Upload File

david h. spach, md the international aids society–usa initial evaluation and common clinical...

  • Home
  • Documents
  • David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical
15
David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, August 2004.

Post on 20-Jan-2016

220 views

Category:

Documents


0 download

Report

TRANSCRIPT

Page 1: David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical

David H. Spach, MD

The International AIDS Society–USA

Initial Evaluation and Common Clinical Manifestations

DH Spach, MD.Presented at IAS–USA/RWCA Clinical Conference, August 2004.

Page 2: David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical

Slide #2

DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, August 2004.

Recommended Routine Serologic Tests

Toxoplasmosis

Syphilis

Hepatitis A Virus

Hepatitis B Virus

Hepatitis C Virus

Cytomegalovirus

DHS/HIV//PP

Anti-Toxoplasma IgG

VDRL or RPR

HAV total antibody

Anti-HBc, HBsAb

Anti-HCV IgG

*Anti-CMV IgG

Disease Test

*Only in persons with relatively low risk

Page 3: David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical

Slide #3

DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, August 2004.

Acquisition of Toxoplasma gondii

DHS/HIV/PP

Cat Feces

Undercooked Red Meat

Page 4: David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical

Slide #4

DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, August 2004.

ACIP: Recommended Vaccinations

Influenza Vaccine

Pneumococcal

Hepatitis A Vaccine

Hepatitis B Vaccine

Tetanus-Diphtheria

DHS/HIV/PP

Yearly

*Once & Repeat after 5 Years

0 & 6-12 months

0, 1, 6 months

Every 10 Years

Vaccine Schedule

*Optimal to vaccinate when CD4 counts highest

From: ACIP. MMW 2002;51 (40):904-8.

Page 5: David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical

Slide #5

DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, August 2004.

Pneumococcal Disease in HIV-Infected PersonsSummary of Data

Pneumonia: 10-fold increase in HIV-infected persons

Bacteremia: 50-100 fold increase in HIV-infected persons

Mortality: no evidence for increase in HIV-infected persons

CD4 Count: risk greatest with CD4 count less than 200 cells/mm3

Antimicrobial Prophylaxis: risk decreased with TMP-SMX or Azithromycin

DHS/HIV/PPFrom: Feikin DR et al. Lancet ID 2004;187:44-55.

Page 6: David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical

Slide #6

DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, August 2004.

Vaccines Related to TravelAdvice for HIV-Infected Persons

Centers for Disease Control and Prevention. General Information Regarding HIV and Travel.

www.cdc.gov/travel/hivtrav.htm

DHS/HIV/PP

Page 7: David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical

Slide #7

DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, August 2004.

Vaccinations in HIV-Infected AdultsKey Points

Give as early as possible (high CD4 count)

No significant impact on CD4 count or HIV RNA levels

Avoid most live vaccines

Get expert advice regarding travel-related vaccines

DHS/HIV/PP

Page 8: David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical

Slide #8

DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, August 2004.DHS/HIV/PP

Oral CandidiasisClinical Types

Erythematous Pseudomembranous Angular Cheilitis

Page 9: David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical

Slide #9

DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, August 2004.

Oropharyngeal CandidiasisTreatment Options

Topical Therapy- Clotrimazole troches: 10 mg 5x/d x 7-10d- Nystatin pastilles: 1-2 pastilles 5x/d x 7-10d

Systemic Therapy (Oral)- Fluconazole: 100 mg qd x 7-10d- Itraconazole solution: 200 mg qd x 7-10d- Ketoconazole: 200 mg qd x 7-10d

DHS/HIV/PP

Page 10: David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical

Slide #10

DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, August 2004.

Oropharyngeal CandidiasisSuggested Guidelines for Therapy

Indications for Topical Agents- No esophageal involvement- CD4 count greater than 50 cells/mm3

- Receiving or expect to receive HAART

Indications for Systemic Agents- Esophageal involvement- CD4 count less than 50 cells/mm3

- NOT receiving or expecting to receive HAART

Chronic Suppressive Therapy - NOT recommended

DHS/HIV/PPFrom: Powderly WG et al. AIDS Research & Human Retroviruses. 1999;15:1619-23.

Page 11: David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical

Slide #11

DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, August 2004.

