Guidelines For Hiv/Aids Diagnosis And Treatment
MINISTRY OF HEALTHGUIDELINES FOR HIV/AIDSDIAGNOSIS AND TREATMENT(Published with Decision No. 3003/Qð-BYT dated19/8/2009 of the Minister of Health)Ha Noi – 20091
TABLE OF CONTENTSI. DIAGNOSIS AND STAGING OF HIV INFECTION IN ADULTS . 71. Diagnosis of HIV infection: . 72. Staging of HIV infection . 7II. CLINICAL MANAGEMENT OF PERSONS WITH HIV/AIDS . 101. Initial assessment: . 102. Follow-up visits: . 13III. PROPHYLAXIS FOR OPPORTUNISTIC INFECTIONS . 141. Co-trimoxazole prophylaxis . 14IV. APPROACH TO COMMON CLINICAL SYNDROMES IN PATIENTS WITHHIV/AIDS . 191. Prolonged fever . 192. Respiratory manifestations . 213. Neurological abnormalities (a, b) . 234. Odynophagia . 256. Lymphadenopathy (a) . 297. Anemia (a, b). 318. Mucocutaneous manifestations . 339. Wasting (a, b) . 35V. DIAGNOSIS AND TREATMENT OF COMMON OPPORTUNISTIC INFECTIONS. 381. Fungal diseases . 382. Protozoal diseases . 413. Bacterial diseases . 424. Viral diseases . 455. Diagnosis and treatment of TB in patients with HIV/AIDS . 47VI. ANTIRETROVIRAL THERAPY (ART) . 542
1. Goals and Principles of Antiretroviral Therapy . 542. Criteria for initiating Antiretroviral Therapy . 543. Preparation for readiness to commence Antiretroviral Therapy . 554. First-line Antiretroviral Regimens: . 575. Side effects of ARVs drugs and its management: . 606. Monitoring of Antiretroviral Therapy . 657. Immune Reconstitution Inflammatory Syndrome (IRIS) . 688. First-line treatment failure and second-line regimens . 699. Antiretroviral therapy for patients with specific conditions: . 74VII. ANTIRETROVIRAL THERAPY IN PREGNANT WOMEN AND PREVENTION OFMOTHER-TO-CHILD TRANSMISSION OF HIV (PMTCT) . 811. ARV therapy for HIV-infected pregnant women . 812. Antiretroviral prophylaxis for preventing mother-to-child transmission of HIV. 833. Other interventions and referral for the mothers and their infants to care andtreatment services after birth . 85VIII. POST-EXPOSURE PROPHYLAXIS . 861. Post-occupational exposure prophylaxis . 862. Non-Occupational Post-Exposure Prophylaxis: . 89PART B - DIAGNOSIS, TREATMENT AND CARE FOR CHILDREN LIVING WITHHIV/AIDS . 92I. DIAGNOSIS, CLINICAL AND IMMUNOLOGICAL STAGING OF HIV INFECTION INCHILDREN . 921. Diagnosis of HIV infection in children . 922. HIV infection staging . 933. Diagnosis criteria of advanced HIV infection (including AIDS) . 98II. CLINICAL MANAGEMENT OF HIV EXPOSED INFANTS AND CHILDREN WITHCONFIRMED HIV INFECTION . 981. Initial assessment: . 983
2. Follow-up visit: . 101III. PROPHYLAXIS FOR OPPORTUNISTIC INFECTIONS, IMMUNIZATIONSCHEDULE . 1011. Prophylaxis with co-trimoxazole (CTX) . 1012. Immunization . 104IV. APPROACH TO COMMON CLINICAL SYNDROMES IN CHILDREN WITHHIV/AIDS . 1061. Prolonged fever . 1062. Respiratory findings. 1083. Neurologic findings . 1104. Persistent diarrhea (a) . 1135. Wasting and Failure to Thrive . 115V. DIAGNOSIS AND TREATMENT OF COMMON OPPORTUNISTIC INFECTIONSIN HIV INFECTED CHILDREN . 116VI. ANTIRETROVIRAL THERAPY . 1261. Goals and principles of ART . 1262. Criteria for initiating ART . 1263. Preparation for readiness to commence Antiretroviral Therapy . 1274. First-line Antiretroviral Regimens: . 1295. ARV drug side effects and its management . 1316. Monitoring Antiretroviral Therapy. 1367. Immune Reconstitution Inflammatory Syndrome (IRIS) . 1388. First-line treatment failure and second-line regimens . 1409. ART for children with TB. 14310. ARV treatment for children with hepatitis coinfection . 144ANNEX . 146Annex 1 - Clinical and definitive diagnosis criteria of HIV/AIDS-related diseases inadults and adolescents . 1464
Annex 2 - Clinical and definitive diagnosis criteria of HIV/AIDS-related diseases inchildren . 155Annex 3 - Summary of ARV drugs . 166Annex 4 - Pediatric ARV dosages – Standardized with Developmental Indexes ofVietnamese Children . 168Annex 5 - Interactions of ARVs . 177Annex 6 - Severity grading of ARV side effects in adults. 179Annex 7 - Severity grading of ARV side effects in children. 184REFERENCES . 1925
