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 The WHO Regional Office for Europe has combined its 13 protocols on treatment of and care for people with HIV and AIDS in one volume. The protocols are the cornerstone of the strategic actions that WHO has taken as part of its contribution to achieving the goal of universal access to HIV/AIDS prevention, treatment, care and support services. The protocols were specifically developed for the entire WHO European Region. Together, they represent a comprehensive and evidence-based tool that offers health professionals clear and specific advice on diagnosing and managing a wide range of health issues related to HIV/AIDS for adults, adolescents and children, including antiretroviral treatment, the management of opportunistic infections, tuberculosis, hepatitis, injecting drug use, sexual and reproductive health, the prevention of mother-to-child HIV transmission, immunization, palliative care and post-exposure prophylaxis. [Ed.]