แนวทางการตรวจรักษาและป้องกันการติดเชื้อเอชไอวี ประเทศไทย ปี 2557 ฉบับเต็ม PDF

2557
Thailand National Guidelines on
HIV/AIDS
Treatment and Prevention 2014
2557
Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014
2557
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CD4

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5
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1 (Introduction)
25
2

(HIV Laboratory for Diagnostic and Monitoring)

2.1

2.2
2.2.1 HIV viral testing
2.2.2
2.3

2.3.1 CD4 (CD4 count)
2.3.2 (HIV viral load)
2.3.3 (HIV drug resistance testing)
2.4
35
36
40
40
41
55
55
57
58
61
3 (Management of HIV-Infected Adult) 65

3.1
66
3.2
72
3.3
73
3.4 75
3.5
77
3.5.1
77
3.5.2
78

(Multi-class antiretroviral treatment failure)
3.6
80
3.7
82
3.8 (Drug-drug interaction)
83
3.9
100
3.9.1
100
3.9.2 ( OIs 6) 102
7
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3.9.3
3.9.4

3.9.5
3.10
3.11

3.12

3.12.1

()
3.13
(Adherence to antiretroviral therapy)
3.13.1 adherence
3.13.2 adherence
3.14 Immune reconstitution inflammatory syndrome (IRIS)
3.15
3.15.1

(acute HIV infection)

6 (recent HIV infection)
3.15.2
3.15.3
3.15.4

3.15.5
3.15.6
3.15.7
3.15.8
3.16
3.17 (Treatment as Prevention)
3.18
8
106
107
108
109
110
115
128
131
131
132
137
141
141
143
148
150
154
156
158
159
162
165
166
4

(Management of HIV-Infected Children and Adolescent)
4.1
4.1.1
4.1.2
4.1.3
4.2

4.2.1
4.2.2
4.2.3

4.2.4

3

4.2.5

4.3
4.3.1
4.3.2
4.3.3
4.4

4.5
(Immune reconstitution inflammatory syndrome: IRIS)

4.6
4.6.1
4.6.2
169
170
170
171
178
181
182
185
188
189
190
194
194
195
196
197
208
212
212
215
9
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4.7
4.7.1

HIV genotyping
4.7.2

2NRTIs + 1NNRTI
4.7.3

2NRTIs + 1PI
4.7.4 3 NRTIs, NNRTIs

PIs
4.7.5
4.8

4.9
4.10
4.11
4.12

4.13
4.14
5

(Prevention of Mother-to-Child HIV Transmission)
5.1
5.1.1
5.1.2
5.2

5.3
10
216
218
220
221
223
225
226
228
230
231
234
234
236
237
239
240
242
245
250
5.3.1
5.3.2
5.3.3
5.3.4

(no ANC)
5.3.5
5.4
5.5
5.5.1
5.5.2
5.6
5.7
5.7.1
5.7.2
5.8
(Early infant diagnosis EID)
6

(Opportunistic Infections: Prophylaxis and Treatment)
6.1 (Tuberculosis)
6.2
6.2.1 Pneumocystis pneumonia (PCP)
6.2.2 Cryptococcosis
6.2.3 Candidiasis
6.2.4 Toxoplasmic encephalitis
6.2.5 Penicilliosis histoplasmosis
6.2.6 Cytomegalovirus (CMV) infection
6.2.7 Mycobacterium avium complex (MAC) infection
251
253
258
259
262
267
270
270
270
272
272
272
274
275
277
278
293
294
298
302
305
309
312
315
11
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7 (HIV Prevention)
7.1
(Antiretroviral-based HIV prevention)
7.1.1 (Treatment as Prevention)
7.1.2

(Pre-Exposure Prophylaxis)
7.1.3

(Post-Exposure Prophylaxis)
7.2 (Male circumcision)
7.3
7.4
7.5
8

(Service Delivery Guidance)
8.1 (Recruit)
8.2 (Test)
8.3 (Treat)
8.4 (Retain)
8.5
8.6

12
333
334
334
337
341
351
356
360
367
369
371
379
386
389
402
410

(Dose and Route of HIV Medication in Adults)
CDC Classification

(WHO Classification System for HIV-Infected Children)

(Dose and Route of HIV Medication in Pediatrics)
creatinine clearance

rapid desensitization TMP-SMX

417
422
432
438
441
450
451
456
457

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475
13
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2.1

2.2

2.3
2.4
2.5

99.5
99.0

42
3.1
3.2
3.3
3.4

CD4 >500 cells/mm3
3.5

3.6
3.7 virological failure
3.8
3.9

3.10
3.11
3.12 NNRTIs, RAL, and PIs
68
70
72
73
14
42
61
63
64
74
75
77
79
79
81
87
97
3.13

3.14

3.15

3.16
3.17 adherence /
3.18 adherence /
3.19

Immune reconstitution inflammatory syndrome IRIS
3.20 IRIS
3.21 IRIS
3.22 acute HIV infection
3.23
3.24
3.25
3.26
3.27 PIs methadone
3.28
111
4.1

4.2

4.3

172

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1-6
7-18
114
116
130
134
135
137
138
140
143
144
147
149
157
158
163
177
178
15
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4.4
4.5
4.6
4.7
4.8

%CD4 < 15%
187
188
197
222
227
5.1

5.2
5.3

5.4 HAART

5.5

5.6

5.7

5.8

HAART
5.9 100 g OGTT
5.10
240
6.1
6.2

319
324
16
244
251
252
254
265
267
268
269
275
6.3

6.4

CD4
CD4
330
7.1

7.2

7.3
7.4

7.5
7.6
PrEP
adherence
HIV oPEP
HIV oPEP
HIV oPEP HIV nPEP

HIV nPEP
nPEP nPEP
337
8.1
8.2

8.3

396

399
411
1.
2.
CD4
3. (staging)
4.
5.
6. rapid desensitization TMP-SMX

331
345
346
347
349
350
422
435
436
437
441
456
17
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2.1
2.2

