HIV AIDS treatment and care : clinical protocols for the WHO European region

Front
Cover......Page 1
Contents......Page 4
Acknowledgements......Page 5
Abbreviations......Page 8
Foreword......Page 14
Introduction......Page 15
1. Patient Evaluation and Antiretroviral Treatment for Adults and Adolescents
......Page 18
Contents......Page 19
I. Introduction......Page 21
II. Management of patients with HIV......Page 22
III. Suggested minimum data to be collected at the clinical level......Page 44
Annex 1. Essential information on personal history of
HIV/AIDS treatment......Page 45
Annex 2. Revised WHO clinical staging of HIV/AIDS for adults and adolescents......Page 46
Annex 3. Resistance tests......Page 47
Annex 4. Essential information about ARVs......Page 48
Annex 5. Tools for adherence monitoring......Page 50
Annex 6. List of antiretroviral drugs......Page 52
Annex 8. Beyond the horizon......Page 55
References......Page 56
2. Management of Opportunistic Infections and General Symptoms of HIV/AIDS
......Page 65
Contents......Page 66
I. Principles......Page 68
II. Management of opportunistic infections......Page 69
III. General symptoms......Page 91
References......Page 97
3. Palliative Care for People Living with HIV
......Page 100
Contents......Page 101
I. Policy, principles and organization of services......Page 103
II. General considerations for palliative home careof people living with HIV (PLHIV)......Page 105
III. Initial evaluation......Page 107
IV. Treatment......Page 109
V. Special advice for terminal care......Page 137
VI. Suggested minimum data to be collected at theclinical level......Page 141
References......Page 143
4. Management of Tuberculosis and HIV Coinfection
......Page 145
Contents......Page 146
I. Epidemiology of TB, TB/HIV/AIDS and reciprocalinfluence of TB and HIV......Page 148
II. Identification of TB/HIV in adults and adolescents......Page 150
III. Clinical management of TB/HIV in adults andadolescents......Page 152
IV. Identification of TB/HIV in infants and children......Page 161
V. Clinical management of TB/HIV in children......Page 163
VI. Suggested minimum data to be collected at the clinicallevel......Page 164
Annex 1. TB drugs......Page 166
Annex 2. ARV drugs......Page 167
References......Page 169
5. HIV/AIDS Treatment and Care for Injecting Drug Users
......Page 172
Contents......Page 173
I. Policy and principles......Page 175
II. Background and general considerations......Page 178
III. Organization and management considerations......Page 181
IV. Clinical management of HIV-infected IDUs......Page 186
V. Suggested minimum data to be collected at theclinical level......Page 208
Annex 1. Addiction Severity Index......Page 209
Annex 2. Alcohol and Drug Listing......Page 222
Annex 3. ICD-10 symptom checklist for mental disorders......Page 223
Annex 4. Examination findings suggestive of addiction orits complications......Page 224
Annex 5. Bloodborne Virus Transmission Risk AssessmentQuestionnaire......Page 226
References......Page 230
6. Management of Hepatitis C and HIV Coinfection
......Page 237
Contents......Page 238
I. Epidemiology and natural history of HCV in HIV infection......Page 240
II. Identification of HCV/HIV......Page 245
III. Clinical management of HCV/HIV patients......Page 255
IV. Suggested minimum data to be collected at the clinicallevel......Page 268
Annex 1. Laboratory assays for HCV......Page 269
Annex 2. Alternative biochemical tests to assesshepatic fibrosis......Page 271
Annex 3. Alcohol screening questionnaires......Page 272
Annex 4. Management of end-stage liver disease......Page 274
Annex 5. Research needs and alternative treatments......Page 276
References......Page 279
7. Management of Hepatitis B and HIV Coinfection
......Page 284
Contents......Page 285
I. Epidemiology and natural course of HBV infection......Page 287
II. Identification of HBV/HIV......Page 291
III. Clinical management of HBV/HIV patients......Page 296
IV. Suggested minimum data to be collected at the clinicallevel......Page 305
References......Page 306
