1. Initial Evaluation and Common Clinical Manifestations
David H. Spach, MD
DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, August 2004.
The International AIDS Society–USA

2. Recommended Routine Serologic Tests
Disease
Test
Toxoplasmosis
Syphilis
Hepatitis A Virus
Hepatitis B Virus
Hepatitis C Virus
Cytomegalovirus
Anti-Toxoplasma IgG
VDRL or RPR
HAV total antibody
Anti-HBc, HBsAb
Anti-HCV IgG
*Anti-CMV IgG
*Only in persons with relatively low risk
DHS/HIV//PP 1

3. Acquisition of Toxoplasma gondii
Cat Feces
Undercooked Red Meat
DHS/HIV/PP 1

4. ACIP: Recommended Vaccinations
Vaccine
Schedule
Influenza Vaccine
Pneumococcal
Hepatitis A Vaccine
Hepatitis B Vaccine
Tetanus-Diphtheria
Yearly
*Once & Repeat after 5 Years
0 & 6-12 months
0, 1, 6 months
Every 10 Years
*Optimal to vaccinate when CD4 counts highest
From: ACIP. MMW 2002;51 (40):904-8.
DHS/HIV/PP 1

5. Pneumococcal Disease in HIV-Infected Persons Summary of Data
Pneumonia: 10-fold increase in HIV-infected persons
Bacteremia: fold increase in HIV-infected persons
Mortality: no evidence for increase in HIV-infected persons
CD4 Count: risk greatest with CD4 count less than 200 cells/mm3
Antimicrobial Prophylaxis: risk decreased with TMP-SMX or Azithromycin
From: Feikin DR et al. Lancet ID 2004;187:44-55.
DHS/HIV/PP 1

6. Vaccines Related to Travel Advice for HIV-Infected Persons
Centers for Disease Control and Prevention. General Information Regarding HIV and Travel.
DHS/HIV/PP 1

7. Vaccinations in HIV-Infected Adults Key Points
Give as early as possible (high CD4 count)
No significant impact on CD4 count or HIV RNA levels
Avoid most live vaccines
Get expert advice regarding travel-related vaccines
DHS/HIV/PP 1

8. Oral Candidiasis Clinical Types
Erythematous Pseudomembranous Angular Cheilitis
DHS/HIV/PP 1

9. Oropharyngeal Candidiasis Treatment Options
Topical Therapy - Clotrimazole troches: 10 mg 5x/d x 7-10d - Nystatin pastilles: 1-2 pastilles 5x/d x 7-10d
Systemic Therapy (Oral) - Fluconazole: 100 mg qd x 7-10d - Itraconazole solution: 200 mg qd x 7-10d - Ketoconazole: 200 mg qd x 7-10d
DHS/HIV/PP 1

10. Oropharyngeal Candidiasis Suggested Guidelines for Therapy
Indications for Topical Agents - No esophageal involvement - CD4 count greater than 50 cells/mm3 - Receiving or expect to receive HAART
Indications for Systemic Agents - Esophageal involvement - CD4 count less than 50 cells/mm3 - NOT receiving or expecting to receive HAART
Chronic Suppressive Therapy - NOT recommended
From: Powderly WG et al. AIDS Research & Human Retroviruses ;15:
DHS/HIV/PP 1

11. Fluconazole-Resistant Oropharyngeal Candidiasis Treatment Options
Topical Therapy - Amphotericin B solution: 5 ml (100 mg/ml) qid x 7-10d
Systemic Therapy - Amphotericin B: 0.3 mg/kg IV qd x 7-10d - Caspofungin: 50 mg/kg* IV qd x 7-10d - Itraconazole solution: 100 mg bid x 7-10d - Fluconazole: 800 mg PO/IV qd x 7-10d - Voriconazole: 200 mg PO/IV bid x 7-10d
* Use 70 mg/kg IV qd for the first dose
DHS/HIV/PP 1

12. Aphthous Lesions Clinical Types
Minor (Lip) Minor (Tongue) Major
DHS/ HIV/PP 1

13. Oral Aphthous Lesions Treatment Options
Topical Therapy - Topical Corticosteroids
Intralesional - Triamcinolone: 40 mg /ml (0.5 ml-1.0 ml injected bid)
Systemic Therapy - Prednisone: mg/kg qd x 7-10d, then taper - Thalidomide: 200 mg PO qd
DHS/HIV/PP 1

14. Herpes Simplex Virus Infection Chronic Ulcerative Lesions Types
Ear Face Scrotum
DHS/HIV/PP 1

15. Cutaneous HSV Infections Treatment Options
Recurrent HSV - Acyclovir: 400 mg PO tid x 5-10d* - Valacyclovir: 500 mg PO bid x 5-10d* - Famciclovir: 500 mg PO bid x 5-10d*
Suppressive Therapy - Acyclovir: mg PO bid - Valacyclovir: 500 mg PO bid - Famciclovir: mg PO bid
*Longer courses typically needed for chronic ulcerative herpes simplex
DHS/HIV/PP 1