2.3

2.4

18

18

37
44
52
60
3.1 Crypto Ag
3.2
105
129
4.1 IRIS
4.2
4.3
210
215
217
5.1
5.2

247
248
7.1
7.2 body fluids

335
344
8.1
8.2
8.3
8.4
8.5

8.6

8.7

370
376
378
390
405
18
409
412
/r
Ritonavir boosted
3TC
Lamivadine
ABC
Abacavir
ATV
Atazanavir
AZT
Zidovudine
CCBs
Calcium channel blockers
COBI
Cobicistat
d4T
Stavudine
DCCBs
Dihydropyridine calcium channel blockers
ddl
Didanosine
DMPA
Depot medroxyprogesterone acetate
DRV
Darunavir
DTG
Dolutegravir
Ethambutol
EE
Ethinyl estradiol
ENG
Etonogestrel
EFV
Efavirenz
ETR
Etravirine
EVG
Elvitegravir
FTC
Emtricitabine
HRAs
H2-receptor antagonists
IDV
Indinavir
19
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LNG
Levonorgestrel
INH, H, I
Isoniazid
LPV/r
Lopinavir/ritonavir
MVC
Maraviroc
NET
Norethindrone
NFV
Nelfinavir
NGM
Norgestimate
NRTI
Nucleoside reverse transcriptase inhibitor
NSAIDs
Nonsteroidal anti-inflammatory drugs
NVP
Nevirapine
PAS
Para-aminosalicylic acid
PI
Protease inhibitor
PPIs
Proton pump inhibitors
PZA, Z
Pyrazinamide
Rifampicin
RAL
Raltegravir
RPV
Rilpivirine
RTV
Ritonavir
SQV
Saquinavir
TCAs
Tricyclic antidepressants
TDF
Tenofovir
TMP
Trimethoprim
TMP-SMX
Trimethoprim/sulfamethoxazole
20
BCG
Bacillus Calmette-Gurin
DT/dT
Diphtherias, tetanus vaccine
DTaP/Tdap
Diphtherias, tetanus, acellular pertussis vaccine
DTP
Diphtherias, tetanus, pertussis vaccine
DTwP
Diphtheria, tetanus, whole cell pertussis vaccine
HAV
Hepatitis A vaccine
HBV
Hepatitis B vaccine
Hib
Haemophilus influenza type B vaccine
HPV
Human papillomavirus vaccine
IPV
Injection polio vaccine
JE
Japanese encephalitis vaccine
MMR
Measles, mumps, rubella vaccine
OPV
Oral polio vaccine
PCV
Pneumococcal conjugate vaccine
PPSV-23
23-valent pneumococcal polysaccharide vaccine
PRP-T
Polyribose ribital phosphate-tetanus toxoid
Td
Tetanus and diphtheria toxoid
TT
Tetanus toxoid
VZV
Varicella-zoster virus vaccine
21
2557
AFB
AHI
ALT
ARS
AST
AUC
BMD
BMI
CBC
CD4
CITC
CMV
CrCl
CT
CXR
DOT
DSC
DXA
EBV
EID
EM
EWI
FBS
FDA
GCT
HAART
22
Acid-fast bacilli
Acute HIV infection
Alanine aminotransferase
Acute retroviral syndrome
Aspartate aminotransferase
Area under the curve
Bone mineral density
Body mass index
Complete blood count
Cluster of Differentiation
Client-initiated testing and counseling
Cytomegalovirus
Creatinine clearance
Chlamydia trachomatis
Chest x-ray
Directly observed therapy
Disease specific certification
Dual energy x-ray absorptionmetry
Ebstein-Barr virus
Early infant diagnosis
Erythema multiforme
Early warning indicators
Fasting blood sugar
Food and Drug Administration
Glucose challenge test
Highly active antiretroviral therapy
HAV
HBV
Hct
HCT
HCV
HDL
HHV
HPV
IGRA
INR
IPT
IRIS
IRS
IUD
IUI
IVF
LDL
MAC
MEMS
MMT
NAT
NTM
OGTT
OI
PCP
PCR
Hepatitis A virus
Hepatitis B virus
Hematocrit
HIV counseling and testing
Hepatitis C virus
High-density lipoprotein
Human herpes virus
Human papillomavirus
Interferon gamma release assay
International normalised ratio
Isoniazid preventive therapy
Immune reconstitution inflammatory syndrome
Immune restoration syndrome
Intrauterine device
Intrauterine insemination
In vitro fertilization
Low-density lipoprotein
Mycobacterium avium complex
Medication events monitoring system
Methadone maintenance treatment
Nucleic acid testing
Nontuberculous mycobacteria
Oral glucose tolerance test
Opportunistic infection
Pneumocystis carinii pneumonia
Polymerase chain reaction
23
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PDCA
PEP
PITC
PML
PMTCT
PrEP
PwP
RPR
SDR
SJS
TAMs
TasP
TB
TEN
TG
TLTI
TST
UIC
UNAIDS
UP
VCT
VDRL
VL
WHO
.
24
Plan do check act

Post-Exposure Prophylaxis
Provider-initiated testing and counseling
Progressive multifocol leukoencephalopathy
Prevention of mother-to-child transmission
Pre-Exposure Prophylaxis
Prevention with positives
Rapid plasma reagin
Same day result
Stevens Jonhson syndrome
Thymidine analog mutations
Treatment as Prevention
Tuberculosis
Major/Toxic epidermal necrolysis
Triglyceride
Treatment latent tuberculous infection
Tuberculin skin test
Unified identification code
Universal precaution
Voluntary counseling and testing
Venereal disease research laboratory test
Viral load
World Health Organization
(Introduction)
.. 2527
25
Introduction
.. 2557 1,175,084
431,475 8,535
.. 2556 286,214
.. 2547 (58,133 )
30

CD4 200 350
cells/mm3 1 2555 5 2556

1.
(
)
2.
( CD4)
3.
4.
2557

CD4 100 cells/mm3

CD4 CD4

CD4

2555

(treatment as prevention)

(early diagnosis
and early treatment)
90 (key
populations; KPs) (same day
result HIV testing)

(PMTCT option B+)

26
27
Introduction
(pre-exposure prophylaxis; PrEP)

(prevention and care
continuum)
(task shifting/task sharing)
2557

2557
2557

2

(HIV Laboratory for Diagnosis and Monitoring)

- algorithm

rapid test algorithm
- window period 3
1
- (indeterminate)
(inconclusive)
2 / 1 3
inconclusive 3
- DNA PCR
EDTA
(dried blood spot; DBS)
- HIV DNA PCR

HIV DNA PCR
28
3

(Management of HIV-Infected Adult)
29
Introduction
-
CD4 CD4 < 500 cells/mm3

- NRTIs + NNRTI
TDF/3TC TDF/FTC EFV
- NRTIs
ABC + 3TC AZT + 3TC
- VL > 1,000 copies/mL
VL > 50 < 1,000 copies/mL
VL 2-3
2557
4

(Management of HIV-Infected Children and Adolescent)
- < 1
CD4, %CD4
- 1 (CDC category B, C
WHO stage 3, 4) CD4
- CD4
o 1-< 3 %CD4 < 25% CD4
< 1,000 cells/mm3
o 3-< 5 %CD4 < 25% CD4
< 750 cells/mm3
o 5-15 CD4 < 350 cells/mm3
CD4 350-500 cells/mm3
2 nucleoside reverse transcriptase inhibitors (NRTIs) + NNRTI Boosted PI

2 NRTIs
o 12 AZT/3TC ABC/3TC
o > 12 TDF/3TC
NNRTI boosted PI
o < 3 LPV/r
o 3 EFV
- HIV viral load testing
VL > 1,000 copies/mL
HIV drug resistance testing
-

30
5

2553
2557
CD4 350 cells/mm3

CD4
3
CD4 > 350 cells/mm
14
: AZT + 3TC + LPV/r : TDF + 3TC + EFV
: AZT TDF + 3TC + LPV/r

discordant couple,

(HAART) > 4

50 copies/mL

> 50 copies/mL
: AZT x 4 : AZT x 4
: AZT + 3TC + NVP

: AZT + 3TC + x 6
NVP x 4-6
31
Introduction
CD4 350 cells/mm3

CD4 > 350 cells/mm3
2557
2553
2557

(elective caesarean
section)

latent phase
of labor
4 .
DNA
PCR 2 1-2
4-6
anti HIV 12-18
: 2 1
2-4
: 3 1, 2
4

TSH
TSH

anti-HIV 18
4-6
32
6

(Opportunistic Infections: Prophylaxis and Treatment)
33
Introduction
CD4
o CD4 50 cells/mm3 2
o CD4 > 50 cells/mm3

2 2-8
- rifampicin EFV
EFV NVP RAL
- protease inhibitor
rifampicin
- primary prophylaxis cryptococcosis, penicilliosis,
histoplasmosis Mycobacterium avium complex (MAC)

-
2557
7 (HIV Prevention)
8


treatment cascade

(
)
VL
1 VL < 50 copies/mL

recruit-test-treat-retain (--)
34
(HIV Laboratory for Diagnostic and Monitoring)
.. 2555-2559
35
HIV Laboratory for Diagnosis and Monitoring
1)
2) 3)

CD4

(VL)

2557
2.1

(voluntary counseling and testing; VCT)

(pre-test/
post-test counseling) 2.1
(group counseling)
(individual counseling)
2
(client-initiated
testing and counseling; CITC) (provider-initiated
testing and counseling; PITC) PITC
(WHO) (UNAIDS)

36
2.1
CITC
PITC

(pre-test counseling)
()
(ongoing counseling)
37
2557
(same day result)

rapid test
(machine based)
3

2-3
38
39

1)
2)
- - -
3)
4)
5)
6)
7)
8)
9)
10)
2557

1)
2
2) window period
2 1 seroconversion
3 6
3)
1
2.2
window period window

period 4
2.2.1 HIV viral testing
p24
antigen
( window period)
18

(qualitative assay)1 NAT (nucleic acid amplification
testing) RNA proviral DNA

(positive or negative)
40
p24 antigen
positive
p24 antigen negative
-
-

-
2.2.2
.. 2551
.. 2552
(sensitivity)
(specificity) 2.1
41
ELISA (enzyme-linked immunosorbent assay)

