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INFECTIOUS DISEASES 5, :recycle:Tenofovir-emtricitabine and raltegravir (…
INFECTIOUS DISEASES 5
HIV
ODYNOPHAGIA AND DYSPHAGIA IN PATIENTS WITH HIV
- white plaques ( canida- fluconazole)+ >60% cases
- Large line uclers( CMV-- ganciclovir)
- vesicles( HSV- acyclovir)
- Apthous ulcer ( triệu chứng)
DIARRHEA IN AIDS
- tiêu chảy nước NẶng
---> Crytosporodium
- sốt cao>39
----> mycobacterium Avium
- tiêu chày ít., nhỏ +hematochezia
---> CMV
OPPORTUNISTIC INFECTIONS IN HIV
- Pnemocytitis jirovecii: CD4<200+ canida:->TMS
- toxoplasma: CD<100+ IgG--> TMS
- Mycobacerum avium : CD4<50--> Arth
- HIstoplasma capsulatum: CD4<150 + Ohio---> Itrconazole
TDP của thuốc HIV
- NRTIs (Nucleotide Reverse Transcriptase Inhibitors)
- NNRTIs (Non-nucleoside Reverse Transcriptase Inhibitors)
- PI (protease inhibitor)
- integrase inhibitor
- NRTIs( Tenofovir/zidovudine/lamivvudine)
- zidovudine:bone marrow suppresion
- didanosine: pancreatitis
- abacavir: tăng thân nhiêt
- NNRTI
- Nevirapine: rash ..SJS/hepatoxity
- Efavirens; tk
VACCINES RECOMMENDED FOR ADULTS WITH HIV
- HAV/HBV/HPV/Influenza/Menigoccous ( A....)/ Pneumoccocus/ Tdap( bach hầu,uốn vàn,ho gà)
- CCD live vaccine( MMR,,zoter, varicella nếu CD4<200
ACUTE HIV INFECTION
ls
- tc 2-4 tuần sau tiếp xúc
- mononucleosis- like syndrome( fever, lymphadenopathy.sore throat, arthralgias)
- macular rash
- gastrointestinal symptoms
CLS
- viral load>100.000
- HIv antibody testing may be negative
- CD4 normal
- phối hợp nhiều loại kháng virut
- BN ko triệu chứng---> Dtri dự phòng
RECOMMENDED SCREENING FOR HIV
- initial screening: 15-65t / tuberculosis/STD
Annual: IVDU+ sex/MSM.....
additional: pregnacy/ dich bắn vô mắt/any new STD. trước khi new sexual RLS
HIV SCREENING IN PREGNANCY
- High risk -—“window period x3 tháng--->>high level of HIV present but Ab screen is falsely negative
HIV SCREENING IN INFANCY
- YTNC: mẹ/ breastfeeding
- tiêu chảy mãn/nổi hạch/PCP
- CLS : PCR< 18 thang
- Dtri; bằng thuoc khang virut phồi hợp
PRENATAL, INTRAPARTUM AND POSTNATAL MANAGEMENT OF HIV PATIENT
INTRAPARTUM
- viral load=<1000: ART + vaginal delivery
- viral load >1000: ART + cesarean delivery
POSTNATAL
- Me : ART
- Infant( <1000): zidovudine
- Infant( >1000):multi drug ART
PRENATAL
- TD HIV RNA viral load+ CD4 mổi tháng
- Avoid Amniocentesis: CD4 <1000
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:recycle:Tenofovir-emtricitabine and raltegravir ( dau cơ) is the preferred therapy because of less SE and low drug-drug
interaction.