ACRONYMS AND ABBREVIATIONSABCAbacavirHIVHuman immunodeficiency virusAFBAcid Fast BacilliHPVHuman papiloma virusAIDSAcquiredsyndromeHSVHerpes simplex virusDNADesoxyribonucleic acidLIPLymphoid interstitial pneumoniaALT (SGPT)Alanin aminotransferaseLPVLopinaviranti-HBcAnti-Hepatitis B core antigenMTCTMother to child transmissionanti- HBeAnti-Hepatitis B envelopimmunodeficiencyAntigenanti- HCVAnti-Hepatitis C antibodyMACMycobacterium avium complexRNARibonucleic acidNRTINucleoside reverse transcriptaseinhibitorARVAntiretroviral drugNNRTINon-nucleosidtranscriptase inhibitorAST (SGOT) Asparate aminotransferasereverseBCGBacillus Calmett-GuerrinNVPNevirapineb.i.dtwo times per dayPCRPolymerase chain reactionCMVCytomegalovirusPIProtease berculosisEFVEfavirenzTCD4Lymphocyte T CD4 ( )DOTDirectly observed therapyTDFTenofovirELISAEnzyme-linked immunosorbentt.i.dthree times per ghly active antiretroviral therapy3TCLamivudineHBeAgHepatitis B Envelop AntigenHBsAgHepatitis B surface antigen6
PART A - DIAGNOSIS, TREATMENT AND CARE FORADULTS LIVING WITH HIV/AIDSI. DIAGNOSIS AND STAGING OF HIV INFECTION IN ADULTS1. Diagnosis of HIV infection:HIV infection in adults is diagnosed on the basis of laboratorydetection of anti-HIV antibody. A person is defined as infected with HIVwhen his/her serum specimen is reactive in all three anti-HIV antibodytests, which rely on different antigens or of different operating characteristics (asregulated by the Ministry of Health).2. Staging of HIV infection2.1. Clinical staging:Adults with HIV infection are classified into 4 clinical stages depending onthe presence of HIV-related conditions (Table 1).Table 1: Clinical staging of HIV/AIDS in adultsClinical stage 1: Asymptomatic-Asymptomatic-Persistent generalized lymphadenophathyClinical stage 2: Mild symptoms-Moderate unexplained weight loss (less than 10% of body weight)- Recurrent respiratory tract infections (sinusitis, tonsillitis, otitis media,pharyngitis)-Zona (Herpes zoster)-Angular cheilitis-Recurrent oral ulceration-Papular pruritic eruption.7
-Seborrhoeic dermatitis-Fungal nail infectionsClinical stage 3: Advanced symptoms-Unexplained severe weight loss (more than 10% of body weight)-Unexplained chronic diarrhoea for longer than one month.-Unexplained persistent fever (intermittent or constant and lasting forlonger than one month).-Recurrent oral candidiasis.-Oral hairy leukoplakia.-Pulmonary tuberculosis.-Severe bacterial infections (pneumonia, empyema, pyomyositis, bonejoint infection, meningitis, septicemia).-Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis.-Unexplained anaemia ( 80g/L), neutropenia ( 0.5x109/L), and/orchronic thrombocytopenia ( 50x109/L).Clinical stage 4: Severesymptoms-HIV wasting syndrome (loss of more than 10% of body weight withprolonged & unexplained fever or diarrhoea of more than one monthduration).-Pneumonia caused by Pneumocystis jiroveci (PCP).-Chronic herpes simplex virus infection (orolabial, genital or anorectal)of more than one month duration, or visceral at any site-Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs).-Extrapulmonary tuberculosis-Kaposi’s sarcoma-Diseases due to Cytomegalovirus (CMV) in retina or other organs.-Toxoplasmosis in central nervous system.-HIV encephalopathy.-Extrapulmonary cryptococcosis including meningitis.8