(agglutination assay) dot line immunoassay
rapid test
ELISA
2557
2.1
1
2
3
p24 antigen
anti-HIV
100
100
99.5
99.5
99.5
99.0
: .. 2552
2.2.2.1

(predictive value) (positive predictive value: PPV)
(negative predictive value: NPV) PPV NPV

2[2]
.. 2555 0.89
PPV NPV 99.99

3 UNAIDS WHO
3 2.2
2.2
99.5
99.0
Prevalence
0.05
0.5
1.4
2.0
5.0
10.0
42
%PPV:1 test %PPV: 2 tests %PPV:3 tests

4.7
33.3
58.6
67.0
83.97
91.7
83.2
98.0
99.3
99.5
99.8
99.9
99.8
99.98
99.993
99.995
99.998
99.9999
%NPV
100.00
99.997
99.99
99.98
99.97
99.94
rapid test
2.2.2.3

18
18
3 UNAIDS WHO 2.2
43
2.2.2.2

3

3 2 3

(machine based assay) rapid test
simple test 1 2
3
simple test rapid test
2557
2.2
18
1 (A1)(1)
A1_
A1+
2 (A2)(1)
A1+, A2 _
A1+, A2+
A1 A2
A1_, A2 _
A1+, A2 _
A1+, A2+
3
(A3)(1)
A1+, A2+, A3 _ A1+, A2+, A3+
(anti-HIV negative)
44
(inconclusive)(3,4)
(anti-HIV positive)(2)

1) (anti-HIV negative)
(non-reactive)
2) (anti-HIV positive) 3
(reactive)
3) (inconclusive) 3

2 / 1 3

45
(1) A1, A2 A3 1, 2 3
1
2 3
(2) positive
(newly diagnosed) 2
1
(3) (inconclusive) 2
/ 1 3 A1, A2
A3 3

(4)
2 / 3

(3) NAT neutralization
p24 assay
2557
(false positive) anti-HIV
(false positive)

anti HIV
(antibody cross reactivity)

(mycobacteria) (giardia)
(cytomegalovirus; CMV)

(influenza vaccination)

(human
leukocyte antigen; HLA) 1
46
47
2.2.2.4

18

18
12 95
12-18
18 12

30 1 50 2

PCP
/
DNA PCR
2 2.3
2557
DNA PCR
DNA PCR
18
DNA PCR 2
(1) (dried blood spot ; DBS)
EDTA

.

(DBS)

(2) EDTA
citrate 0.5-2.0 mL

-
.
-
12

48
49
DNA
PCR
1. PCR 1

PCR
2.
PCR ( 4-6

)
4 5
3. PCR 1 PCR

PCR 2 2-4 PCR 2 2
3 4
. 2

2.3
. 2
2 4 PCR
4
2.3
18

2557
12-18
1.
12-18
.

.
18
5-10

12-18 18
2.
(HIV Ag/Ab)

18
PCR
HIV Ag/Ab 18
24
50
51

1. (definitive exclusion of HIV infection)

. PCR
2 2
2 4
. 6
2
. PCR 1 4
1 6

CD4
3 18
2. (presumptive exclusion of HIV infection)

. PCR
2
. PCR 1
2
. 6 1

CD4
52
(5)
2 3
(negative)
2 3
(inconclusive)
(inconclusive)
(5)
2 3
DNA PCR
2 3
(4)
DNA PCR
4
(3)
(negative)
(positive)
(positive)
DNA PCR 2
DNA PCR
(negative)
(negative)
(positive)
HIV DNA PCR 1 (2)
12
(8)
(anti - HIV positive)
(7)
(anti - HIV negative)(10)
(9)
Anti - HIV
18
Anti HIV(6)
12 - 18
18 (1)
2.3 18
2
2557
53
(1)

18
DNA PCR
(2) NAT (nucleic acid amplification testing)

(3) 4
VL 50 copies/mL
(4)
(5) 18
(6) 18
DNA
PCR
(7)
3 3 2
(8) PCR 2

24
(9) PCR 2

(10) 6
2557
18

18

proviral DNA DNA PCR HIV RNA
HIV RNA HIV RNA (qualitative
HIV RNA)
(copies/mL)
(quantitative HIV RNA)
HIV RNA (qualitative HIV RNA)

(in-house)

54
2.3

2.3.1 CD4 (CD4 count)
CD4

CD4 CD4

CD4
CD4

CD4 1-2 CD4 VL
CD4 3-6
CD4 (absolute CD4)
55
CD4
CD4 2
flow cytometer flow cytometer
flow
cytometer 2.3
2557
(CBC)
CD4

%CD4 x absolute WBC x % lymphocyte
CD4 =
10,000
NRBC (nucleated RBC) CD4
%CD4
- CD4
- 5 CD4
EDTA
6

25C
CD4
CD4

steroid
CD4
56
2.3.2 (HIV viral load)
viral load (VL) RNA

real time nucleic amplification
VL

2.3
57
Viral load
VL
1
1
3 6
1
3 6
VL 2 copies/mL Log10 equivalence
EDTA
6
/
VL
1
VL > 1,000 copies/mL 2.4
VL
2557
viral load

10
VL
2.3.3 (HIV drug resistance testing)
genotype

(in-house)

2.3

4
VL
VL > 1,000 copies/mL 2.4
EDTA
58
6
/

2.5
59
2557
2.4
viral load 6 1
viral load
viral load <1,000 copies/mL
(1)
viral load >1,000 copies/mL
drug resistance(2)

(1)
VL EDTA 6-9 mL
VL -20 -70C
(2)
VL drug
resistance
60
2.4
2.3

(IQC)
(EQA)
HIV testing (machine based)
IQC
2 levels
HIV testing (simple test)
IQC
2 levels
HIV testing (rapid test)
IQC
1 level
CD4 test
IQC
1 level
Viral load
IQC
1 level
Drug resistance testing
IQC
1 level
61

CD4 VL
ISO15189

CD4 VL
2.3
CD4 dual platform
(CBC analysis machine)
2557
CD4, viral
load

US FDA
IVD CE mark

(WHO prequalification of diagnostics program)
2556 ( CD4)

2

3
/

62
Viral load testing

(HIV-1 RNA)
63
6-9 mL
2
1.5 mL 6 .
( 4 C)
6 .
4-8 C 24 .
EDTA blood
EDTA plasma
6 .
4-8 C 24 .
(18-25 C)
6 . ( 18-25 C
)
2-8 C
24 .
2-8 C
24 .
6-9 mL
2
1.5 mL 6 .
( 4 C)
6-9 mL
2-3 mL
5 mL
1 mL
2-3 mL
1 mL
., 12 ,
(1)
Genotype
PPT EDTA gel

()
EDTA blood
EDTA Plasma
Real time nucleic acid

amplification
HIV viral testing(1)
CD4 count
ELISA, agglutination test, Clotted blood

dot/line test
Serum plasma
Nucleic acid amplification EDTA blood
testing (NAT)
EDTA plasma
Dried blood spot
Flow cytometry
EDTA blood
Anti-HIV testing
2.4
64
Possible resistance
Resistance
mutation
mutation
( )
No evidence
of resistance
TruGene
(mutation)
Resistance
Possible resistance
None
ViroSeq
High level resistance
Low level resistance

Intermediate resistance
Susceptible
Stanford (in-house)
2.5
2
2557
(Management of HIV-Infected Adult)
65
Management of HIV-Infected Adult
2

( 50 copies/mL) CD4

(AIDS- related illness)
(adherence)
95

2 12
1 24

2557
3.1

o CD4 6-12
o
o
o
o
o

o
o
66

CD4
3.1 3.2
67
68
(current lifestyle)

6 12
6 12
3.1
- sexual dysfunction
-
3
2557
69
drug adherence

EFV
70
Syphilis (VDRL)
ALT
HBsAg
Anti-HCV
(VL)
CD4
3 6
6 12
- 6 12
CD4 > 350 cells/mm3
VL < 50 copies/mL
1
VL < 50 copies/mL
1 VL
50 copies/mL

