September 8, 2005
These are general recommendations for clinicians who are not HIV specialists. We encourage you to call the NIH Medical Consultation Services at 1-866-887-2842 or the National HIV/AIDS Clinical Consultation Center at 1-800-933-3413 to consult with HIV experts. Visit www.aahivm.org or www.hivma.org for updates to this document.
|CD4 <500||TB, Herpes zoster, sinusitis, bronchitis.|
|CD4 <200 Pulmonary||Include Pneumocystis jiroveci (former carinii) pneumonia (PCP) in your differential diagnosis. Subacute symptoms include dry cough.|
|CD4 <100 CNS||Include toxoplasmosis and cryptococcal meningitis in differential diagnosis.|
|CD4 <50 with unexplained fever||Consider Mycobacterium avium complex (MAC) and systemic fungal disease in differential diagnosis, especially if patient is not on clarithromycin or azithromycin prophylaxis.|
|efavirenz (Sustiva)||AVOID clarithromycin, triazolam, rifampin.|
|ritonavir (Norvir) or lopinavir + ritonavir (Kaletra)||AVOID alprazolam, buspirone, daizepam, flurazepam, triazolam, zolpidem.|
saquinavir (Invirase, Fortovase), indinavir (Crixivan), ritonavir (Norvir), nelfinavir (Viracept), fosamprenavir (Lexiva), lopinavir/ritonavir (Kaletra), atazanavir (Reyataz), tipranavir (Aptivus)
|USE CAUTION WITH rifampin and rifabutin, dose modification required.|
|atazanavir (Reyataz)||AVOID Proton pump inhibitors and H2 blockers.|
Pregnant Women: For pregnant patients be sure to consult fact sheets about appropriate antiretroviral medications. Recommendations on antiretroviral treatment for pregnant women and interventions to reduce perinatal HIV transmission are available at http://aidsinfo.nih.gov/guidelines. An easy-to-read chart of acceptable medications for pregnant women is available at www.aidsmeds.com/lessons/Pregnancy8a.htm.
Treatment for Possible Exposure to HIV Infection: Prophylactic antiretrovirals should be administered if at all possible in occupational and non-occupational exposures. Recommendations for healthcare workers are available at http://aidsinfo.nih.gov/guidelines/health-care/HC_062901.pdf. Recommendations for non-occupational exposures are available at http://aidsinfo.nih.gov/guidelines/nonexposure/NE_012105.pdf. Consultation on PEP is available from the National PEPline at 1-888-HIV-4911
Rapid HIV Testing: If possible -- do rapid HIV testing. People will need proof of their HIV status to obtain help from HIV service providers.
Locating HIV Providers and Clinics: For a list of HIV clinics, go to www.aahivm.org or www.hivma.org and click on the Hurricane Katrina links. HIVMA and AAHIVM members accepting patients also are available from our websites or by calling 888-844-4372 (HIVMA) or 866-241-9601 (AAHIVM).
Patients Enrolled in Clinical Trials: Patients enrolled in clinical trials should contact the trial sponsor to obtain experimental study drugs. Some contacts are:
For others, call the main number for the pharmaceutical company involved.