 2018, adult OI guidelines HIV disease, fail to stay in treatment, or fail to maintain viral suppression. were accessed more than 420,000 Clinicians should remain vigilant for OIs and for changes in recommended times; of these, approximately 72,000 management strategies. Issues that often arise in this regard include how to page views were for Pneumocystis interpret polymerase chain reaction diagnostic results in individuals with HIV jiroveci pneumonia (PCP), 45,000 for infection; whether primary prophylaxis for Mycobacterium avium complex tuberculosis drug dosing, 28,000 for is still needed; whether clinicians should screen asymptomatic patients for toxoplasmosis, and 25,000 for Myco- cryptococcal antigen; and need for amphotericin B in treatment regimens bacterium avium complex (MAC). for cryptococcal meningitis. This article summarizes a presentation by Henry Masur, MD, at the IAS–USA continuing education program held in Washing- Most-Asked Questions about OIs ton, DC, in April 2018. Very few controlled trials related to Keywords: HIV, opportunistic infections, Pneumocystis pneumonia, PCP, Myco- the diagnosis, therapy, or prevention bacterium avium, MAC, Toxoplasma, cryptococcal meningitis, PCR, diagnostics of OIs are currently being performed, in contrast to the numerous studies Despite the success of current anti- approximately 1100 to approximately performed in the 1980s and 1990s. The retroviral therapy (ART) in reducing 350 over the last 10 years. However, guidelines currently rely on observa- the burden of HIV-related opportunis- the prevalence and incidence in this tional data from patients with HIV tic infections (OIs), a large number of district remain unacceptably high. As infection, and experience in other individuals living with HIV infection of 2016, the overall prevalence of HIV patient populations that are plausibly present late in HIV disease or do not infection was 1.9%, including rates of applicable to patients with HIV infec- maintain viral suppression and thus 0.9% among whites, 3.1% among Afri- tion. Thus some of the recent changes remain at risk for opportunistic dis- can Americans, and 1.2% among His- in the guidelines are based on obser- eases. Management of OIs is thus still panics/Latinos. Data from 2016 indicate vational data from patients with HIV relevant for practitioners who care for that among individuals with known infection, and some of the recommen- this patient population. HIV infection, only 63% are virally sup- dations are extrapolated from other pressed, with only 47% of youth with patient populations. HIV Epidemic in Washington, DC HIV infection being virally suppressed (Figure 1). Thus, there remains a large Polymerase Chain Reaction (PCR)- Based Diagnosis The current state of the HIV epidemic patient population with low or declin- in Washington, DC, provides an exam- ing CD4+ cell counts who are suscep- For the management of HIV-related ple of the ongoing risk of OIs in current tible to OIs. From 2011 to 2015, 21% of OIs, clinicians must be aware that patient populations. The good news in newly diagnosed individuals had CD4+ microbiology laboratories are changing Washington, DC, is that, thanks to the cell counts below 200/µL at diagnosis; their testing platforms dramatically. efforts of many funding agencies, fed- at 1 year after diagnosis, 50% of these When organisms are grown in conven- eral and local health administrations, patients still had counts below 200/µL. tional media, any growth can often clinics and hospitals, and health care be identified by genus and species practitioners, the annual number of within a few hours by techniques such newly recognized cases of HIV infection Surrogate Markers for Incidence of OIs in Recent Years as Matrix Assisted Laser Desorption/ in this district has been reduced from Ionization/Time of Flight Mass Spec- In the absence of hard data on inci- trometry (MALDI-TOF) Other speci- Dr Masur is Clinical Professor of Medicine dence of OIs in recent years, there are mens are tested by qualitative nucleic at George Washington University School of some indices that can provide an idea acid amplification methods that are Medicine in Washington, DC. He