: IDU
MSM

MSM 6
SW 3
3.2
3
2557
Pap smear
Anal PAP
Serum cryptococcal Ag
Chest X-ray
Drug resistance
Urinalysis
Total cholesterol
Triglyceride
Fasting blood sugar
1
1
1
1
6 12
Creatinine

50
50 kg IDV 6
TDF IDV
6
< 35
1 /
< 35
2 /
35 2 /

50 IDV
6
TDF IDV
6

6
CD4 < 100 cells/mm3
71
2557
3.2

CD4 350 cells/mm3

CD4 > 500 cells/mm3
VL
2557
CD4
< 500 cells/mm3 3.3
3.3
CD4 CD4 < 500 cells/mm3

CD4 > 500 cells/mm3

adherence
72
CD4 > 500 cells/mm3

3.4
3.4 CD4 > 500 cells/mm3
CD4 > 500 cells/mm3
(Public health
benefits)
(Serodiscordant couples)

TB/HIV co-infection
Acute HIV infection
3.3
CD4 < 50 cells/mm3

2
CD4 >50 cells/mm3
2-8
3.5
Cryptococcosis Cryptococcosis
4-6

73
(Individual benefits)
TB/HIV co-infection
HBV/HIV co-infection with cirrhosis
HCV/HIV co-infection with cirrhosis
HIV-associated nephropathy (HIVAN)
Acute/recent HIV infection
2557
Pneumocystis Jiroveci pneumonia

(PCP), Mycobacterium Avium Complex (MAC)

2-4
Progressive Multifocal
Leukoencephalopathy (PML)
3.5
CD4 (cells/mm3)
50
(Tuberculosis)
Cryptococcosis
4-6
PCP/MAC/
2-4
> 50
*
2-8
CMV/PML/Cryptosporidium
:

2
74
3.4
3.6
NRTIs + NNRTI TDF + 3TC TDF/FTC
EFV
3.6
NRTI backbone
NNRTIs
TDF/FTC
+
ABC + 3TC
AZT + 3TC
RPV
NVP
NNRTIs
LPV/r
TDF + 3TC*
EFV
ATV/r

TDF NRTIs ABC + 3TC AZT
+ 3TC ABC
VL < 100,000 copies/mL

EFV
NNRTIs RPV NVP
RPV VL VL
> 100,000 copies/mL
NNRTIs 3
PIs LPV/r ATV/r
75
2557
d4T
d4T
VL < 50 copies/mL

integrase inhibitors
3 RAL
DRV/r
2
ABC ABC
(hypersensitivity reaction)
HLA-B*5701 HLA-B*5701
ABC
HLA-B*5701
ABC 6
2 (1) (2) (3)
(4)

creatine
phosphokinase lymphopenia

ABC Child-Pugh Score of 7-12
76
3.5
3.5.1
3 (1) virological failure

(2) immunological failure (3) clinical failure
1 2
3

virological failure
: virological failure HIV RNA (VL)
200 copies/mL 6
virological failure
1.
adherence
VL
1 VL
2.
VL
VL -
> 50-1,000 - 2-3
copies/mL
VL HIV drug resistance
>1,000 genotypic testing
copies/mL
adherence

3

1 VL
VL > 10
VL
3 VL
< 50 copies/mL
VL 10
adherence
VL > 1,000
copies/mL
77
3.7 virological failure
2557

(1) NNRTI VL
1,000 copies/mL
(2) boosted-PIs
poor adherence
VL 50 copies/mL
- VL > 1,000 copies/mL
-

- 2-6
4
3.8 3.9
3.5.2

(Multi-class antiretroviral treatment failure)
VL < 50 copies/mL

3
3 2
VL 3
78
3.8
1.

2. 3
integrase inhibitor, entry inhibitor
3.
1) Integrase inhibitors: RAL, DTG
2) Protease inhibitors: DRV ()
3) NNRTIs: ETR, RPV ()
4) CCR5 inhibitors: MVC
NRTI
TDF
AZT, d4T ABC
NRTI

AZT/3TC LPV/r

TDF/FTC ATV/r
TDF/3TC
DRV/r, RAL*, DTG

* RAL NRTI backbone
: EVG/COBI
70 mL/min
79
3.9
2557
3.6

12

TDF, 3TC EFV 3.10
TDF VL < 50 copies/mL HBV
(HBsAg) EFV

1-2

()

1
12

80

3.10
EFV
NVP
NVP 400 mg 24 .
OD
LPV/r
LPV/r 2 12 . 4 24 .
ATV/r
TDF
TDF
AZT d4T
TDF 24 .
VL < 50 copies/mL TDF
3TC
3TC 1 12 . 2 24 .
81
EFV
2557
3.7

1 NRTI + 1 NNRTI 1 NRTI + 1 PI boosted RTV 1 NRTI + RAL
2 NRTIs
NRTIs 2

d4T + AZT antagonism
FTC + 3TC resistance profiles
TDF + ddI ddI
d4T + ddI peripheral neuropathy, pancreatitis,
hyperlactatemia lactic acidosis
2
Triple NRTI combinations TDF + 3TC + ABC
NVP CD4 > 400 cells/mm3 CD4

> 250 cells/mm3
2 NNRTIs combination
ATV + IDV hyperbilirubinemia

VL < 50 copies/mL
82
3.8 (Drug-drug interaction)
1) CYP inducer CYP inducer CYP450

CYP450
rifampicin CYP inducer NNRTIs
PIs rifampicin
EFV
PIs
83
NNRTIs PIs
cytochrome P450 (CYP450) CYP3A4 isoenzyme

PIs
CYP450 p-glycoprotein NRTIs
CYP450 ddI
hydroxyurea, ribavirin TDF
2557
2) CYP inhibitor CYP inhibitor CYP450

CYP450
RTV CYP inhibitor PIs
PIs
boosted PIs
3) CYP inducer CYP inhibitor EFV NVP
(substrate) CYP450 CYP inducer
1) Ergotism
- (peripheral vascular vasoconstriction)
Ergot derivative ergotamine

(ischemia)
- Ergot CYP450 CYP inhibitor

Ergot clarithromycin, ketoconazole,
NNRTIs EFV PIs RTV
- PIs EFV ergotamine
: /
() (cyanosis)
(gangrene)
: (vasodilator drug)
prostaglandin analogue
84
85
2) Torsades de Pointes
- (ventricular arrhythmia)
QT prolong
- PIs ATV QT
prolong
: CYP inhibitor RTV
QT prolong terfenadine, astemizole,
cisapride pimozide calcium channel bolckers diltiazem
flecainide, propafenone, amiodarone,
quinidine
3) Rhabdomyolysis
-

CYP inhibitor RTV
statins simvastatin
pravastatin rosuvastatin
- fibrate statins

- 2 statins
pravastatin rosuvastatin fibrate derivative
fenofibrate gemfibrozil
2557
4) Symptomatic hypotension
-
- CYP inhibitor RTV
dihydropyridine calcium channel blockers felodipine, nifedipine,
amlodipine -blocker

sidenafil (viagra)
- sidenafil boosted PIs LPV/r
sidenafil 11
o 25 mg 48 .
o sidenafil nitrate

5) Excessive sedative
- benzodiazepines
- benzodiazepines midazolam, triazolam, alprazolam
diazepam benzodiazepines

- lorazepam CYP450
6) Cushings syndrome
Cushings syndrome
(adrenal insufficiency) RTV fluticasone
RTV CYP inhibitor
CYP450
86
87
Antifungals
Fluconazole
Cisapride
EFV
ETR
NVP
HRAs RPV
PPIs ATV
HRAs ATV
ETR
NVP AUC 110%
NVP
boosted ATV / HRAs

