Product Selection for Opportunistic Infections

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Product Selection for Opportunistic Infections

• IDA HIV/AIDS Group, Nienke Gruppelaar

HIV does not kill, opportunistic infections do!
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Frequency of OI (US)
Male() Female() Pneumocystis carinii
pneumonia 35.7 33.7 Kaposi sarcoma 12.5 1.3 Esoph
ageal candidiasis 11.9 19.9 Wasting
syndrome 7.8 9.0 Mycobacterium avium
complex 6.4 6.8 Pulmonary tuberculosis 4.8 6.6
Extrapulmonary cryptococcosis 4.3 3.1 HIV
encephalopathy 4.2 3.2 Cytomegalovirus
retinitis 3.8 3.4 Cytomegalovirus
disease 3.4 2.1 Toxoplasmosis of
brain 2.9 3.8 Chronic cryptosporidiosis 2.9 1.
5 Recurrent pneumonia 2.3 7.1 Extrapulmonary
tuberculosis 2.0 3.0 Chronic herpes
simplex 2.0 4.1
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Pneumocystis Carinii Pneumonia (PCP)

• Very common among HIV-infected people
• PCP almost always occurs when CD4 lt 200
• First choice Co-Trimoxazole oral tablets (960 mg
  or higher dosage), 3 times a day
• If CD4lt200, Profylaxis Co-Trimoxazole 960 mg once
  a day

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Bacterial infections and Protozoal Infections

• TB, PCP (pneumonia),Toxoplasmosis,
  gastro-intestinal infections
• Medicines
• Azithromycine (tabs), Clarithromycine (tabs)
• Ceftriaxone (tabs, injection)
• Cefixime (tabs)
• Ciprofloxacin (tabs), Ofloxacin (tabs),
  Levofloxacin
• Co-trimoxazole, (CTX) prophylaxis daily (tabs,
  injection)
• Clindamycine (caps)
• Tinidazole (caps), Metronidazole
• Pyrimethamine, Sulfadiazine

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Effect of TB on HIV disease

• TB is the most frequent opportunistic infection
  in HIV people
• TB is the leading cause of death in HIV people
• TB may occur at any moment in HIV disease but the
  risk increases as the disease progresses
• TB treatment Attention to overlapping drug
  toxicities drug-drug interactions

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Fungal Infections

• Candidiasis (oral trush), Cryptococcal Menigitis,
  Cryptosporidiosis
• Medicines
• Clotrimazole (cream, vaginal tabs)
• Miconazole (oral tabs)
• AmphotericineB (injection)
• Fluconazole (caps)

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Miconazole for treatment of Oral candidiasis

• IDA supplies a convenient once daily dosage form
  of Miconazole
• Cost-effective treatment for oral candidiasis
• Convenient, long-acting
• topical drug which can
• be used at lowest level
• of care (home based care workers)

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Viral Infections

• Cytomegalovirus (CMV), Herpes Zoster, Hepatitis,
  Herpes Simplex
• Medicines
• Aciclovir (tabs, IV)
• Ganciclovir (caps, IV)
• Valganciclovir (tabs)
• Ganciclovir Valganciclovir are relative
  expensive, and require skilled healthcare
  workers in high-end resource setting

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Malignancies

• Kaposi's sarcoma, CNS lymphoma, Non
• Hodgkin's lymphoma, Cervical cancer
• Medicines
• Vincristine, Vinblastine
• Etoposide
• Doxorubicine
• All injections, Specialised care is needed

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Other infections

• Diarrhoea ORS
• Worm infections Albendazole
• Malaria Quinine, Artmether, Artesunate

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Palliative Care

• Reliefing pain, improving quality of life
• Physical pain, Fevers, night sweats, poor sleep,
  weight loss
• Paracetamol (tab 500mg), Codeine (tab), Ibuprofen
  (tab) Diclofenac (tab), Multivitamins (tabs,
  syrup), Diazepam (tab 5mg, injection 10mg/2ml)
• Physical pain (severe)
• Opioids Morphine (tabs, oral solution,
  injection)
• Psychological effects anger, anxiety,
  depression, fatigue/lethargy, loss of appetite
  etc.

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Conclusion

• Treatment OIs essential part of HIV/AIDS programs
• Effective treatment for most frequent OIs is
  available
• Not all medicines are currently available from a
  generic source
• Total overview Price Indicator IDA