is Cochair of the scope of the problem of HIV- extremely sensitive for minute quan- of the National Institutes of Health-Centers for Disease Control and Prevention-Infec- related OIs. One such metric is how tities of organisms and are highly tious Disease Society of America Guidelines often the National Institutes of Health specific for identifying organisms for the Management of HIV-Related Oppor- (NIH)-Centers for Disease Control and accurately. Thus, the clinician is get- tunistic Infections in Adults and Adolescents. Prevention (CDC)-Infectious Disease ting information faster, and can obtain 79 IAS–USA Topics in Antiviral Medicine 14,000 500 450 12,000 400 10,000 350 300 8,000 250 6,000 200 Number of Cases 4,000 Number of Youths 150 100 2,000 50 0 0 Living Ever linked to Retained in Retained in Virally Living Ever linked to Retained in Retained in Ever virally Virally in DC HIV care any care in any care in supressed in in DC HIV care any care in any care in supressed supressed in (98%) 2016 (76%) 2016: >1 2016 (63%) (95%) 2016 (77%) 2016: >1 (57%) 2016 (47%) medical visit medical visit (56%) (53%) Figure 1. Contact with HIV care and viral suppression among known individuals (left) and youth (right) with HIV infection in Washington, DC (DC) in 2016. Adapted from the DC Health Annual Epidemiology and Surveillance Report, 2017.10 far more sensitive testing, often with is a nasopharyngeal swab (not nasal contaminate lower respiratory speci- concurrent information about whether swab) so that cells in the posterior mens) with respiratory viruses, or with specific resistance-associated genes retropharynx are collected. The Bio- MAC, Cryptococcus, or Pneumocystis. are present. Thus, the data coming to fire upper respiratory panel tests for a Thus, because PCR is ultrasensitive clinicians must be interpreted with number of bacteria such as Bordetella, compared with conventional smears analytic approaches that are consider- Chlamydophila pneumonia, and Myco- and cultures, a negative PCR test is con- ably different from interpretations that plasma pneumonia, and several viruses vincing evidence that the pathogen is clinicians made when diagnoses were such as influenza, parainfluenza, coro- not present. A positive result, however, established based on smears of bio- navirus and adenovirus. If the speci- must be evaluated in the context of the logic fluids and tissues, conventional men is positive for coronavirus, for clinical situation, and what other path- cultures, antigen detection assays, and example, how much confidence is there ogens or processes are concurrently serum antibody tests. For example, that the identified agent is the cause of present. Some pathogens that can col- increasingly, laboratories are not per- the patient’s syndrome? onize the airways of an individual with forming immunofluorescence assays Coronavirus may be present in very HIV infection, including herpes simplex for PCP, with diagnoses being primarily small quantities and represent coloniza- virus, cytomegalovirus (CMV), MAC, and based on PCR assays. tion following an acute infection days Candida, are so rarely the cause of pul- The question is whether the detec- or weeks before, depending on the monary dysfunction in persons with tion of an organism in respiratory sam- patient’s immune status (ie, some HIV infection, even those with very low ple, stool, cerebrospinal fluid (CSF), or immunosuppressed persons can shed CD4+ cell counts, that they should be blood is an indication that the identi- a respiratory virus for many months considered as extremely unlikely etio- fied organism is causing the syndrome after an acute infection). If coronavirus logic agents for pulmonary dysfunction. of concern rather than being detected is the only pathogen detected, the cli- Conventional cultures can detect as a bystander/colonizer or contami- nician might assume that coronavirus colonizers as well, but conventional nant. For instance, when bronchoalve- has caused the clinical illness, assum- cultures are not as sensitive as PCR. olar lavage fluid is tested by the Biofire ing the clinical illness is compatible Thus, when the cultures are positive, Platform (Salt Lake City, Utah), does the with what is known about a corona- the quantity of organisms present is detection of an organism provide the virus infection. However, the patient more likely to indicate causality; the clinician with assurance that Pneumo- may in fact be infected with an organ- same is true for a smear. In addition, in cystis is the causative organism? ism not tested for by this platform, or contrast to PCR, conventional cultures Consider a scenario in which a 35- missed by this specimen or by a pro- can be quantitative or semiquantitative, year-old patient recently diagnosed cess that is not due