10 .
HRAs 12 . 4 . RPV
ATV PIs ,
PIs PPIs 12 . ATV
boosted ATV
RPV
serious life-threatening events
Ergot boosted PIs Ergot PI EFV

severe vasoconstriction gangrene
EVG COBI Ergot
Ergot EVG/COBI
RPV
PPIs RPV
EVG/COBI/TDF/FTC cisapride
EFV
ergotamine
Ergotamine group
PIs, EFV
(dihydroergotamine,
ergotamine) methergin EVG/COBI
(methylergonovine)
H2-receptor
ATV
antagonists (HRAs)
RPV
Proton-pump
ATV
inhibitors (PPIs)
3.11
88
Voriconazole
Posaconazole
Ketoconazole
Itraconazole
Voriconazole: AUC 77%

EFV: AUC 44%
Voriconazole
ETR
Voriconazole
NVP
EFV
ETR
NVP
ETR
ETR
Ketoconazole AUC 72%

NVP 15-30%
NVP
Posaconazole: AUC 50%
Ketoconazole
ETR
ETR
EFV
Ketoconazole
EFV
Itraconazole
NVP
NVP
voriconazole
voriconazole
voriconazole
voriconazole 400 mg
12 . EFV 300 mg 24 .
ketoconazole
itraconazole NVP
itraconazole
itraconazole
Itraconazole
ETR
ETR
Itraconazole OH-itraconazole AUC, itraconazole

Cmax Cmin 35-44%
itraconazole
EFV
3
2557
Clarithromycin (Clar)
Antimycobacterials
Carbamazepine,
phenobarbital,
phenytoin
Clar AUC 39%

OH-clar AUC 21%
ETR AUC 42%
Clar AUC 31%
OH-Clar AUC 42%
Clar AUC 94%
ETR
NVP
ATV/r
Anticonvulsant NVP
NVP
Clar AUC 39%
Anticonvulsant ETR
ETR
EFV
Carbamazepine + EFV:
Carbamazepine AUC 27%
EFV AUC 36%
Phenytoin + EFV: EFV
phenytoin
EFV
(anticonvulsants)
QT prolong clarithromycin 50%

azithromycin

azithromycin ( MAC)
azithromycin ( MAC)

azithromycin ( MAC)
NVP
EFV
89
90
Rifampicin
Rifabutin
ETR
NVP 20-58%
ETR
NVP
RAL
NVP 400 mg/day lead-in EFV
EFV 600 mg/day >60 kg EFV 800

mg/day
RAL 400 mg:

RAL 800 mg 12 .
RAL AUC 40%, Cmin 61%
rifabutin
RAL 400 mg 12 .,
rifampicin RAL 800 mg 12 .
RAL AUC 27%, Cmin 53%
EVG/COBI/TDF/FTC Rifampicin EVG COBI
EFV AUC 26%
EFV
Rifabutin AUC 17% metabolite rifabutin

AUC 24%, NVP Cmin 16%
NVP
Rifabutin 300 mg/day ETR boosted PIs

boosted PIs rifabutin
Rifabutin metabolite AUC 17%

ETR AUC 37%
ETR
Rifabutin 450-600 mg/day EFV PIs
clarithromycin
azithromycin
- CrCl 30-60 mL/min clarithromycin 50%
- CrCl < 30 mL/min clarithromycin 75%
Rifabutin 38%
Clar AUC 57%
EFV
DRV/r, LPV/r
3
2557
91
sertraline
trazodone
DRV/r, EFV
PIs
alprazolam
benzodiazepine
diazepam
benzodiazepine
sertraline
trazodone
Tricyclic
PIs
TCAs
TCAs
antidepressants (TCAs)
(alpha-adrenergic blockers 5-alpha-reductase inhibitors)

Tamsulosin
PIs
tamsulosin
tamsulosin dose
Finasteride
PIs
finasteride
finasteride
triazolam
PIs EFV
Triazolam
Antidepressants
Sertraline
Trazodone
PIs
diazepam
PIs
Lorazepam: Cmax 16%,
AUC
midazolam
PIs EFV
ETR
PIs
ETR
PIs
EFV
Midazolam
Lorazepam
Diazepam
Benzodiazepines
Alprazolam
92
sildenafil
sildenafil
PIs
ETR
Sildenafil
bosentan
PIs
Bosentan
pulmonary arterial hypertention
ETR
PIs
bosentan unboosted ATV

PI ( unboosted ATV) > 10
bosentan 62.5 mg
PI ( unboosted ATV) bosentan
bosentan 36 . PI
PI 10 62.5 mg
DCCBs
DCCBs
diltiazem
CCBs
Diltiazem
NVP
diltiazem
diltiazem 50% ATV RTV
DCCBs
diltiazem AUC 69%
EFV
Dihydropyridine calcium EFV, NVP

channel blockers (DCCBs) PIs
diltiazem
PIs
Diltiazem
amiodarone
PIs
Amiodarone
3
2557
93
EFV, ETR, NVP
EFV
Ethinyl estradiol (EE), ETR

progestin,
norgestimate,
NVP
norethindrone
Hormonal contraceptives
St.Johns Wort
EE AUC 20%
Norethindrone AUC 19%
Depot medroxyprogesterone acetate
EE AUC, levonogestrel

AUC 83%, norelgestromin

AUC 64%, etonogestrel (implant) levonogestrel, norelgestromin, etonogestrel
EE AUC 22%
Norethindrone
NNRTIs
Herbal products
PIs, NVP, EFV, ETR, Dexamethasone PIs, NVP, EFV, RPV,

RPV
ETR, RPV
dexamethasone
Fluticasone, budesonide RTV boosted fluticasone budesonide

(inhaled intranasal) PIs
Dexamethasone
(corticosteroids)
94
EE AUC 25%
norethindrone AUC 26%
EE AUC 47%
EE
progestin, norgestimate
EE AUC 44%
EE 42%
IDV
NFV
ATV/r
DRV/r
LPV/r
EFV, ETR, NVP
ETR
Atorvastatin
Fluvastatin
EE 35 g
progestin
norgestimate norethindrone
Fluvastatin
fluvastatin
Atorvastatin AUC 32-43% atorvastatin

EFV, ETR
EE 14%
norethindrone: no significant effect
RPV
HMG-CoA reductase inhibitors
3
2557
Clopidogrel
Warfarin
Oral anticoagulant
Pravastatin,
rosuvastatin
INR warfarin
INR warfarin
pravastatin rosuvastatin
simvastatin lovastatin
simvastatin lovastatin
simvastatin
clopidogrel
Warfarin
ETR
ETR
Warfarin
ETR
EFV, NVP
Pravastatin AUC 44%

Rosuvastatin
Lovastatin
Simvastatin
NVP
EFV
Lovastatin
Simvastatin
Simvastatin AUC 68%
ETR
Lovastatin, simvastatin EFV
95
96
Methadone
AUC =
Cmax =
Cmin =
CrCl =
Opioid antagonist
AZT 29-43%
AZT
aera under the curve

maximum plasma concentration
minimum plasma concentration
ETR
AZT
methadone withdrawal
methadone
methadone 41-52%
EFV, NVP
R-methadone (active form methadone withdrawal methadone

methadone)
LPV/r methadone 26-53%

ATV/r, DRV/r methadone
( methadone 16-18%)
Boosted PIs
3
2557
97
DRV/r
600/100 mg 12 . + EFV
600 mg 24 .
ATV EFV
RTV
DRV Boosted DRV:
DRV AUC 13%, Cmin 31%
EFV AUC 21%
Boosted ATV: ATV

unboosted ATV
EFV
ATV Unboosted ATV:

ATV AUC 74%
EFV
Unboosted ATV:
ETR AUC 50% Cmin
58%
ATV AUC 17% Cmin
47%
Boosted ATV:
ETR AUC Cmin ~ 30%
ATV AUC 14% Cmin
38%
ETR ATV
ATV/r
Boosted DRV:
DRV
ETR AUC 37%, Cmin 49%

