Human Immunodeficiency Virus (HIV, AIDS) (cont.)
Eric S. Daar, MD
Dr. Daar received his undergraduate degree from UCLA and medical degree from Georgetown University School of Medicine. He completed an internship and residency in internal medicine at Cedars-Sinai Medical Center and his clinical and research fellowship in infectious diseases at Cedars-Sinai Medical Center and UCLA.
Jay W. Marks, MD
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
In this Article
- HIV facts
- What is the history of HIV, and when was HIV discovered?
- What tests are used in the diagnosis of HIV?
- How is HIV transmitted (spread)?
- What happens after an exposure to the blood or genital secretions of an HIV-infected person?
- What are HIV symptoms and signs in men, women, and children?
- What laboratory tests are used to monitor HIV-infected people?
- What are the key principles in managing HIV infection?
- Should patients with the flu- or mono-like illness of primary HIV infection be treated?
- What about treatment for HIV during pregnancy?
- What can be done for people who have severe immunosuppression?
- What is the future for HIV-infected individuals with regards to treatment simplification and cure research?
- What is in the future for preventing HIV transmission?
- HIV-AIDS Rxlist FAQs
- Find a local Infectious Disease Specialist in your town
What can be done for people who have severe immunosuppression?
Although one goal of antiviral therapy is to prevent the development of immune suppression, some individuals are already immunosuppressed when they first seek medical care. In addition, others may progress to that stage as a result of resistance to antiviral drugs. Nevertheless, every effort must be made to optimize antiviral therapy in these patients. In addition, certain specific antibiotics should be initiated, depending on the number of CD4 cells, to prevent the complications (that is, the opportunistic infections) that are associated with HIV immunosuppression. Guidelines for the prevention of opportunistic infections can be found at http://www.aidsinfo.nih.gov.
In summary, patients with a CD4 cell count of less than 200 cells/mm3 should receive preventative treatment against Pneumocystis jiroveci with trimethoprim/sulfamethoxazole (Bactrim, Septra), given once daily or three times weekly. If they are intolerant to that drug, patients can be treated with an alternative drug such as dapsone or atovaquone (Mepron). Those patients with a CD4 cell count of less than 100 cells/mm3 who also have evidence of past infection with Toxoplasma gondii, which is usually determined by the presence of toxoplasma antibodies in the blood, should receive trimethoprim/sulfamethoxazole. Toxoplasmosis is an opportunistic parasitic disease that affects the brain and liver. If a person is using dapsone to prevent Pneumocystis jiroveci, pyrimethamine and leucovorin can be added once a week to dapsone to prevent toxoplasmosis. Finally, patients with a CD4 cell count of less than 50 cells/mm3 should receive preventive treatment for Mycobacterium avium complex (MAC) infection with weekly azithromycin (Zithromax), or as an alternative, twice daily clarithromycin (Biaxin) or rifabutin (Mycobutin). MAC is an opportunistic bacterium that causes infection throughout the body. Many of these drugs can be stopped if initial antiviral therapy results in good viral suppression and sustained increases in CD4 cells.
Learn more about: trimethoprim | Bactrim | Septra | Mepron | leucovorin | Zithromax | Biaxin | Mycobutin
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