Load more

Recommended publications
  • The Impact of Infection During Pregnancy on the Mother and Baby
    16 The Impact of Infection During Pregnancy on the Mother and Baby Heather E. Jeffery and Monica M. Lahra Infection continues to account for a major pro- ascending infection from the lower genital tract, portion of maternal, fetal, and neonatal mortality and perinatal acquisition, which includes nos- and morbidity worldwide. ocomial infection and transmission of infection In the developing world, maternal systemic via breast milk (maternal or banked milk). infections, such as pneumonia, malaria, tubercu- The impact of infection (bacterial, viral, or losis, typhoid fever, and pyelonephritis, which are other) on the mother or the fetus is dependent often functions of poverty, crowding, and malnu- on maternal and fetal factors in addition to the trition, impose health costs to the mother and pathogenic properties of the infecting agent. risks to the fetus. These risks include spontaneous Maternal factors include immune function and abortion, stillbirth, preterm labor and preterm status, anatomical factors, and comorbidity. birth, low birth weight, intrauterine growth Infecting agent factors include dose, exposure, restriction (IUGR), and infection. This is in addi- and individual virulence factors. Fetal factors tion to the rapidly escalating rates of a number of include gestational age, developmental stage, and sexually transmitted diseases, in particular, fetal immune function. Table 16.1 summarizes human immunodefi ciency virus (HIV) infection the potential impact on the fetus and neonate with its associated comorbidities. with respect to the ante-, peri-, and postnatal In the developed world, preterm birth remains periods. a major, unresolved public health issue. Intrauter- The impact of infection in pregnancy on both ine infection has been shown to play a major role mother and baby is discussed in this chapter.
    [Show full text]
  • Treating Opportunistic Infections Among HIV-Infected Adults and Adolescents
    Morbidity and Mortality Weekly Report Recommendations and Reports December 17, 2004 / Vol. 53 / No. RR-15 Treating Opportunistic Infections Among HIV-Infected Adults and Adolescents Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/ Infectious Diseases Society of America INSIDE: Continuing Education Examination department of health and human services Centers for Disease Control and Prevention MMWR CONTENTS The MMWR series of publications is published by the Epidemiology Program Office, Centers for Disease Introduction......................................................................... 1 Control and Prevention (CDC), U.S. Department of How To Use the Information in This Report .......................... 2 Health and Human Services, Atlanta, GA 30333. Effect of Antiretroviral Therapy on the Incidence and Management of OIs .................................................... 2 SUGGESTED CITATION Initiation of ART in the Setting of an Acute OI Centers for Disease Control and Prevention. Treating (Treatment-Naïve Patients) ................................................. 3 Management of Acute OIs in the Setting of ART .................. 4 opportunistic infections among HIV-infected adults and When To Initiate ART in the Setting of an OI ........................ 4 adolescents: recommendations from CDC, the National Special Considerations During Pregnancy ........................... 4 Institutes of Health, and the HIV Medicine Association/ Disease Specific Recommendations ....................................