DRV/r
600/100 mg + ETR 100 mg
12 .
ETR
-
Boosted ATV:
ATV AUC 42% Cmin
72%
NVP AUC 25%
NVP ATV
ATV/r
Boosted DRV:
DRV AUC 24%
NVP AUC 27% Cmin
47%
DRV/r
600/100 mg + NVP 200 mg
12 .
NVP
EFV
3.12 NNRTIs, RAL, and PIs
DRV/r
600/100 mg + RAL 400 mg
12 .
Boosted DRV:
RAL AUC 29% Cmin
38%
Boosted ATV:
RAL AUC 41%
Unboosted ATV:
RAL AUC 72%
RAL
98
RAL
LPV/r 500/125 mg 12 .
+ EFV 600 mg 24 .
LPV/r 500/125 mg + NVP 200

mg 12 .
LPV AUC 27% Cmin

51%
ETR Cmin 17%

RAL Cmin 34%
LPV/r LPV/r 500/125 mg 12 . ETR 30-45%

+ EFV 600 mg: LPV LPV 13-20%
LPV/r 400/100 mg
12 . EFV
IDV 31%
NVP
ETR
NVP EFV AUC 36%
EFV AUC 22%
NVP
IDV/r 800/100 mg + NVP 200

mg 12 .
IDV
ETR
ETR
IDV/r 800/100 mg 12 .
+ EFV 600 mg 24 .
IDV IDV 31%
ETR ETR
EFV
EFV
3
2557
ETR
RAL
* LPV 7.3 mg/L (LPV 1-4 mg/L)
SQV/r 1,000/100 mg 12 .: SQV 600 mg 8 .:
SQV AUC
SQV AUC 24%
ETR AUC 33%, Cmin 29% NVP
ETR Cmin 17%

RAL Cmin 34%
NVP
SQV/r 1,000/100 mg 12 . SQV/r 1,000/100 mg 12 .
SQV SQV 1,200 mg 8 .:

SQV AUC 62%
EFV AUC 12%
RAL RAL AUC 36%
NVP NVP ETR
EFV AUC 22%
EFV
99
2557
3.9
3.9.1
1) (hepatitis B)

9
( 6-14)
4 (liver enzymes
> 10 upper limit)
3

anti-HBc, anti-HBs HBsAg
HBsAg
2) (hepatitis C)

8
( 72-95) ( 1-12)
( 9-27)
95
( 500,000 IU/mL)
100
101

anti HCV CD4 > 200 cells/mm3
( CD4 )

3)

herpes simplex type 2
2
(atypical manifestation)

nuerosyphilis
(trichomonas
vaginalis) genital tract

2557
RPR
1 MSM,
( 2-4
) RPR titer >1:32 CSF RPR
neurosyphilis
-

2 neurosyphilis
3.9.2 ( OIs 6)
1)

latent infection
primary tuberculosis 10
50
5-10

6

CXR

CXR
102
103
2) CMV retinitis

cytomegalovirus (CMV)
CD4 < 100 cells/mm3
(sensitivity 7%)

indirect ophthalmoscope CD4
< 100 cells/mm3
3)

CD4 < 100 cells/mm3
CD4 < 100 cells/mm3

serum cryptococcal Ag CD4 < 100
cells/mm3 3.1 Crypto Ag positive
LP meningitis ( stiff neck + ve)
cryptococcus menigitis
( )
LP cryptococcemia
fluconazole LP cryptomeningitis
2557
/ cryptococcus
menigitis CSF cryptococcal antigen
serum cryptococcal Ag
cryptomeningitis ( serum antigen
meningitis disseminated disease serum
antigen CSF ) secondary prophylaxis
fluconazole 200 mg CD4 > 100 cells/mm3 3
serum cryptococcal Ag
primary prophylaxis
104
3.1 Crypto Ag
Anti HIV +
CD4 < 100 cells/mm3
Negative
serum cryptococcal
antigen
+ *
Positive
lumbar
puncture**
uconazole 800 mg 2
400 mg 8
CSF WBC, sugar ,

cryptococcal Ag +
amphotericin B 0.7-1 mg/kg/day

+ uconazole 800 mg 2
uconazole 400-800 mg
8-10
10
uconazole 200-400 mg
1 CD4 > 100

cells/mm3 3
4-6 ***
* primary prophylaxis
primary prophylaxis
** CT brain lumbar puncture
105
2557
:
cryptococcal capsular polysaccharide antigen serum CSF
latex agglutination (LA) enzyme immunoassay (EIA) overall
sensitivity 93-100% specificity 93-98% test
false positive (0-0.4%) serum CSF
: cryptococcal antigen
rheumatoid factor ( LA serum specimen CSF),
non-specific protein CSF autoimmune diseases,
malignancy CNS involvement / lymphoma/leukemia,
, Trichosporon spp. false
positive test titer 1:8
3.9.3
70
HIV
dementia, impaired cognitive function

2

MSM transgender (TG)

106

Q2 Q9

Q2 Q9
3.9.4
107

BMI (kg/m2)
17 BMI 18.5 2

PIs

2557
3.9.5
1)

20 HPV
CD4

CD4

pap smear 6
1
2)

11-36 human papilloma virus
anal dysplasia
HPV
CD4
Pap smear 6

108

controversial standard protocol

MSM digital
anorectal examination anal pap 1-3
anoscopy
3)

VL CD4 VL
CD4

VL
50 copies/mL 6 VL 50 copies/mL
200 copies/mL
50-200 copies/mL
VL
CD4 CD4
clinical failure

109
3.10
2557
VL 6
1
2-4 VL
.
CD4
CD4
CD4
(OI prophylaxis)
CD4 6
CD4
100-150 cells/
CD4
CD4 CD4 25 50

CD4 VL < 50 copies/mL
3.11
2 NRTIs
AZT ddI NNRTIs PIs

(creatinine
clearance; CrCl) Child-Pugh score
3.13 3.14
110
TDF/FTC
1 24 .
48 .
250 mg 24 . 125 mg 24 .
< 60 kg
300 mg 12 . 600 mg 24 .
400 mg 24 . 200 mg 24 .
> 60 kg
15 mg 12 .
ddI(5)
30 mg 12 .
30 mg 12 .
200-300 mg 12 .
AZT
300 mg 48 .
d4T
300 mg 24 .
< 10
300 mg
7 AD(3)
50-25 mg
24 .(2) AD(3)
Hemodialysis
15 mg
24 . AD(3)
75 mg/24 .
100 mg/24 .
15 mg 24 .
100 mg 8 . 300 mg 24 .
100 mg 24 .
150 mg 24 .
15 mg 24 .
300 mg
2
ABC
10-29
300 mg 24 . 150 mg 12 . 150 mg 24 . 100 mg 24 .(2) 50-25 mg 24 .(2)
50
TDF(4)
3TC
NRTIs
eGFR CrCl (mL/min)(1)

30-49
3.13
111
112
50
DRV
800/100 mg 24 . (nave)
600/100 mg 12 .
LPV/r
400/100 mg 12 .
Integrase inhibitors
RAL
400 mg 12 .
EVG/COBI/
1 24 .
TDF/FTC
NNRTIs
EFV
600 mg 24 .
NVP
200 mg 12 .
ETR
200 mg 12 .
RPV
25 mg 24 .
EFV/TDF/FTC
1 24 .
RPV/TDF/FTC
1 24 .
Protease inhibitor (PIs)
ATV
400 mg 24 .
300/100 mg 24 .
10-29
< 10
Hemodialysis
CrCl < 70 mL/min CrCl < 50 mL/min
HD
Hemodialysis (HD)
: ATV/r 300/100 mg 24 .
ATV ATV/r
eGFR CrCl (mL/min)(1)

30-49
3
2557
creatinine clearance:
: (140 - ) x (kg) x 0.85
72 x serum creatinine
60 eGFR < 50 mL/min TDF

eGFR 30 mL/min
(2)
150 mg loading dose

(3)
AD:
(4)
CKD , TDF PI TDF
GFR < 60 mL/min 1 48 .
(5)
TDF
: (140 - ) x (kg)
72 x serum creatinine
(1)
113
2557
3.14
5-6 A
NRTIs
3TC
TDF
AZT
d4T
ddI
ABC
TDF/FTC
NNRTIs
EFV
NVP
ETR
RPV
EFV/TDF/FTC
RPV/TDF/FTC
PIs
ATV
200 mg 12 .
10 C
300 mg 24 .
RTV
boosting

