Aids B24.x2

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Acquired immune deficiency syndrome; Acquired Immune Deficiency Syndrome; AIDS full picture; immune deficiency syndrome acquired

Definition
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Stage 1-4 (CDC 1993) of HIV infection, characterised by the occurrence of opportunistic infections or AIDS-defining tumours.

Etiopathogenesis
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Infection with HIV (Human Immunodeficiency Virus).

Clinical features
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AIDS-related complex, opportunistic infections and tumours (see table).

Therapy
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Antiretroviral therapy as a combination regime under control of viral load and CD4 cell progression (see below HIV infection). Adequate therapy of opportunistic infections and HIV-associated tumours (see table below) as well as for the corresponding clinical pictures, introduction of primary prophylaxis against opportunistic infections, see below. HIV infection. After some opportunistic infections, secondary prophylaxis until the immune system is restored (> 300 CD4-T lymphocytes) is necessary (see table).

Tables
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Important AIDS-defining opportunistic infections and tumours

Pathogen / Cause

Opportunistic infection or tumor

Protozoa

toxoplasma gondii

cerebral or disseminated toxoplasmosis

Cryptosporidium parvum

chronic intestinal cryptosporidiosis

Isospora belli

chronic intestinal isosporidiosis

Mushrooms

pneumocystis carinii

pneumocystis carinii pneumonia

Candida spp.

Candida esophagitis, bronchitis, tracheitis or pneumonia

cryptococcus neoformans

extrapulmonary cryptococcosis

histoplasm capsulatum

disseminated or extrapulmonary histoplasmosis

Viruses

herpes simplex

chronic herpes simplex ulcers or bronchitis, pneumonia, esophagitis

Cytomegalovirus

CMV retinitis, generalized CMV infection (not of liver or spleen)

Jakob Creutzfeld Virus

progressive multifocal leukoencephalopathy

HI-Virus

HIV encephalopathy, wasting syndrome

Bacteria

Salmonella spp.

rez. Salmonella septicemias

mycobacterium tuberculosis

Tuberculosis of any localization

M. avium intracellular

atypical mycobacteriosis of any localization

Tumours

Kaposi's Sarcoma

malignant lymphomas (e.g. Burkitt's lymphoma, primary cerebral lymphoma)

invasive cervical carcinoma

Note: In Thailand, Talaromyces marneffei infection is the third most common AIDS-defining disease after tuberculosis and cryptococcosis.

Therapy of non-dermatological opportunistic infections and tumors in AIDS patients

Disease

Clinic

Diagnostics

Therapy

pneumocystis carinii pneumonia

Dry cough, fever, progressive exercise dyspnea, weight loss, performance slump.

Auscultation mostly o.B.; hypoxemia, LDH-, BSG ↑.

Cotrimoxazole (e.g. Eusaprim forte) 4 times 1920 mg/day p.o. over 3 weeks.

X-ray thorax: Interstitial proliferation of drawings, especially middle and subfields.

Alternatively: Pentamidine inhalations (e.g. pentacarinate) 200 mg over 4 days or Atoquavon (Wellvone) 3 times 750 mg/day p.o. over 3 weeks.

Histology, PCR (provoked sputum, BAL, transbronchial biopsy).

Cerebral toxoplasmosis

Subacute mono- or hemiparesis, sensitivity disorders, visual field defects, vigilance reduction, change of character, headaches, fever, epileptic seizures.

CT or NMR: One or more space-occupying lesions with ring or spot-like KM image and perifocal oedema. Pathogen detection by PCR.

Pyrimethamine (Daraprim) day 1 200 mg, then 100 mg/day p.o. plus sulfadiazine (e.g. sulfadiazine-heyl) 3-4 times 2 g/day p.o. over 4-6 weeks.

Alternatively: Atovaquon (Wellvone) 4 times 750 mg/day p.o.

Candida esophagitis

Dysphagia, tenesmus, diarrhea, weight loss, retrosternal pain.

Candida detection.

Fluconazole (Diflucan) 400 mg/day p.o. over 2-3 weeks.

Alternatively: Itraconazole (Sempera) 2 times 100-200 mg/day p.o.

CMV-Retinitis

Restricted field of vision, threat of blindness.

Characteristic changes of the ocular fundus

Foscarnet (Foscavir) initial 2 times 90 mg/kg bw/day i.v. in 500 ml NaCl 0.9% over 2-3 weeks; maintenance therapy: 90 mg/kg bw i.v. 5 days/week for life.

Alternatively: Ganciclovir (Cymeven) 2 times 5 mg/kg bw/day for 3 weeks, then maintenance therapy with 6 mg/kg bw for 5 days/week.

Alternatively, intravitreal injections or implantation of a drug depot (pellets) by specialized ophthalmologists.

Secondary prophylaxis of opportunistic infections in AIDS

Disease

Substance

Dosage

Preparation

pneumocystis carinii pneumonia

Cotrimoxazole

480 mg/day p.o. or 960 mg 3 times/week

eusaprim forte

Dapson

100 mg twice a week p.o.

Dapsone Fatol

Toxoplasmosis

Cotrimoxazole

480 mg/day p.o.

eusaprim forte

Alternative: Pyrimethamine

50-75 mg/day p.o.

Daraprim

Alternative: Folinic acid

5 mg/day p.o.

leather folate

Systemic candidiasis

Fluconazole

50 mg/day p.o. or 3 times 100 mg/week

Diflucan

Alternative: Itraconazole

100 mg/day p.o.

Sempera

Aspergillosis

Itraconazole

400-600 mg/day p.o.

Sempera

Alternative: Amphotericin B

0.75 mg/kg bw i.v. 2-3 times/week

amphotericin B

Cryptococcosis

Fluconazole

200 mg/day p.o.

Diflucan

Alternative: Itraconazole

400 mg/day p.o.

Sempera

Histoplasmosis

Itraconazole

200-400 mg/day p.o.

Sempera

Alternative: Fluconazole

200-400 mg/day p.o.

Diflucan

Atypical mycobacteriosis

Rifabutin

300 mg/day p.o.

Mycobutin

Alternative: Azithromycin + Rifabutin

1200 mg/week p.o. + 300 mg/week p.o.

Ultreon + Mycobutin

Alternative: Clarithromycin

2 times 500 mg/day p.o.

Klacid, Mavid

shingles

Aciclovir

2 times 400-800 mg/day p.o.

Aciclovir

CMV retinitis

Ganciclovir (alternating with foscarnet)

5-6 mg/kg bw 5 times/week i.v.

Cymeven

Foscarnet

90-120 mg 5 times/week IV

Foscavir

Literature
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  1. Hamouda O (2003) HIV/AIDS surveillance in Germany. J Acquir Immune Defic Syndr 32: S49-54
  2. Kelly JA et al (2003) The newest epidemic: a review of HIV/AIDS in Central and Eastern Europe. Int J STD AIDS 14: 361-371
  3. Knodela J et al. The impact of the AIDS epidemic on older persons. AIDS 16: S77-83
  4. Letvin NL et al (2003) Immunopathogenesis and immunotherapy in AIDS virus infections. Nat Med 9: 861-866
  5. Sabin CA (2002) The changing clinical epidemiology of AIDS in the highly active antiretroviral therapy era. AIDS 16: S61-68
  6. Scadden DT (2003) AIDS-related malignancies. Annu Rev Med 54: 285-303
  7. Weiss RA (2003) HIV and AIDS: looking ahead. Nat Med 9: 887-891

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 29.10.2020