    [Show full text]
  • Guidelines for Management of Opportunistic Infections and Anti Retroviral Treatment in Adolescents and Adults in Ethiopia
    GUIDELINES FOR MANAGEMENT OF OPPORTUNISTIC INFECTIONS AND ANTI RETROVIRAL TREATMENT IN ADOLESCENTS AND ADULTS IN ETHIOPIA Federal HIV/AIDS Prevention and Control Office Federal Ministry of Health July 2007 PART I GUIDELINES FOR MANAGEMENT OF OPPORTUNISTIC INFECTIONS IN ADULTS AND ADOLESCENTS ii Table of Contents Foreword iv Acknowledgement v Acronyms and Abbreviations vi 1. Introduction 1 2. Objectives and Targets 2 2.1. Objectives 2 2.2. Targets 2 3. Management of Common Opportunistic Infections 2 4. Unit 1: Management of OI of the Respiratory System 3 1.1 Bacterial pneumonia 6 1.2 Pneumonia due to Pneumocystis jiroveci. 6 1.3 Pulmonary tuberculosis 7 1.4 Correlation of pulmonary diseases and CD4 count in HIV-infected patients 9 Unit 2: Management of GI Opportunistic Diseases 11 2.1. Dysphagia and odynophagia 11 2.2. Diarrhoea 12 2.3 Peri-anal problems 14 2.4. Peri-anal and/or genital herpes 15 Unit 3: Management of Opportunistic Diseases of the Nervous system 16 3.1. Peripheral neuropathies 17 3.2. Persistent headache with (+/-) neurological manifestations (+/-) seizure 18 3.3. Management of common CNS infections presenting with headache and/or seizure 19 3.3.1. Toxoplasmosis 19 3.3.2 Management of seizure associated with toxoplasmosis and other CNS OIs 21 3.3.3 Cryptococcosis 23 3.3.4 CNS Tuberculosis 25 Unit 4: Management of Skin Disorders 26 4.1 Aetiological Classification of Skin Disorders in HIV disease. 27 4.2 Selected skin conditions in patients with HIV infection 28 4.2.1 Seborrheic dermatitis 28 4.2.2 Pruritic Papular Eruption 29 4.2.3 Kaposi’s Sarcoma 29 Unit 5: Management of Fever 30 5.1 Selected causes of fever in AIDS patients 33 5.1.1 Malaria 33 5.1.2 Visceral Leishmaniasis 33 5.1.3 Sepsis 34 Unit 6: Some Special Conditions in OI Management 35 6.1 Initiating ART in context of an acute OI 35 6.2 When to initiate ART in context of an acute OI 36 iii Tables 1.
    [Show full text]
  • Opportunistic Infections Moorine Sekadde, Mbchb Heidi Schwarzwald, MD, MPH
    HIV Curriculum for the Health Professional Opportunistic Infections Moorine Sekadde, MBchB Heidi Schwarzwald, MD, MPH Objectives Overview 1. Define opportunistic infections (OIs) in people with Many people living with human immunodeficiency virus human immunodeficiency virus (HIV)/AIDS. (HIV)/AIDS acquire diseases that also affect otherwise 2. Describe primary prophylaxis to prevent OIs in healthy people. In such cases, HIV-infected patients people with HIV/AIDS. may have a more severe disease course than uninfected 3. Evaluate the clinical manifestations of bacterial, people or may develop symptoms that uninfected viral, parasitic, and fungal OIs in people with HIV/ people do not. However, HIV-infected people are also AIDS. susceptible to opportunistic infections (OIs), which 4. Describe the treatment for bacterial, viral, parasitic, are infections caused by organisms that in a healthy and fungal OIs in people with HIV/AIDS. host would not cause significant disease. This module 5. Review specific interventions that can decrease the discusses both types of infection. The most common OIs development of OIs in people with HIV/AIDS. vary with geographic location. This module will give a broad overview of the concepts of preventing OIs and Key Points will discuss the most commonly diagnosed diseases worldwide. The module will cover specific diseases, how to 1. An OI is caused by organisms that would not recognize them, and which medicines are recommended produce significant disease in a person with a well- to treat them. Treatment recommendations are based functioning immune system. on available information and research. Not every 2. People with HIV/AIDS are susceptible to OIs because recommendation will be feasible in every setting.