Fluconazole-Resistant Oropharyngeal CandidiasisTreatment Options

Topical Therapy- Amphotericin B solution: 5 ml (100 mg/ml) qid x 7-10d

Systemic Therapy- Amphotericin B: 0.3 mg/kg IV qd x 7-10d- Caspofungin: 50 mg/kg* IV qd x 7-10d- Itraconazole solution: 100 mg bid x 7-10d - Fluconazole: 800 mg PO/IV qd x 7-10d- Voriconazole: 200 mg PO/IV bid x 7-10d

DHS/HIV/PP

* Use 70 mg/kg IV qd for the first dose

Page 12: David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical

Slide #12

DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, August 2004.DHS/ HIV/PP

Aphthous LesionsClinical Types

Minor (Lip) Minor (Tongue) Major

Page 13: David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical

Slide #13

DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, August 2004.

Oral Aphthous LesionsTreatment Options

Topical Therapy- Topical Corticosteroids

Intralesional - Triamcinolone: 40 mg /ml (0.5 ml-1.0 ml injected bid)

Systemic Therapy- Prednisone: 0.5-1.0 mg/kg qd x 7-10d, then taper- Thalidomide: 200 mg PO qd

DHS/HIV/PP

Page 14: David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical

Slide #14

DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, August 2004.DHS/HIV/PP

Herpes Simplex Virus InfectionChronic Ulcerative Lesions Types

Ear Face Scrotum

Page 15: David H. Spach, MD The International AIDS Society–USA Initial Evaluation and Common Clinical Manifestations DH Spach, MD. Presented at IAS–USA/RWCA Clinical

Slide #15

DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, August 2004.

Cutaneous HSV InfectionsTreatment Options

Recurrent HSV- Acyclovir: 400 mg PO tid x 5-10d*- Valacyclovir: 500 mg PO bid x 5-10d*- Famciclovir: 500 mg PO bid x 5-10d*

Suppressive Therapy- Acyclovir: 400-800 mg PO bid- Valacyclovir: 500 mg PO bid- Famciclovir: 250-500 mg PO bid

DHS/HIV/PP

*Longer courses typically needed for chronic ulcerative herpes simplex


Management of NRTI Resistance - University of …depts.washington.edu/nwaetc/presentations/uploads/194/...Management of NRTI Resistance David Spach, MD Principal Investigator, NW AETC

Antimicrobial Therapy David H. Spach, MD Professor of Medicine Division of Infectious Diseases University of Washington, Seattle

April 2003 DHS/HIV/ARV Rx/PP HIV/AIDS Opportunistic Infection Update David H. Spach, MD Medical Director Northwest AIDS Education and Training Center Associate

Cyperus medusaeus (Cyperaceae) redescribedCyperus conglomeratus itself has small, unwinged nutlets (Kukkonen 1991). Cyperus aucheri Jaub. & Spach, commonly included in C. conglomeratus,

Chemical composition of horse-chestnut (Aesculus) leaves and … · 2017-04-11 · Hook, Aesculus californica (Spach) Nutt., Aesculus parviflora Walter, Aesculus assamica Griff.,

Tick-Borne and Zoonotic Diseases in the United States David Spach, MD Professor, Division of Infectious Diseases University of Washington, Seattle DHS/PP

Management of Skin & Soft Tissue Infections of Skin & Soft Tissue Infections David H. Spach, MD Professor of Medicine Division of Infectious Diseases University of Washington, Seattle

Naima BOUTAGHANENaima BOUTAGHANE · 2017-11-13 · Soutenue publiquement le 29/04/2013 devant le jury : JURY ... Algériennes Genista ulicina Spach (Fabaceae) et Chrysanthemum macrocarpum

86. ISODON (Schrader ex Bentham) Spach, Hist. Nat. Veg ...flora.huh.harvard.edu/china/pdf/pdf17/isodon.pdfFlora of China 17: 269Œ291. 1994. 86. ISODON (Schrader ex Bentham) Spach,

2013 Infectious Diseases Update David H. Spach, MD Professor of Medicine Division of Infectious Diseases University of Washington, Seattle

Hepatitis web study H EPATITIS W EB S TUDY H EPATITIS C O NLINE Peginterferon alfa-2b (PegIntron) Prepared by: David Spach, MD & H. Nina Kim, MD Last Updated:

2005 Asilomar HIV/AIDS Medical Update David H. Spach, MD Clinical Director, Northwest AIDS Education and Training Center Professor of Medicine, Division

July 24th, 2008 HIV Lifecycle and Mechanisms of Antiretroviral Therapy David Spach, MD

Radykalna rewolucja w zarządzaniu. Przewodnik menedżerapdf.helion.pl/rareza/rareza.pdf · Zasada nr 7: interaktywna komunikacja 223 Cz II. Implementacja 239 11. Rozmowa niczym rwca