-Disseminated disease due to Mycobacteria avium complex (MAC).-Progressive multifocal leukoencephalopathy (PML).-Chronic diarrhea due to Cryptosporidia.-Chronic diarrhea due to Isospora-Disseminated mycosis (penicilliosis, extrapulmonary histoplasmosis).-Recurrent septicemia (including non-typhoid salmonellosis).-Cerebral or B cell non-Hodgkin lymphoma.-Invasive cervical carcinoma.-Atypical disseminated leishmaniasis.-HIV-associated nephropathy.-Myocarditis due to HIV.2.2. Immunological staging:Immune status of adults with HIV infection is evaluated bynumber of CD4 cellsof the patient.Table 2: Immunological staging of HIV/AIDS in adultsCD4 cell count/mm3 500350 - 499200 - 349 200SeverityNormal or not significant deficiencyMild deficiencyAdvanced deficiencySevere deficiency2.3. Criteria for diagnosis of advanced HIV infection (including AIDS):Any stage 3 or stage 4 clinical condition (presumptive or definitivediagnosis)and/or- CD4 cell count 350 cells/mm3AIDS is defined as clinical diagnosis (presumptive or definitivediagnosis) of any stage 4 condition or CD4 cell count 200 cells/mm3-9
II. CLINICAL MANAGEMENT OF PERSONS WITH HIV/AIDS1. Initial assessment:1.1. Clinical and laboratory assessment:1.1.1. Taking present and previous medical history: History of HIV testing: time of detection, place of testing, risksbehaviour of HIV infection (injecting drug use, unsafe sexual practices),duration of risks behaviours. History of TB and TB treatment (time of diagnosis and treatment, placeof treatment, treatment regimen and outcome); history of exposure toTB source. History of OIs, sexually transmitted and other diseases Obstetric, gynecological history, use of contraceptive methods History of drug allergy to antibiotics (such as cotrimoxazole) andantiretrovirals Recently developing signs and symptoms, their progress and responseto treatment, especially TB-related symptoms. Medications used recently:o OI prophylaxis (cotrimoxazole)o ARV treatment: reason for use, duration, specific regimen, drugsource, treatment adherenceo Other medications used Status of drug and other substances dependence, including injectingdrugand opioid use, substitution treatment (e.g. methadonemaintenance therapy); history of alcohol use and cigeret smoking History of nutrition History of HIV infection in the family: any other family members with HIVinfection; if yes, whether ART is given and where ART is provided;issues of HIV status disclosure of patients and their family members (ifany)1.1.2. Physical examination: Do thorough and meticulous physicalexamination Vital signs, body weight, pain symptoms.10
Assessment of functional status: able to worknormally, ambulatory, orbed-ridden General condition, mucocutaneous manifestations Visual ability, Ear-Nose-Throat status Neurological symptoms: meningeal syndrome, focal neurological signs Respiratory and circulatory organs Abdominal conditions, enlarged liver and spleen, lymph nodes andabnormal intra-abdominal mass1.1.3. Laboratory: CBC, Hb, ALT Chest X-ray, sputum AFB in case of suspected pulmonary TB; otherinvestigations necessary for diagnosis of extrapulmonary TB and otherOIs CD4 (if available). Lab tests supporting selection of ARV regimen such as HBsAg, antiHCV (if available). Creatinin, lipid, glucose in case the patient is using TDF or proteaseinhibitors Pregnancy tests as needed.1.1.4. Diagnosis of OIs and clinical staging: Diagnosis of progressive tuberculosis: (see Chapter V, Section 5:Diagnosis and treatment of TB in patients with HIV). Diagnosis of other OIs: see Chapter IV (Approach to common clinicalsyndromes in people living with HIV/AIDS) and Chapter V (Diagnosisand Treatment of common opportunistic infections). Clinical staging (see Table 1).1.2. Management: Provide treatment for opportunistic infections and other conditions,symptom releave Provide prophylaxis for opportunistic infections Assess for eligibility to ARV treatment. If the patient is eligible, , followpreparation for treatment readiness11