DRV
LPV/r
Integrase inhibitor
RAL

EVG/COBI/

TDF/FTC
114
Child-Pugh score
7-9 B
Child-Pugh score
1
2
Total bilirubin (mg/dL)
<2
2-3
3
>3
(g/L)
> 35
28-35
< 28
International normalized ratio (INR)
< 1.7
1.7-2.3
> 2.3
Prothrombin time
()
<4
4-6
>6
(ascites)
Encephalopathy*
1-2
3-4
3.12

3
1) (life-threatening adverse effects)
2) (serious adverse effects)
3) (long-term adverse effects)
3.15
115
: Encephalopathy
* 1:
2:
3: routable
4:
116
1) (life-threatening adverse effects)

Stevens-Johnson
2-3 NVP NVP 200 mg 24
Syndrome (SJS)
2-3 CD4 > 250 cells/mm3 . 2
Toxic Epidermal Necrolysis

(TEN)
200 mg 12 .
skin eruption

NVP 0.3-1%, mucosal ulceration
DLV EFV 0.1%, ETR ( )
< 0.1% 1-2 blister/bullae

AZT, ddI, ABC,
IDV, LPV/r, ATV, DRV
epidermal detachment
necrosis

fluid depletion, bacteria
or fungal superinfection,
multiorgan failure
NVP

cotrimoxazole

supportive,
cross reaction
, ,
NNRTIs
parenteral nutrition

superinfection
corticosteroids
IVIG
3.15
3
2557
1-3 CD4 NVP
18
(> 250 cells/mm3
NVP , > 400 cells/mm3 CD4 > 250 cells/mm3
hepatic necrosis

)
CD4 > 400
Baseline AST cells/mm3

NVP 4% ALT
11% HBV /
CD4 > 250 cells/mm3 HCV
NVP
( 0.9%
CD4 250 fulminant
2
cells/mm3) 6.3% hepatic failure

CD4 > 400 encephalopathy
3
cells/mm (
AST ALT
2.3% CD4 50%
2
3
400 cells/mm )

DRESS syndrome
NVP NVP

NNRTIs
supportive care
EFV
NVP

3TC
FTC TDF
117
Lactic acidosis, hepatic NRTI

steatosis +/- pancreatitis
d4T
(severe mitochondrial
nonspecific ddI, AZT
toxicities)
gastrointestinal syndrome
BMI
NRTIs
d4T ddI
d4T ddI
AZT
ddI
0.85% hydroxyurea
50%

ribavirin

:
Lactate ( > 5 mmol/L)
Arterial pH ( < 7.0)
Serum CO2
Anion gap
ALT, AST, prothrombin time, bilirubin , albumin
amylase lipase
Histology microvesicular
macrovesicular steatosis
118
lactate
NRTIs mitochondrial toxicities
ABC, TDF, 3TC, FTC
serum lactate
NRTI-sparing regimens
boosted PIs + NNRTI LPVr + EFV (
LPV/r 500/125-600/150 mg 12 .
EFV 600 mg 24 .)
d4T

ddI supportive care lactate
IV fluid

acidosis
lactate
IV bicarbonate,
hemodialysis/

hemofiltration,
serum lactate
IV thiamine
/ riboflavin
3
2557
119
d4T

supportive care

lactic
acidosis

plasmapheresis, high
dose steroid, IVIG,

carnitine
Lactic acidosis, rapidly d4T

progressive ascending

neuromuscular weakness

d4T
ascending
demyelinating
polyneuropathy
Guillain-Barr
syndrome

:
Serum lactate, anion gap
Arterial pH, serum CO2

Creatine phosphokinase
120
Hypersensitivity reaction HLA-B*5701,

ABC ABC ABC
(HSR)
9 90% HLA-DR7, HLA-DQ3 HLA-B*5701 HSR
6 HSR grade 3 screening

ABC
ABC
4 ABC ABC 48 .
8% 600 mg 24 . HSR
2-9%
300 mg
12 . (5%
supportive
2%)
IV fluid HLA-B*5701

screening
HSR ABC
ABC
viral syndromes ABC

3
2557
121
Advanced HIV
AZT
AZT

neutropenia
CBC

3-6 (
cotrimoxazole, ribavirin,
ganciclovir
)
Bone marrow suppression 2-3
AZT
1.1-4.0%

neutropenia 1.8-8.0%

neutropenia
AZT NRTI
G-CSF
neutropenia
erythropoietin
anemia

folic acid supplement
Skin rash
2-3 NVP NVP 200 mg 24

. 2
NVP 14.8% diffuse antihistamine NVP
( 1.5%), EFV
maculopapular rash EFV
18
26% ( grades 3-4 1%),
AST, ALT
ABC < 5%

HSR, ATV 2.1%

( < 1%)
bleb
blisters, ,
TDF,
mucous membrane
NNRTI
LPV, AZT, 3TC
involvement
NNRTI mucous membrane

involvement
2) (serious adverse effects)
Hepatotoxicity, clinical NNRTIs 60%

HBV/HCV NVP hepatotoxicity
hepatitis or symptomatic 12
HBV
serum transaminase

AST, ALT
3TC, FTC, TDF
elevation
2 4

1
NNRTIs, 50% NVP-associated hepatic 3
PIs, NRTIs
NVP hepatitis events
3-6
AST, ALT
CD4 > 250 cells/mm3

NRTIs d4T, CD4 > 400 AST, ALT ALT > 5-10
ddI, AZT cells/mm3
3-4

AST, ALT

3TC, FTC, TDF
HBV
PIs

3
2557
122
123

/
pyuria, hematuria, crystalluria
creatinine

IDV

TDF

nephrogenic diabetes insipidus
Fanconi syndrome
:
IDV: Cr , pyruria, hydronephrosis
renal atrophy
TDF: Cr , proteinuria, glycosuria,
hypokalemia, hypophosphatemia,
non-anion gap, metabolic acidosis
Nephrolithiasis,
urolithiasis, crystalluria
IDV
12.4% (4.7-34.4%)
ATV, EFV
Nephrotoxicity
IDV , TDF
ATV
IV fluid
1.5-2

urinalysis

serum creatinine 3-6
IDV
IDV

serum creatinine, supportive care
CD4
urinalysis, serum
electrolytes
potassium
phosphorus

nephrolithiasis

peak IDV
IDV

124
Bleeding episodes
increase in hemophiliac
patients
PIs
intracellular
/ serum ddI

pancreatitis

hypertriglyceridemia
ddI d4T,
hydroxyurea, ribavirin
ddI TDF
ddI
2-3
PIs
hemophilia
Pancreatitis

ddI 1-7%
ddI d4T
ribavirin
Amylase lipase
hydroxyurea
3TC, d4T
TDF
NNRTI Factor VIII

regimen
ddI
pancreatitis

ddI pancreatitis
d4T, ribavirin,
bowel rest, IV hydration,
hydroxyurea
pain control, parenteral
ddI nutrition
TDF

amylase lipase

hypertriglyceridemia
3
2557
125
PIs NNRTIs
d4T
fasting lipid profile
3-6

cardiac risk
factors

lifestyle
modifications

simvastatin
atorvastatin

rhabdomyolysis

LPV/r
lipoatrophy ATV/r
injectable poly-L-lactic visceral fat
acid

lipohypertrophy
lipohypertrophy
recombinant human

growth hormone
GH-releasing hormone
restorative
analogue
3) (long-term adverse effects)

