|
RISK: CD4 count <250 cells/mm3(JID 2000;181:1428) plus exposure in an endemic area (Southwest US, usually CA or AZ). The frequency in the endemic area is about 4% per year in untreated AIDS patients, 0.2% per year for HIV without AIDS, and 0.015% per year in the general population (JID 2000;181:1428).
RECOMMENDATION
- Fluconazole 400 mg po/d
- Itraconazole 200 mg po bid
Pencillium marneffi prevention
INDICATION:1) CD4 count <100 cells/mm3 for patients in highly endemic area
PREFERRED:Itraconazole 200 mg po qd
Chagas disease
INDICATION:1) Antibody to T. cruzi, 2) no prior therapy and 3) infection likely to be <20 years' duration defines the group that may benefit from treatment
PREFERRED:Benznidazole* 5-8 mg/kg/d po x 30-60 days
ALTERNATIVE:Nifurtimox* 8-10 mg/kg/d x 90-120 days
*Neither drug is available in US: obtain from CDC drug service
PREVENTION OF EXPOSURE
- ENTERIC BACTERIAL PATHOGENS
The risk of infection with enteric bacterial pathogens is significantly increased with HIV infection and immunosuppression. The risk is most striking for Salmonella (JID 1987;156:998; AIDS 1992;6:1495; CID 1995;21:S84), but also noted with Shigella (CID 2007;44:327) and Campylobacter (Ann Intern Med 1984;101:187). These pathogens are generally transmitted by contaminated food or water and less commonly by fecal contact. Recommendations for prevention: 1) hand washing; 2) avoid undercooked eggs and other common food sources of Salmonella; 3) avoid undercooked meat and 4) avoid cross-contamination with cutting boards, knives, hands, etc.
With travel: avoid undercooked meat, tap water or ice from tap water (unless water is boiled >1 minute or decontaminated with iodine or chlorine), unpasteurized milk and raw vegetables.
- TOXOPLASMOSIS
Major sources are contaminated stool from infected cats and soil contact. Seronegative patients with HIV infection should: 1) avoid undercooked pork, beef and venison; 2) wash
|