Hospitalize cases with severe conditions; seek consultation orreferpatients to at higher level if in the case is to complicated to manage atthe localfacilities ; collaborate with TB services, dermatovenereologyand obstetrics specialists, with program for prevention of mother to childtransmission of HIV and other specialties as needed.1.3. Counseling and support:Counseling and support should be provided to all patients with HIVinfection both on ARVs or not receiving the ones. Contents of counselingsession arebased on assessment need of each patient’s needs: Psycho-social support and introduction of supportive services Provision of knowledge on HIV/AIDS Explanation about life-long care and treatment Counseling on positive living and nutrition Counseling on pregnancy and HIV-related issues Counseling on prevention of HIV transmission and safe practice Counseling on treatment adherence: importance and contents oftreatment adherence, especially to patients on ARV treatment Counseling on the necessity of having a treatment supporter whenpatient enrolled in the treatment program Counseling on disclosure of HIV status to family members and partners. Referral of other family members to services such as voluntarycounseling and testing, as needed1.4. Follow-up plan and other necessary supports1.4.1. Schedule for follow-up visits for each patient: For patients not receiving ART: Follow-up visits should be scheduled onthe basis of clinical stage and CD4 cell count: Clinical Stages 1, 2 and CD4 350 /mm3: follow-up visit atevery 3 months and whenever abnormal manifestations occur. Clinical Stages 1, 2 and CD4 350 /mm3; Clinical Stage 3 andCD4 350 /mm3: follow-up visit at every 1-2 months andwhenever abnormal manifestations occur.12
For patients eligible to ART: follow-up visit should be scheduled toprepare for treatment readiness. For patients on ART: follow-up visit as scheduled.1.4.2. Explan to patients to come to health facilities whenever abnormalmanifestations occur in order to be timely managed.1.4.3. Dispense medications as scheduled by the care and treatment team.2. Follow-up visits:Patients should come to HIV care and treatment facilities for follow-up visit asscheduled or whenever abnormal manifestations occur.2.1. Clinical examination and laboratory testing: Taking history: symptoms newly occurred since the last visit, such asfever, weight loss, cough, diarrhea, eruption, etc.; psycho-social issues,treatment adherence. Clinical examination: general and specific organsexamination fordetection of opportunistic infections and other conditions, side effects ofprophylactic and therapeutic medications. Re-assess clinical staging. Perform routine tests, CD4 cell count; diagnostic tests for OIs anddetection of drug side effects as well as treatment failure, as needed.2.2. Management:Management will be provided depending on the clinical condition and testresults of the patient. Treatment for OIs and management of drug side effects if any. Consideration of ARV treatment if patient is eligible. Psycho-social counseling and support for treatment adherence. Referral for patients to other relevant services.13
III. PROPHYLAXIS FOR OPPORTUNISTIC INFECTIONS1. Co-trimoxazole prophylaxisObjective: CTX is effective to prevent opportunistic infections includingPCP, toxoplasma encephalitis, as well as other bacterial and protozoalinfections that cause pneumonia, diarrhea.1.1. Indication of Co-trimoxazole prophylaxisIf CD4 is available, start cotrimoxazole prophylaxis for: Persons with HIV infection at clinical stages 3 and 4, regardless of CD4cell count. Persons with HIV infection at clinical stage 1 and 2 if CD4 200cells/mm3If CD4 cell count not available, start cotrimoxazole prophylaxis for: HIV-infected patients at clinical stage 2, 3 or 4.Pregnant women should start Cotrimoxazole prophylaxis regardless ofperiod of pregnancy. Breastfeeding women should continue cotrimoxazoleprophylaxis.1.2. Dosage for prophylaxis Co-trimoxazole 960mg (SMX800mg/TMP160mg) orally once per day orthree times per week. Alternatives (in case of Co-trimoxazole intolerance): Dapsone100mg/day. Dapsone is less effective than Co-trimoxazole in preventingPCP.Note: Co-trimoxazole and ARVs (especially nevirapine and efavirenz) cancause rash. Co-trimoxazole prophylaxis should be given 1-2 weeks prior toARV treatment tohelp with differentiation of side effects between the drugsif occur.1.3. Contraindication: allergy to sulphonamides1.4. Common side effects of Co-trimoxazole:14
