1. Affordable healthcare Product Selection for Opportunistic Infections IDA HIV/AIDS Group, Nienke Gruppelaar “ HIV does not kill, opportunistic infections do!”

2. - 2 - Frequency of OI (US) Male(%)Female(%) Pneumocystis carinii pneumonia35.733.7 Kaposi sarcoma12.51.3 Esophageal candidiasis11.919.9 Wasting syndrome7.89.0 Mycobacterium avium complex6.46.8 Pulmonary tuberculosis4.86.6 Extrapulmonary cryptococcosis4.33.1 HIV encephalopathy4.23.2 Cytomegalovirus retinitis3.83.4 Cytomegalovirus disease3.42.1 Toxoplasmosis of brain2.93.8 Chronic cryptosporidiosis2.91.5 Recurrent pneumonia2.37.1 Extrapulmonary tuberculosis2.03.0 Chronic herpes simplex2.04.1

3. - 3 - Pneumocystis Carinii Pneumonia (PCP) Very common among HIV-infected people PCP almost always occurs when CD4 < 200 First choice Co-Trimoxazole oral tablets (960 mg or higher dosage), 3 times a day If CD4<200, Profylaxis Co-Trimoxazole 960 mg once a day

4. - 4 - Bacterial infections and Protozoal Infections TB, PCP (pneumonia),Toxoplasmosis, gastro-intestinal infections Medicines: Azithromycine * (tabs), Clarithromycine * (tabs) Ceftriaxone (tabs, injection) Cefixime (tabs) Ciprofloxacin (tabs), Ofloxacin (tabs), Levofloxacin Co-trimoxazole, (CTX) prophylaxis daily (tabs, injection) Clindamycine (caps) Tinidazole (caps), Metronidazole Pyrimethamine, Sulfadiazine*

5. - 5 - Effect of TB on HIV disease TB is the most frequent ‘opportunistic’ infection in HIV+ people TB is the leading cause of death in HIV+ people TB may occur at any moment in HIV disease but the risk increases as the disease progresses TB treatment: Attention to overlapping drug toxicities & drug-drug interactions

6. - 6 - Fungal Infections Candidiasis (oral trush), Cryptococcal Menigitis, Cryptosporidiosis Medicines: Clotrimazole (cream, vaginal tabs) Miconazole (oral tabs) AmphotericineB (injection) * Fluconazole (caps)

7. - 7 - Miconazole for treatment of Oral candidiasis IDA supplies a convenient once daily dosage form of Miconazole Cost-effective treatment for oral candidiasis Convenient, long-acting topical drug which can be used at lowest level of care (home based care workers)

8. - 8 - Viral Infections Cytomegalovirus (CMV), Herpes Zoster, Hepatitis, Herpes Simplex Medicines: Aciclovir (tabs, IV) Ganciclovir (caps, IV) * Valganciclovir (tabs) * Ganciclovir & Valganciclovir are relative expensive, and require skilled healthcare workers in high-end resource setting

9. - 9 - Malignancies Kaposi's sarcoma, CNS lymphoma, Non Hodgkin's lymphoma, Cervical cancer Medicines: Vincristine, Vinblastine Etoposide Doxorubicine All injections, Specialised care is needed

10. - 10 - Other infections Diarrhoea: ORS Worm infections: Albendazole Malaria: Quinine, Artmether, Artesunate

11. - 11 - Palliative Care Reliefing pain, improving quality of life Physical pain, Fevers, night sweats, poor sleep, weight loss –Paracetamol (tab 500mg), Codeine (tab), Ibuprofen (tab) Diclofenac (tab), Multivitamins (tabs, syrup), Diazepam (tab 5mg, injection 10mg/2ml) Physical pain (severe) –Opioids: Morphine (tabs, oral solution, injection) Psychological effects: anger, anxiety, depression, fatigue/lethargy, loss of appetite etc.

12. - 12 - Conclusion Treatment OIs essential part of HIV/AIDS programs Effective treatment for most frequent OIs is available –Not all medicines are currently available from a generic source Total overview: Price Indicator IDA