Therapy and prophylaxis of opportunistic infections in HIV-infected patients: a guideline by the German and Austrian AIDS societies (DAIG/ÖAG) (AWMF 055/066)

Abstract

IntroductionThere was a growing need for practical guidelines for the most common OIs in Germany and Austria under consideration of the local epidemiological conditions.Materials and methodsThe German and Austrian AIDS societies developed these guidelines between March 2010 and November 2011. A structured Medline research was performed for 12 diseases, namely Immune reconstitution inflammatory syndrome, Pneumocystis jiroveci pneumonia, cerebral toxoplasmosis, cytomegalovirus manifestations, candidiasis, herpes simplex virus infections, varizella zoster virus infections, progressive multifocal leucencephalopathy, cryptosporidiosis, cryptococcosis, nontuberculosis mycobacteria infections and tuberculosis. Due to the lack of evidence by randomized controlled trials, part of the guidelines reflects expert opinions. The German version was accepted by the German and Austrian AIDS Societies and was previously published by the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF; German Association of the Scientific Medical Societies).ConclusionThe review presented here is a translation of a short version of the German–Austrian Guidelines of opportunistic infections in HIV patients. These guidelines are well-accepted in a clinical setting in both Germany and Austria. They lead to a similar treatment of a heterogeneous group of patients in these countries.

Ocular Toxoplasmosis: Recent Aspects of Pathophysiology and Clinical Implications

“…cytomegalovirus retinitis. The essential role of the host immune response is underlined by the fact that patients are at particular risk when CD4+ T cell numbers are reduced below 200 cells/mm 3 and, therefore, subsequent monitoring is advised [55]. Often these individuals demonstrate an atypical fulminant clinical course of ocular toxoplasmosis and provide a great diagnostic challenge.…”

Multiple spontaneous perforation of small bowel by Mycobacterium avium complex infection in an AIDS patient

“…Furthermore, in a case of small intestine involvement in AIDS patients, the responsible organisms should be exactly determined, because treatment will be different according to the organism. To help decrease the MAC infection rate and avoid fatal complications [6], it is recommended that, MAC prophylaxis be applied in HIV positive patients who cannot tolerate or access HAART therapy [5].…”

“…Younger age and no access to HAART therapy are the most important factors for MAC infection [5]. Without HAART, the immunity system weakens and patients become prone to opportunistic infections [6].…”

Development of visceral leishmaniasis in an HIV+ patient upon immune reconstitution following the initiation of antiretroviral therapy

“…IRIS may arise in two different ways, i.e. in a paradoxical or an unmasking pattern [13]. The paradoxical pattern occurs in patients who have been sufficiently treated for the triggering opportunistic infection but then show recurrence of symptoms at the time when the immune system is restored.…”