Vomiting and nausea can be seen, commonly within 1-2 weeks afterstarting prophylaxis. Co-trimoxazole rash can be of mild, moderate orsevere grade (see Table 3). Severe side effects due to Co-trimoxazolesuch as anemia, granulocytopenia, hepatotoxicity are uncommon. Counsel the patients about potential side effects for self monitoring; tellthe patients to come immediately to health facilities when signs ofsevere side effects occur. Perform complete blood count, liver enzyme measurement whenanemia or hepatotoxicity is suspected.Table 3: Grading and management of co-trimoxazole rashGradeClinical manifestationsGrade 1Erythema(mild)Grade 2Diffuse maculopapular(Moderate) rash, dry desquamationManagement recommendations ose daily Symptomatictreatmentantihistamines.and DISCONTINUE the drug untilsymptoms resolve (usually after 2weeks).Grade 3(Severe)Vesiculation, onand ThenCONSIDERTOREINTRODUCEco-trimoxazolewith desensitization.Grade 4(Verysevere)Exfoliative dermatitis,Stevens-Johnsonsyndrome or erythemamultiforme, moistdesquamation PERMANENTLY DISCONTINUECo- trimoxazole Symptomaticantihistamines15treatmentand
Co-trimoxazole desensitization in adults: Co-trimoxazole desensitization can be attempted in patients withmild and moderate allergy (grades 1 and 2); patients with severeallergy (grade 3) should be desensitized cautiously. Desensitizeshould not be attempted in patients with very severe allergicreactions to Co-trimoxazole or other sulphonamides in history Desensitization should be commenced about 2 weeks afterdiscontinuing Co-trimoxazole when patients’ symptomes resolved.Desensitization should preferably be performed in hospital, whereintensive treatment for anaphylactic shock available if needed Desensitization is commenced according to the following protocol(see Table 4); dose of desensitization is increased only if patients donot develop hypersensitivity to previous dose of cotrimoxazole (norash). If a reaction occurs, the desensitization should be stopped.Once the patient recovers fully, dapsone can be used assubstitution.Table 4: Desensitization protocol for co- trimoxazoleStepDosageDay 180 SMX 16 mg TMP (2ml of oral suspension(*))Day 2160 SMX 32mg TMP (4ml of oral suspension(*))Day 3240 SMX 48mg TMP (6ml of oral suspension(*))Day 4320 SMX 64mg TMP (8ml of oral suspension(*))Day 5One single strength (480mg) tabletFrom day 6Two single strength (480mg) tablets or one doublestrength (960mg) tablet(*) Oral suspension of Co-trimoxazole contains 200mg SMX 40mg TMP in each 5ml. In caseoral suspension not available, dissolve 400mg SMX 80mg TMP tablet and use in dosage asabove.16
1.5. Duration of co- trimoxazole prophylaxis for adults with HIVinfection:Table 5: Duration of Co-trimoxazole prophylaxis for adults with HIVinfectionPatientManagementPatientsnotreceiving ARTPatientsARTLife-long prophylaxison Discontinuation of prophylaxis: Co-trimoxazoleprophylaxis should be discontinued if the patient has CD4 200 cells/mm3 for at least 6 months. If CD4 cell count isnot available, discontinue Co-trimoxazole prophylaxiswhen the patient receives ARV treatment for at least 1year with good adherence and without clinicalmanifestations related to HIV.Reintroduction of prophylaxis: Co-trimoxazoleprophylaxis should be reintroduced when the patient hasdecreased CD4 count 200 cells/mm32. Prevention of active tuberculosis with isoniazide (INH) Objective: prevention of latent TB infection to become active TBdisease Criteria for prophylaxis: All HIV infected people (adults and children)with no active tuberculosis on TB screening. Regimen: oral isoniazide (INH) 5 mg/kg/day (maximal dose in adults is300 mg per day) given daily for 9 months in combination with vitaminB6, 25 mg daily. Monitoring and evaluation: Deliver the drug monthly and evaluate thedrug use at least once a month. Management of stopping therapy: lost:if the patient missed less than 50% of total doses, give additional doses17