    [Show full text]
  • Preventing Emerging Infectious Diseases: a Strategy for the 21St Century
    September 11, 1998 / Vol. 47 / No. RR-15 TM Recommendations and Reports Preventing Emerging Infectious Diseases: A Strategy for the 21st Century Overview of the Updated CDC Plan U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention (CDC) Atlanta, Georgia 30333 The MMWR series of publications is published by the Epidemiology Program Office, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333. SUGGESTED CITATION Centers for Disease Control and Prevention. Preventing emerging infectious diseases: a strategy for the 21st century. Overview of the updated CDC plan. MMWR 1998;47(No. RR-15):[inclusive page numbers]. Centers for Disease Control and Prevention................................ Claire V. Broome, M.D. Acting Director The material in this report was prepared for publication by National Center for Infectious Diseases.................................. James M. Hughes, M.D. Director The production of this report as an MMWR serial publication was coordinated in Epidemiology Program Office............................................Barbara R. Holloway, M.P.H. Acting Director Office of Scientific and Health Communications ......................John W. Ward, M.D. Director Editor, MMWR Series Recommendations and Reports................................... Suzanne M. Hewitt, M.P.A. Managing Editor Valerie Johnson Project Editor Morie M. Higgins Peter M. Jenkins Visual Information Specialists Use of trade names and commercial sources is for identification
    [Show full text]
  • Guidelines for the Prevention and Treatment of Opportunistic
    Morbidity and Mortality Weekly Report www.cdc.gov/mmwr Recommendations and Reports September 4, 2009 / Vol. 58 / No. RR-11 Guidelines for the Prevention and Treatment of Opportunistic Infections Among HIV-Exposed and HIV-Infected Children Recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics INSIDE: Continuing Education Examination department of health and human services Centers for Disease Control and Prevention MMWR CONTENTS The MMWR series of publications is published by the Coordinating Center for Health Information and Service, Centers for Disease Background ...........................................................................................2 Control and Prevention (CDC), U.S. Department of Health and Opportunistic Infections in HIV-Infected Children in the Era of Potent Human Services, Atlanta, GA 30333. Antiretroviral Therapy .......................................................................2 Suggested Citation: Centers for Disease Control and Prevention. History of the Guidelines ......................................................................3 [Title]. MMWR 2009;58(No. RR-#):[inclusive page numbers]. Why Pediatric Prevention and Treatment Guidelines? .............................3 Diagnosis of HIV Infection and Presumptive Lack of HIV Infection in Centers for Disease Control and Prevention Children with Perinatal HIV Exposure ..................................................4
    [Show full text]
  • Opportunistic Infections: Prevention
    © National HIV Curriculum PDF created September 27, 2021, 1:51 pm Opportunistic Infections: Prevention This is a PDF version of the following document: Module 4: Co-Occurring Conditions Lesson 2: Opportunistic Infections: Prevention You can always find the most up to date version of this document at https://www.hiv.uw.edu/go/co-occurring-conditions/opportunistic-infections-prevention/core-concept/all. Background and Overview Background and Overview Despite the widespread availability and use of potent antiretroviral therapy, individuals with HIV continue to suffer significant morbidity and mortality from opportunistic infections, defined as infections that are more frequent or severe due to immunosuppression. The introduction of effective antiretroviral therapy in the mid-1990s led to a decrease in the rate of AIDS-defining opportunistic infections in the United States. Data from the Centers for Disease Control and Prevention (CDC)-sponsored HIV Outpatient Study (HOPS) showed this decline was dramatic in the mid-1990s, continued through 2007 (Figure 1), and included major deceases in the rates of all major AIDS-defining opportunistic infections (Figure 2).[1,2] Subsequent data from 16 cohorts in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) study during 2000 through 2010 (in the United States and Canada) showed relatively low rates of AIDS-defining opportunistic infections and a continued overall decline during the study period (Figure 3).[3] Nonetheless, AIDS-defining opportunistic infections still occur in individuals with HIV, particularly in the setting of undiagnosed HIV, late diagnosis of HIV, or known HIV with poor retention in care. Clinicians who provide care to persons with HIV should have basic competency in the prevention, diagnosis, and treatment of common AIDS-defining opportunistic infections.