8. Prevention of Hepatitis A, B and C and Other Hepatoxic Factors in People Living with HIV
......Page 309
Contents......Page 310
I. Prevention strategies......Page 312
References......Page 317
9. Support for Sexual and Reproductive Health in People Living with HIV
......Page 318
Contents......Page 319
I. Introduction......Page 321
II. Background......Page 322
III. Principles of SRH Services for PLHIV......Page 323
IV. Sexual health of PLHIV......Page 325
V. Contraception......Page 335
VI. Safe abortion......Page 346
VII. Natural or medically assisted reproduction......Page 349
VIII. Cervical intraepithelial lesions and cervical cancer......Page 352
IX. Suggested minimum data to be collected atthe clinical level......Page 354
Annex 1. Suggested topics and questions for takinga sexual history......Page 355
Annex 2. Management of syphilis in PLHIV......Page 358
Annex 3. Management of vulvovaginal candidiasis inwomen living with HIV......Page 359
Annex 4. Management of bacterial vaginosis in womenliving with HIV......Page 360
Annex 5. Cervical cancer screening methods......Page 361
Annex 6. PAP smear report, in accordance with the 2001Bethesda system......Page 362
Annex 7. Recommended management for abnormal Papsmears......Page 363
References......Page 364
10. Prevention of HIV Transmission from HIV-infected Mothers to Their Infants
......Page 368
Contents......Page 370
I. Policy issues......Page 372
II. Background......Page 373
III. Initial evaluation......Page 374
IV. PMTCT management in antenatal care settings andmaternity wards......Page 376
IV. Suggested minimum data to be collected at the clinical level
......Page 387
Annex 1. Currently available medications forsubstance-dependence treatment during pregnancy......Page 389
Annex 2. Definitions of acceptable, feasible, affordable,sustainable and safe replacement feeding......Page 391
Annex 3. Neonatal abstinence syndrome scores......Page 392
References......Page 393
11. Paediatric HIV/AIDS Treatment and Care
......Page 396
Contents......Page 397
I. Introduction......Page 399
II. Laboratory diagnosis of HIV......Page 400
III. Clinical management of HIV-infected children......Page 403
IV. Prevention and management of majoropportunistic infections......Page 416
V. Paediatric HIV pain management......Page 427
VI. Suggested minimum data to be collected at theclinical level......Page 428
Annex 1. Revised WHO clinical staging of HIV/AIDSfor infants and children......Page 430
Annex 2. WHO classification of HIV-associatedimmunodeficiency in infants and children......Page 432
Annex 3. ARV dosage ranges
......Page 434
Annex 4. Developmental assessment checklist......Page 436
References......Page 437
12. Immunization of People Living with HIV and People at Risk of HIV Infection
......Page 443
Contents......Page 444
I. Introduction......Page 446
II. General principles for the immunization of PLHIV......Page 447
III. Use of vaccines and immunoglobulins......Page 448
Annex 1. Summary of immunization recommendationsfor people immunocompromised due to HIV/AIDS......Page 462
Annex 2. WHO Classification of HIV-associatedimmunodeficiency in infants and children......Page 463
Annex 3. Rabies vaccines......Page 464
Annex 4. Glossary......Page 465
References......Page 468
13. Post-exposure Prophylaxis for HIV Infection
......Page 470
Contents......Page 471
I. Policy issues......Page 473
II. Background and general considerations......Page 474
III. Evaluation of the exposure, exposure source andexposed person......Page 477
IV. Clinical management of people incidentallyexposed to HIV......Page 480
V. Prevention of occupational and nosocomial exposure......Page 485
VI. Suggested minimum data to be collected atthe clinical level......Page 489
Annex 1. Informed consent form for source person......Page 490
Annex 2. Informed consent form for exposed person......Page 491
Annex 3. Proposed occupational exposure report(confidential)......Page 492
Annex 4. Proposed non-occupational exposure report(confidential)......Page 494
Annex 5. Standard precautions – an aide memoire5......Page 496