Table of Contents
1 Overview of HIV Infection 1
Overview 2
Stages of HIV Infection 3
Acute HIV Infection 4
Differential Diagnosis 4
Signs and Symptoms 5
Laboratory Findings 5
Diagnostic Testing 5
Management 6
2 Testing for HIV and Baseline Evaluation 7
HIV Diagnostic Testing 8
Whom to Test 8
Testing for HIV 8
HIV Antibody Tests 10
Selected Licensed HIV Diagnostic Tests 11
HIV Viral Load Assays 13
Uses 13
Assays and Interpretation 13
Indications 14
Initial Assessment of HIV-infected Patients 14
Clinical Evaluation 14
Laboratory Testing 15
CD4 Cell Count 22
3 Treatment of HIV Infection 24
Initiation of Antiretroviral Therapy 25
Selection of an Optimal Initial Antiretroviral Regimen 30
Antiretroviral Therapy Adverse Effects 37
4 Management of the Treatment-Experienced Patient 45
Antiretroviral Treatment Failure 46
Virologic Response Definitions 46
Evaluation of Virologic Failure 47
Important Genotypic Resistance Patterns 51
Poor CD4 Recovery Despite Virologic Suppression 55
Regimen Switching in the Setting of Virologic Suppression (See Table 4-2) 56
General Principles of Regimen Switching 56
Regimen Switch Strategies in the Setting of Drug Toxicity 58
5 Prophylaxis and Treatment of Opportunistic Infections 62
Prophylaxis of Opportunistic Infections 63
Treatment of Opportunistic Infections 74
Aspergillosis, Invasive 75
Bacterial respiratory Diseases 76
Bartonella Infections 78
Campylobacteriosis 79
Candidiasis (Mucosal) 80
Chagas Disease 83
Clostridium Difficile Diarrhea/Colitis 83
Coccidioidomycosis 84
Cryptococcal Meningitis 88
Cryptosporidiosis 90
Cytomegalovirus Disease 91
Hepatitis B Virus 94
Hepatitis C Virus 96
Herpes Simplex Virus Disease 117
HHV-8 Infection 119
Histoplasma Capsulatum 119
Human Papillomavirus Disease 121
Isospora Belli Infection 122
Leishmaniasis, Cutaneous 123
Malaria 124
Microsporidiosis 124
Mycobaterium Avium Complex Disease 126
Mycobaterium Tuberculosis 127
Penicilliosis 129
Pneumocystis Pneumonia 130
Progressive Multifocal Leukoencephalopathy 133
Salmonellosis 134
Shigellosis 135
Toxoplasma Gondii Encephalitis 136
Treponema Pallidum (Syphilis) 137
Varicella-Zoster Virus Disease 140
6 Complications of HIV Infection 142
Hematologic Complications 143
Thrombocytopenia/anemia 143
Neutropenia 144
Eosinophils 145
Oncologic Complications 145
Kaposi's Sarcoma 145
Non-Hodgkin's Lymphoma 146
Primary CNS Lymphoma 146
Cervical/Anal Cancer 147
Endocrine Complications 147
Adrenal Insufficiency 147
Hypogonadism 148
Thyroid Disease 149
Pancreatitis 149
Hyperglycemia 149
Hypoglycemia 150
Ovarian Complications 150
Bone Disease 150
Morphologic Complications of Therapy 151
Lipoatrophy 151
Fat Accumulation and Weight Gain 152
Prevention of Lipodystrophy 153
Lipid Abnormalities 153
Gastrointestinal Tract Complications 155
Anorexia 155
Nausea/vomiting 155
Diarrhea 156
Oral/esophageal ulcers 156
HIV cholangiopathy 157
Renal Complications 157
HIV-Associated 157
Medication-Related 158
HCV-Associated 159
Heroin Nephropathy 159
Inhibition of Tubular Secretion of Creatinine 159
Cardiac Complications 159
HIV-Related Cardiomyopathy 159
Pericarditis/Pericardial Effusion 160
Iricuspid Valve Endocarditis 160
Pulmonary Complications 161
Pulmonary Hypertension 161
Lymphocytic interstitial Pneumonitis 162
Emphysema 162
Pulmonary Kaposi's Sarcoma 162
HEENT Complications 162
Aphthous Ulcers 162
Oral hairy Leukoplakia 162
Salivary Gland Enlargement 163
Lymphaepithelial Cysts 163
Gingivitis/Periodontitis 163
Musculoskeletal Complications 163
HIV arthropathy 163
Reiter's Syndrome 164
Pyomyositis 164
HIV/NRTI-related myopathy 164
Rhabdomyolysis 164
Neurologic Complications 165
Distal Sensory Neuropathy 165
Other Forms of Neuropathy 165
HIV-Associated/AIDS Dementia 166
Psychiatric Complications 167
Mania 168
Insomnia 168
Dermatologic Complications 168
Herpes simplex infection 168
Varicella-zoster infection 169
Molluscum contagiosum 169
Warts, cutaneous/genital 169
Bacterial infections 170
Fungal infections 171
Seborrheic dermatilis 171
Psoriasis 171
Eosinophilic folliculitis 171
Xerosis/ichthyosis 172
7 HIV and Pregnancy 173
Overview 174
Initial Evaluation 174
Reproductive Options for HIV Serodiscordant Couples 175
Initiation of Antiretroviral Therapy in Pregnancy 176
Goals of Therapy and Monitoring 176
Preferred and Alternative Treatments for Pregnant Women 177
Intrapartum Care 181
Postpartum Management 183
8 Post-Exposure and Pre-Exposure Prophylaxis 187
Occupational Post-Exposure Prophylaxis 188
Nonoccupational Post-Exposure Prophylaxis 194
Evaluation 194
Pre-Exposure Prophylaxis 200
9 Antiretroviral, Anti-HBV, and Anti-HCV Drug Summaries 204
Appendix 1 276
a IAS-USA Drug Resistance Mutations in HIV-1: October/November 2015 282
b IAS-USA Drug Resistance Mutations in HIV-1: User Notes 282
References to the User Notes 286
Appendix 2 292
Selected Key Internet Resources 293
Index 294
