History & exam
Key factors
- no antiretroviral treatment (ART) or failure of ART
- fever
- headache and altered mental status
- dyspnoea or cough
- abdominal pain, diarrhoea, weight loss
- dysphagia
- lymphadenopathy
- visual floaters and blindness
- ocular haemorrhage
- mucosal changes
Other diagnostic factors
- hepatosplenomegaly
- exercise-induced oxygen desaturation
- cyanosis
- blurred vision and photophobia
- papilloedema
- meningismus, focal neurological findings
- pain and weakness
- bone or joint pain
- skin lesions
History & exam details
Diagnostic tests
1st tests to order
- CD4+ cell count
- sputum stain and culture
- blood cultures
- adenosine deaminase
- CMV cultures
- CMV serology
- peripheral blood leukocyte (PBL) culture
- CMV proteins in peripheral blood leukocytes (pp65) antigenaemia
- quantitative CMV PCR
- Toxoplasma gondii serology
- cryptococcal polysaccharide antigen
- FBC
- LFT
- LDH
- ABG
- chest x-ray
- head CT
Tests to consider
- TB nucleic acid amplification
- IGRA
- bronchoalveolar lavage (BAL)
- oropharyngeal scrapings (KOH preparation) and culture
- CSF analysis
- PCR: respiratory specimen for TB
- PCR: CSF, BAL fluid, and vitreous and aqueous humor specimen for T gondii
- PCR: brain specimen for JC virus
- bone marrow aspirate and culture
- lymph node aspirate or biopsy
- tissue biopsy
- brain biopsy
- abdomen CT
- high-resolution CT (HRCT) of the chest
- brain MRI
- gallium-67 (Ga-67) lung scan
- indium 111-DTPA-IgG scan
- thallium single photon emission tomography (SPECT) and positron emission tomography (PET)
- upper GI endoscopy and colonoscopy
Diagnostic tests details
Treatment details
Acute
M tuberculosis infection
-
drug-susceptible
- initial phase: directly observed therapy (DOT)
- continuation phase: directly observed therapy (DOT)
-
isoniazid-resistant
- initial and continuation phase: directly observed therapy (DOT)
-
multi-drug-resistant
- consultation and individualised therapy
Disseminated Mycobacterium avium complex (MAC)
-
without advanced immunosuppression
- initial antimicrobial (2- or 3-drug) therapy
- maintenance prophylaxis
-
with advanced immunosuppression
- initial antimicrobial (3- or 4-drug) therapy
- maintenance prophylaxis
P jiroveci pneumonia (PCP)
-
mild-to-moderate disease
- initial antimicrobial therapy
- maintenance prophylaxis
-
moderate-to-severe disease
- initial antimicrobial therapy + corticosteroids
- maintenance prophylaxis
T gondii infection encephalitis
- initial anti-Toxoplasma regimen
- corticosteroids and anticonvulsants
- maintenance/prophylaxis
cryptococcal meningitis
- initial amphotericin B + flucytosine or fluconazole
- therapeutic drainage of CSF
- azole antifungal consolidation therapy
- azole maintenance therapy
CMV
-
retinitis (immediate sight-threatening lesions)
- initial intra-ocular and/or systemic nucleoside analogue
- maintenance nucleoside analogue
- ganciclovir implant
-
retinitis (small peripheral lesions)
- initial oral valganciclovir
- maintenance nucleoside analogue
- ganciclovir implant
-
oesophagitis or colitis
- nucleoside analogue
-
pneumonitis
- intravenous nucleoside analogue
-
neurological disease
- initial intravenous ganciclovir and foscarnet
- maintenance nucleoside analogue
mucocutaneous candidiasis
-
oropharyngeal (initial episode)
- systemic azole and topical antifungal
-
oropharyngeal (treatment-refractory)
- alternative azole or amphotericin B or echinocandin
- secondary prophylaxis
-
oesophageal (initial episode)
- systemic azole
-
oesophageal (treatment-refractory)
- alternative azole or amphotericin B or echinocandin
- secondary prophylaxis
-
vulvovaginal (uncomplicated)
- systemic azole or topical antifungal
-
vulvovaginal (severe or recurrent disease)
- extended systemic azole or topical antifungal treatment
Treatment details
last updated:=최종 업데이트: 5월 08, 2013