    [Show full text]
  • Nutrition Bytes
    UCLA Nutrition Bytes Title The importance of micronutrient status in the vertical transmission of HIV and pregnancy outcome Permalink https://escholarship.org/uc/item/0qj642nj Journal Nutrition Bytes, 6(2) ISSN 1548-4327 Author Stenson, Amy Publication Date 2000 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Introduction In the world today, over 40 million people are estimated to be living with HIV/AIDS of which approximately 43% are women (1). There are an estimated 1.3 million children infected with HIV, 92% of whom were infected through vertical (mother to child) transmission. Each year, approximately 590,000 infants acquire HIV -1 infections from their mothers (2). The majority of the people living with HIV/AIDS (over 95%) live in the developing world where access to treatment is limited if not impossible t o obtain (1). Despite the fact that vertical transmission rates of HIV -1 have been significantly decreased in the United States and other developed nations through a combination of antiretroviral therapy, caesarian section and other delivery techniques, th e global incidence of vertical transmission continues to increase at the alarming rate of about 1600 new infections each day. Vertical transmission rates in African studies approach 30 - 45%, while rates in developed nations are much lower, 7 -30% (5). Vertic al transmission may occur in utero, during delivery or through breastfeeding. Investigations into new strategies for combating the transmission of HIV from mother to infant that are possible to implement in developing regions are being conducted with posit ive results. These strategies include single doses of an antiretroviral drug nevirapine (6), micronutrient supplementation (7), and alternatives to breastfeeding (8).
    [Show full text]
  • A History of AIDS: Looking Back to See Ahead
    S94 Warner C. Greene Eur. J. Immunol. 2007. 37: S94–102 Breakthroughs in Immunology A history of AIDS: Looking back to see ahead Warner C. Greene Gladstone Institute of Virology and Immunology, University of California, Received 5/7/05 San Francisco, CA, USA Revised 22/8/07 Accepted 4/9/07 [DOI 10.1002/eji.200737441] Since breaking onto the scene 26 years ago, HIV has proven an indefatigable foe. Over 60 million people have been infected with this retrovirus, and 25 million have already died of AIDS. HIV infection is hitting the hardest in the developing world [1]. Tragically, Key words: 1600 babies continue to acquire HIV every day from their infected mothers. Over 12 AIDS Á Drug design/ million children have also been orphaned by AIDS, and this number will likely double by discovery Á Global 2010. With these sobering statistics as a backdrop, this feature traces the history of the pandemic Á HIV devastating HIV/AIDS pandemic and offers a view for what the future may hold. Á Infectious diseases Unfolding of a pandemic The appearance of AIDS in Haiti fueled speculation that the disease had originated there. Although not compell- ing, these theories stoked the fear and prejudice AIDS was first recognized in the summer of 1981 surrounding the disease. (Table 1). Young gay men began falling ill and dying of By late 1982, epidemiologic evidence indicated that opportunistic infections their immune systems should AIDS was an infectious disease transferred by bodily have fended off [2]. Those afflicted became emaciated fluids and by exposure to contaminated blood or blood and often developed dark purple lesions on their arms products [3].
    [Show full text]
  • Antimicrobial Resistant Pathogens Affecting Animal Health in the United States Acknowledgements