for treatment to be completed; if missed over 50% of total doses, thetreatment should be restarted. Side effects: Mild: peripheral neuropathy – manage with vitamin B6100mg/day. Severe: liver involvement (jaundice, anorexia, elevated liverenzymes). Management: stop INH and refer to healthcare facilities fortreatment. Advice patients not to drink alcohol or beer duringtreatment.18
IV. APPROACH TO COMMON CLINICAL SYNDROMES IN PATIENTS WITHHIV/AIDS1. Prolonged feverProlonged fever (a, b)Give antipyretics, counsel on nutrition--History taking (c)Physical examination (d)Suggestive causes of fever (e):Routine analyses and symptom-basedinvestigations (e):- CBC, CD4 (if available)- Respiratory findings: CXR, sputum forAFB- Neurologic findings: CSF analysis- Septicemia, penicilliosis: blood culture- Lymphadenopathy: lymphnodeaspiration and cytology- Respiratory findings: TB, PCP, bacterialpneumonia- Neurological findings: bacterial, TB, cryptococcalmeningitis; toxoplasmal encephalitis- Skin lesions: penicilliosis- Lymphadenopathy: TB, MAC, fungal septicemia- Diarrhea: salmonellosis, TB enteritis, MAC- Anemia: TB, endocarditis, MAC, fungalsepticemia, malaria- Prev. history with using medication: allergyEmpirical treatment (e):- Septicemia: appropriate antimicrobials- Penicilliniosis: itraconazole- PCP: co-trimoxazole- TB: anti-TB drugs, or anti- MAC treatment if noresponse- Bacterial or cryptococcal meningitis: appropriateantimicrobials- Toxoplasma encephalitis: co-trimoxazole- Etc.Diagnosis confirmed by analyses andinvestigation, and/orPatient responds to empirical therapyNo confirmations for diagnosis, patient does notrespond to empirical treatment- Re-evaluate clinically, consider other causes,especially TB, MAC or HIV related fever- Do appropriate analyses and investigations,consider lymph node and bone marrow biopsy,CT scan, echocardiography, etc.- Treat presumptively for TB, consider MAC if noresponse- Consider ART19Continue and complete treatment.Maintenance treatment if indicated
Instructions:(a) Definition: prolonged fever is defined as a fever over 38,50C lasting formore than 14 days without any causes determined.(b) Common causes of prolonged fever-OIs: TB, penicilliosis, cryptococcal meningitis and fungemia,septicemia due to salmonella and other bacteria, MAC, etc.-HIV related neoplasms, such as lymphoma-Drug reactions such as hypersensitivity to CTX, NVP, ABC, etc.-HIV related fever, malaria(c) History taking:-Symptoms from organs and systems: headache (meningitis due tocryptococcus or TB, Toxoplasmosis), diarrhea (salmonellasepticemia, MAC, etc.), cough (pulmonary TB), rash (penicilliosis,drug allergy), etc.-Drugs taken: CTX, ARV, others.-History of any OI or other HIV associated conditions (potentialrecurrence of OIs if secondary prophylaxis or ARV treatment notgiven)-History of drug allergy and other conditions.-History of IDU (septicemia with Staphylococcus aureus), unsafe sex(gonorrhea, syphilis, other STIs)-Family history: TB, cough and other communicable diseases(d) Clinical examination: Examine all systemsandorgans , focus on theones with symptoms.(e) Refer to causes of OIs, investigations and treatment in Section V"Diagnosis and treatment of common Opportunistic Infections”.20
