Guidelines for Prevention and Management of Common Opportunistic Infections/Malignancies among HIV-Infected Adult and Adolescent Guidelines for Prevention and M anagement of Common Oppo r tunistic I n f e c tions/Malignancies among + HIV-Infected HIV-Infected Adult and Adolescent May 2007 NACO Ministry of Health & Family Welfare Government of India Guidelines for Prevention and Management of Common Opportunistic Infections/Malignancies among HIV-infected Adult and Adolescent May 2007 NACO National AIDS Control Organisation Ministry of Health and Family Welfare Government of India TT AA BB L L E E OO FF CC O O N N TETE NN TT SS Acronyms and Abbreviations 1. Introduction ...........................................................................................................................................................................1 2. HIV and Respiratory Infection ......................................................................................................................................5 2.1 Bacterial pneumonias .................................................................................................................................................7 2.1.1 Streptococcus pneumoniae infection........................................................................................................9 2.1.2 Haemophilus influenzae infection ..............................................................................................................9 2.1.3 Nocardiosis ..........................................................................................................................................................9 2.2 Fungal pneumonia ................................................................................................................................................... 10 2.2.1Pneumocystis jiroveci pneumonia (PCP)................................................................................................... 10 2.3 Mycobacterial infections ........................................................................................................................................ 12 2.3.1Mycobacterium tuberculosis – TB and HIV–TB interaction ................................................................. 12 2.3.2 Mycobacteria other than tuberculosis (MOTT).................................................................................... 15 2.3.3 Diagnostic modalities for mycobacterial infections .......................................................................... 16 3. HIV and Gastrointestinal Infection .......................................................................................................................... 19 3.1 Fungal infections ....................................................................................................................................................... 22 3.1.1 Candidiasis ........................................................................................................................................................ 22 3.1.2 Oral hairy leukoplakia ................................................................................................................................... 23 3.2 Diarrhoeal diseases .................................................................................................................................................. 24 3.2.1 Cryptosporidiosis .......................................................................................................................................... 29 3.2.2 Isosporiasis ....................................................................................................................................................... 30 3.3 Bacterial infections ................................................................................................................................................... 31 3.3.1 Shigella infections .......................................................................................................................................... 31 3.3.2 Salmonella infections .................................................................................................................................... 31 4. HIV and Neurological Disorders ............................................................................................................................... 33 4.1.1 Aseptic meningitis ......................................................................................................................................... 38 4.1.2 Acute bacterial meningitis .......................................................................................................................... 38 4.2 Chronic meningitis ................................................................................................................................................... 38 4.2.1 Tuberculous meningitis ................................................................................................................................ 38 4.2.2 Cryptococcal meningitis ............................................................................................................................. 38 4.3 Cerebral toxoplasmosis ........................................................................................................................................... 40 4.4 AIDS Dementia Complex (ADC) ........................................................................................................................... 42 4.5 Primary CNS lymphoma ........................................................................................................................................ 42 4.6 Progressive Multifocal Leukoencephalopathy (PML) ................................................................................... 43 4.7 Cytomegalovirus infection .................................................................................................................................... 43 5. Lymphadenopathy (generalized/localized) ....................................................................................................... 47 6. Dermatological Conditions in HIV Disease......................................................................................................... 51 6.1 Viral infections ............................................................................................................................................................ 57 TT AA BB L L E E OO FF CC O O N N TETE NN TT SS 6.1.1 Herpes simplex ................................................................................................................................................ 57 6.1.2 Herpes zoster ................................................................................................................................................... 58 6.1.3 Molluscum contagiosum (pox virus) ....................................................................................................... 59 6.1.4 Genital warts and human papillomavirus disease ............................................................................. 59 6.2 Fungal infections ...................................................................................................................................................... 60 6.2.1 Tinea versicolor ................................................................................................................................................ 60 6.3 Bacterial infections ................................................................................................................................................... 61 6.3.1 Staphylococcal infections ............................................................................................................................ 61 6.4 Kaposi sarcoma ......................................................................................................................................................... 61 7. HIV and Liver Diseases ................................................................................................................................................. 63 7.1 Acute and chronic hepatitis B............................................................................................................................... 63 7.2 Acute and chronic hepatitis C ............................................................................................................................. 64 8. Management of Common Syndromes, Symptoms and Signs seen among HIV-infected Persons ...................................................................................................................................................... 65 8.1 Syndromes ................................................................................................................................................................... 65 8.1.1 Acute undifferentiated fever ...................................................................................................................... 65 8.1.2 Prolonged fever ............................................................................................................................................... 65 8.2 Symptoms .................................................................................................................................................................... 66 8.2.1 Headache..........................................................................................................................................................