    AVMA/Committee on Antimicrobials ANTIMICROBIAL RESISTANT PATHOGENS AFFECTING ANIMAL HEALTH IN THE UNITED STATES ACKNOWLEDGEMENTS Thank you to the following individuals, who contributed to the development of this report. AVMA COMMITTEE ON AVMA COMMITTEE ON Ian Rubinoff, DVM, MPH, DACPV ANTIMICROBIALS ANTIMICROBIALS ADVISORS G. Donald Ritter, DVM, DACPV Representing Amer Assn of Food Safety & Kathe E. Bjork, DVM, MS Michelle Kromm, DVM, MPH, MAM, DACPV Public Health Veterinarians (AAFSPHV) Susan J. Bright Ponte, DVM, MPH, DACVPM Joni Scheftel DVM, MPH, DACVPM SMALL RUMINANT (SHEEP AND Megin Nichols, DVM, MPH (Project Leader) GOATS) SPECIES GROUP Michele T. Jay-Russell, DVM, MPVM, PhD, Ron Phillips DACVPM Representing American Association of Charles Lemme, DVM Small Ruminant Practitioners (AASRP) Representing American Association of Virginia R. Fajt*, DVM, PhD. DACVCP Bovine Practitioners (AABP) COMPANION ANIMAL Joan Dean Rowe, DVM, MPVM, PhD Terry W. Lehenbauer, DVM, MPVM, PhD (DOG AND CAT) SPECIES GROUP Paula Menzies, DVM, MPVM, DECSRHM David R. Smith, DVM, PhD, DACVPM Representing American Animal Hospital Kelly Still Brooks, DVM, MPH, DABVP (Epidemiology) Association (AAHA) (Food Animal), DACVPM Representing American Association of Erin Frey*, DVM, MPH, DACVPM Kris Clothier, DVM, PhD, DACVM Small Ruminant Practitioners (AASRP) Jeff Bender, DVM, MS, DACVPM Virginia R. Fajt, DVM, PhD. DACVCP Michael Lappin, DVM, PhD, DACVIM BOVINE SPECIES GROUP Paul J. Plummer, DVM, PhD (Project Leader) Mark Papich*, DVM, MS, DACVCP Representing American
    [Show full text]
  • Hiv in Pregnancy
    WHO/RHT/98.24 UNAIDS/98.44 Distr.: General HIV IN PREGNANCY: A REVIEW ACKNOWLEDGEMENTS This paper was prepared by James McIntyre, Perinatal HIV Research Unit, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa. A working group on HIV in pregnancy, composed of staff from WHO’s Reproductive Health Programme and UNAIDS, oversaw this work and the subsequent review of the paper. © World Health Organization, 1998 © Joint United Nations Programme on HIV/AIDS (UNAIDS), 1998 This document is not a formal publication of the World Health Organization (WHO) and UNAIDS, but all rights are reserved by these agencies. The document may, however, be freely reviewed, abstracted, reproduced and translated, in part or in whole, but not for sale nor for use in conjunction with commercial purposes. For authorization to translate the work in full, and for any use by commercial entities, application and enquiries should be addressed to Department of Reproductive Health, World Health Organization, Geneva, Switzerland, which will be glad to provide the latest information on any changes made to the text, plans for new editions, and the reprint and translations that are already available. The designations employed and the presentation of the material in this work does not imply the expression of any opinion whatsoever on the part of WHO and UNAIDS concerning the legal status of any country, territory, city or area of its authorities, or concerning the delimitation of its frontiers and boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.
    [Show full text]
  • Module One: Introduction, Background, and Rationale
    Module One: Introduction, Background, and Rationale Total time for this module: 1 hour, 30 minutes Training Objectives • Participants will learn the basics of HIV and AIDS, how HIV is transmitted, progression of the disease, laboratory diagnosis, and treatment of HIV. • Participants will understand the reasons why TB patients need to be tested for HIV, including— o The relationship between HIV and TB; o The medical benefits of clinicians knowing their patients have both HIV infection and TB disease; o The benefits of HIV-infected patients’ knowing their status so that they may get care and treatment and prevent the spread of HIV. • Participants will understand the reasons why TB clinics are ideal places for providing provider-initiated and delivered HIV testing and counseling (PTC). • Participants will understand some of the challenges that TB clinics may face in providing this new service to their patients and ways to overcome the challenges. Advance Preparation • Prepare overheads (or use the PowerPoint presentation): Overhead 1-1: Overview of HIV Infection Overhead 1-2: What is HIV? Overhead 1-3: What is AIDS? Overhead 1-4: HIV vs. AIDS Overhead 1-5: How Is HIV Transmitted? Overhead 1-6: How Is HIV Transmitted? (2) Overhead 1-7: HIV Is Not Transmitted Overhead 1-8: HIV: A Global Pandemic Overhead 1-9: HIV Epidemic in (country name) Overhead 1-10: HIV Epidemic in (country name) (2) Overhead 1-11: HIV Epidemic in (country name) (3) Overhead 1-12: How Does HIV Cause Illness? Overhead 1-13: HIV Disease Progression Overhead 1-14: HIV Disease
    [Show full text]