2. Respiratory manifestationsRespiratory symptoms (a, b)Normal CXR or diffuse infiltrationor pneumothoraxMild to moderate dyspneaGradual onset, severelyimmunocompromised-- Take history and assess clinically (c)- Routine laboratory testsConsider PCP, givetreatment trial withCTX (e)- Chest X ray, sputum for AFB (d)- Other necessary tests andinvestigations-CXR suggestive of TBChronic or subacute onsetProductive cough, fever, with orwithout cachexiaAFB (-)AFB ( )Treat for TBTreat for causes ifdefined (e)- Acute onset- Fever, productive cough, chest pain( )- CXR: lobar infiltration-History of IDUFever, dyspneaCXR: diffuse nodularinfiltrations21Diagnostic steps forAFB (-) pulmonaryTB as followedNational guidelines(d)Considerpneumococcalpneumonia. Treat withantibiotics (e)Considerstaphylococcalpneumonia endocarditis; treat withantibiotics (e)No improvement:- Re-assess clinically- Repeat essential lab investigations (CXR, sputumAFB, blood culture, lymph node aspiration, etc.)- Con
2.3. Criteria for diagnosis of advanced HIV infection (including AIDS): - Any stage 3 or stage 4 clinical condition (presumptive or definitive diagnosis) and/or - CD4 cell count 350 cells/mm 3 AIDS is defined as clinical diagnosis (presumptive or definitive diagnosis) of any stage 4 condition or CD4 cell count 200 cells/mm 3
Resource pack on gender and HIV/AIDS. (Operational guide; fact sheets; WHO: integrating gender into HIV/AIDS programme, a review paper). UNAIDS Interagency Task Team on Gender and HIV/AIDS. Amsterdam, The Netherlands. 2005. Pack of 2 reports; 16 fact sheets. KEYWORDS: gender; HIV/AIDS manuals. Location: WHO. 0004 - UNAIDS HIV/AIDS: its your .
I am pleased to present this study report on Socio-economic impact of HIV/AIDS on people living with HIV/AIDS and their families' . This study is significant as it was carried out by networks of People Living with HIV/AIDS (PLWHA) in four Indian states. I would like to compliment the PLWHA networks, particularly their members,
This study's main objective is to show the impact of HIV/AIDS on mortality and insurance packages for an infected person. SPECIFIC OBJECTIVE 1. To determine a comprehensive maternity health insurance package for a HIV/AIDS infected person. 2. To estimate premiums payable by a HIV/AIDS infected individual on whole life policy.
NATIONAL HIV/AIDS STRATEGY 2011 ‐ 2016 9 CHAPTER I: INTRODUCTION AND SITUATION ANALYSIS INTRODUCTION National HIV/AIDS Strategy, 2011‐2016 The National HIV/AIDS Strategy is a national guiding document for all sectors, institutions and partners involved in the response to HIV and AIDS in Nepal.
The Difference Between HIV and AIDS Now that we have discussed the symptoms of HIV, we will discuss the differences between HIV and AIDS. First of all it is important to reiterate that HIV is the virus that causes the disease AIDS.
A resource pack for unions www.itfglobal.org. HIV/AIDS and civil aviation: A resource pack for unions V . 23 Mainstreaming HIV and AIDS in core union business 26 Persuading employers that AIDS is a workplace issue 29 Tackling stigma and discrimination 32 No solutions without gender equality 35 ILO Recommendation 200 concerning HIV and AIDS (2010)
The National HIV and AIDS Strategic Plan 2020/21 – 2024/25 iii ACRONYMS AND ABBREVIATIONS ABYM Adolescent Boys and Young Men ACP AIDS Control Programme AGYW Adolescent Girls and Young Women AIS AIDS Indicatory Survey AIDS Indicatory Survey ANC Antenatal Care ART Antiretroviral Therapy ARV Antiretroviral Medicines CSO Civil Society Organizations DAC District HIV/AIDS Committees
The Careers Group University of London runs an annual one day course on working with charities. Ask the RVC Careers Consultant for more information. ANIMAL NUTRITION: The profession is unregulated in terms of being a nutritionist working with animals. However, in order to have any credibility with intending clients or employers, it might be best to take an MSc or PhD in this subject. For a .