RG 326 Atomic Energy Commission Manhattan … 326 Atomic Energy...md-070 md-072 md-097.31 mp092 md-121.2 md-121.4 md-121.6 md-721.6 md-132.2 md- 140 md- 1 40 md- 1 40 md- 1 50 md-

Antiretroviral Therapy Guidelinesdepts.washington.edu/nwaetc/presentations/uploads/16/... · 2014. 5. 29. · Presentation Prepared by: Christian B. Ramers, MD, MPH and David Spach,

POLLINATION OF A FLOWERING ODDITY: (BLUME) SPACH ... · POLLINATION OF A FLOWERING ODDITY: RHIZANTHES ZIPPELll (BLUME) SPACH (RAFFLESIACEAE) Hans Banzige，J ABSTRACT In a pollination

Judith A. Aberg, MD The International AIDS Society–USA Management of AIDS-Related Opportunistic Infections JA Aberg, MD. Presented at IAS–USA/RWCA Clinical

Tick-Borne and Animal-Associated Diseases David Spach, MD Professor of Medicine Division of Infectious Diseases University of Washington, Seattle

USING URS for QUALITY MANAGEMENT Case Study 1: “How many of the women currently enrolled in the RWCA case management program are actually receiving routine

Sarcopoterium spinosum (L.) Spach - ONDEWEBlnx.ondeweb.net/ccb2/uploaded/1/71ff1fb9da9384d30664f...112 INFORMATORE BOTANICO ITALIANO, 40 SUPPL. 1, 2008 Flora da conservare: implementazione

MRSA, VRE, and MDRO - What's New in Medicine · 2012 Infectious Diseases Update MRSA, VRE, and MDRO David H. Spach, MD Professor of Medicine Division of Infectious Diseases University

Teatr 13 Jean -Paul Sartre Przy drzwiach zamkniętych · PDF fileJea -Paul Sartre -urodził się w rodzinie m1e czańskieJ 21 z rwca 1905r. w Paryżu. Jego kuzy­ nem był Albert Schweitzer

Hepatitis web study H EPATITIS W EB S TUDY Hepatitis A: Epidemiology Presentation Prepared by: David Spach, MD and Nina Kim, MD Last Updated: May 31, 2011

Care Primary Care Issues in HIV David H. Spach, MD The International AIDS Society–USA DH Spach, MD. Presented at IAS–USA/RWCA Clinical Conference, June

N ORTHWEST A IDS E DUCATION AND T RAINING C ENTER NNRTI Resistance David H. Spach, MD Principal Investigator, NW AETC Professor of Medicine, Division of

Extracción de Saponina en Cucumis Dipsaceus Ehrenberg Ex Spach y Evaluar Su Actividad Cicatrizante

Welcome to I-TECH HIV/AIDS Clinical Seminar Series 15 October, 2009 New Insights into HIV Pathogenesis and Antiretroviral Therapy Update David H. Spach,

NATIONAL SURVEY OF HEALTH CENTER HIV TESTING, … · 2019-03-19 · Rapid HIV testing was performed more frequently by clinics receiving RWCA Title III funding and CHC 330 funding

„WIR SPRECHEN MIT DEN HÄNDEN.“ - interjuli Multilingualism/03. Rana.pdf · vo nG ebä rd spach. Wie Wisch erörtert, ist Gebärden - sprache entsprechend der allgemeinen Definition

STUDIES ON THAILAND'S FIFTH SPECIES OF (BLUME) SPACH · STUDIES ON THAILAND'S FIFTH SPECIES OF ... incomplete museum material allowed， detailed taxonomic description. ... 抑'eam

2017 RWCA conference and Wake of Fame location

Hepatitis web study H EPATITIS W EB S TUDY H EPATITIS C O NLINE Simeprevir (Olysio) Prepared by: David Spach, MD & H. Nina Kim, MD Last Updated: October

MD-2014 MD-3204 MD-3208 MD-3200 MD-3206 MD-3210 ......MD-5200 MD-5206 MD-CRMI MD-5204 MØRDEN MD-5210 DOORS LTD. #119, 13045-84 AVENUE SURREY, 183 TEE 604.592.0472 • FAX: 604.592.0462

MP T.INTAN MD SELAMA MD T.MALIM MD B.GAJAH MD … · mp t.intan md selama md t.malim md b.gajah md p.tengah mp taiping mp manjung md kampar suk perak mb ipoh md kerian md gerik md