Lipodystrophy
baseline BMI
Lipohypertrophy Lipohypertrophy
PI

NNRTI-based regimens
d4T AZT (dorsocervical
fat pad buffalo

Lipoatrophy hump)
NRTIs d4T Lipoatrophy
AZT,
ddI TDF,
ABC
Hyperlipidemia

PIs ( PIs LDL, TC
unboosted ATV) 47- TG
- PIs: RTV-boosted PIs
75% HDL ATV,
ATV/r
NRTIs NNRTIs
DRV, LPV, SQV
LDL,
- PIs > NNRTIs
boosting RTV
TG
- EFV > NVP
d4T TG, LDL TC
- d4T > AZT > ABC > EFV, NVP LDL, TC,
TDF
TG HDL EFV
NVP
Insulin resistance/diabetes
hyperglycemia
mellitus

polyuria, polydipsia,
FBS
d4T, AZT PIs polyphagia, fatigue
1-3 d4T, AZT
3-5%
3-6
NNRTIs

metformin,
glitazones, sulfonylurea
insulin
Peripheral neuropathy
peripheral

neuropathy

ddI 12-34%, d4T advanced HIV
52%
neuropathy
disease

monotherapy d4T ddI
gabapentin, tricyclic

antidepressants,
painful neuropathy intracellular activities
lamotrigine,
ddI
oxycarbamazepine,
TDF, hydroxyurea,
topiramate, tramadol,
ribavirin
narcotic analgesics,

capsaicin cream, topical
lidocaine

3
2557
126

periarticular pain
85% femoral head

coronary
artery disease cerebrovascular accidents

CVD

coronary artery
disease
premature
coronary artery disease
Advanced AIDS
steroids

hyperlipidemia

steroid

15% bone head
MRI 3-6
1 6
1
cardiac risk
factors

hyperlipidemia
hyperglycemia
lifestyle modification

/
Osteonecrosis
old PIs

HIV
symptomatic
osteonecrosis 0.08-1.33%
asymptomatic
osteonecrosis 4%
MRI
Cardiovascular effects,
including myocardial
infarction (MI),
cerebrovascular accidents
(CVA)

PIs MI CVA
ABC MI
ddI MI
observational studies
RCT
MI 0.3-0.6%
CVA 0.1%

hyperlipidemia, hypertension, insulin resistance/
diabetes mellitus
cardiac risk factors
lifestyle modifications

cardiovascular effects NNRTIs
ATV-based regimen d4T
Conservative management:

Surgical intervention:
- Early stages core decompression /
bone grafting
- Severe debilitating disease total joint
arthroplasty
127
2557
3.12.1 ()

PIs 1.7-2.3

National Cholesterol Education Program,
Adult Treatment Panel III (NCEP ATP III)
10 Framingham
LDL 3.2

10 20
LDL-C 80 mg/
dL

(lifestyle modification)

LDL 220 mg/dL
primary secondary coronary prevention statin

LDL 3.2
LDL
128
129
SBP < 130 mmHg

SBP < 140 mmHg
DBP < 80 mmHg
DBP < 90 mmHg
SBP > 140 mmHg

DBP > 90 mmHg
HbA1C < 6.5-7.0%
< 155
< 190
LDL
< 80
< 115
3 (mg/dL)
10 20%

10 20%2
10 1
3.2
2557
:
1. 10
10 Framingham www.cphiv.dk/tools.aspx
2.
. PI/r NNRTIs, RAL PI/r
. d4T AZT, TDF ABC
3.
LDL 400
mg/dL LDL [ LDL = TC - HDL - (TG/5)]
LDL 30 mg/dL (Ref)
4.

500 mg/dL

3.16
Statin
Atorvastatin 10-80 mg/day

Fluvastatin 20-80 mg/day
PI
1
( 40 mg/day)
NNRTI
2
2 2
Pravastatin 20-80 mg/day
Rosuvastatin 5-40 mg/day
Simvastatin 10-40 mg/day
2,3 2
Cholesterol Ezetimide
uptake
10 mg/day
1
( 20 mg/day)
1
2
:
1. statin statin
2. statin statin statin
3. DRV/r pravastatin
130
3.13

(Adherence to antiretroviral therapy)
3.13.1 adherence
1)
2)
131
3)

adherence
4) adherence

5)

()
6)
7) adherence
8) non-adherence non-adherence

non-adherence
2557
3.13.2 adherence
adherence 2
3.17 3.18

adherence
adherence 1
adherence
adherence visual
analogue scale, self report,
adherence

adherence
30

% adherence
% adherence =
132
dose
dose
133
adherence

adherence
adherence
adherence

adherence (
)
2
adherence
fixed dose combination adherence
adherence
adherence
adherence
134
3.

adherence
(DOT)
2.
/ adherence
12
(therapeutic drug
monitoring)
1.

adherence
VL
(VL assay)
(undetectable level)
gold standard VL
adherence
VL adherence
3.17 adherence /
3
2557
135
2.
(pill counts)
3.
(pill taking record)
4.

(pharmacy refill
records)
1.
(self report)
adherence
(pill dumping)

adherence
(pill dumping) 7

7

pill dumping

3.18 adherence /
136
8. adherence
(provider estimation)
7. Visual analogue scale
self report
6.

(follow up appointment)

5.
MEMS
(medication events monitoring

(electronic

system) caps
drug monitoring)

3
2557
3.14 Immune reconstitution inflammatory syndrome (IRIS)

IRIS

3.19 Immune reconstitution

inflammatory syndrome IRIS
Definition
IRIS 2
Unmasking IRIS
3-6
Paradoxical IRIS

mycobacterium (TB MAC) cryptococcus

3-6

o
o CD4
IRIS (Graves
disease)
137
IRIS

2557
IRIS
IRIS IRIS

paradoxical IRIS
NSAIDs short course corticosteroids
IRIS
o
o
systemic corticosteroids
3.20 IRIS
Tuberculosis
paradoxical reaction [ (
38.5oC), , ,
cutaneous lesions, ascites, CXR worsening], tuberculoma,
inflammatory bowel perforation, serositis, psoas abscess
MAC Localized lymphadenitis, necrotizing subcutaneous nodules,

atypical mycobacteria endobronchial tumors, small bowel involvement, paravertebral
abscesses, osteomyelitis, arthritis, focal brain lesion, ileitis

CMV
CMV retinitis CD4 , immune recovery vitreitis,

immune recovery uveitis, CMV pneumonitis
, pseudotumoral colitis, adenitis,
encephalitis, cutaneous ulceration
Hepatitis (B,C)
Parvovirus B19
Encephalitis, worsening anemia
Herpes simplex
Erosive herpes simplex encephalitis
138
Varicella zoster virus
Acute retinal necrosis ,
Kaposi's sarcoma (KS) Worsening KS lesion with inflammation and edema

Inflammatory PML variant
BK virus
Hemorrhagic cystitis
Cryptococcus
Recurrent meningitis , pulmonary cryptococcosis,

cutaneous cryptococcosis (recurrent abscesses), necrotizing mediastinal
cervical lymphadenitis, intracranial cryptococcoma, intramedullary
abscess, necrotizing pneumonitis
PCP
Pneumonitis (patchy aveolar or reticulonodular infiltrates)
Skin yeasts
Folliculitis
Sarcoidosis
Worsening of sarcoidosis, pulmonary infiltrates, erythrema nodosum,

lymphadenopathy, interstitial nephritis
Toxoplasmosis
Encephalitis
Leishmaniasis
Vitreitis, uveitis, post-kala-azar dermal leishmaniasis
Bartonella henselae
Granulomatous splenitis
Leprosy
Leprosy cutaneous lesions
Microsporidia
Keratoconjunctivitis
Chlamydia trachomatis Reiters syndrome

Non infectious etiology Grave diseases, SLE, vasculitis, relapsing Guillain-Barres syndrome,
rheumatoid arthritis, polymyositis, alopecia universalis, cerebral
vasculitis, hyperergic reaction ( ),
pre-eclampsia, multiple eruptive dermatofibromas, eruptive cheilitis,
Peyronies disease
139
PML
2557
3.21 IRIS
Paradoxical IRIS
1.
2. 1
-
-
1
IRIS
-
-
-
Unmasking IRIS
1.
2.
3.
4. 1
- 3

140
IRIS
-
-
3.15
3.15.1 (acute HIV infection)

141
Early HIV infection

6
(acute HIV infection acute

retroviral syndrome)

anti-HIV inconclusive qualitative HIV
RNA p24Ag
sero conversion 6
6
anti-HIV positive
early HIV infection

CD4 cells count
functional cure
40-90 acute
retroviral syndrome

VL (
100,000 copies/mL)
2557
anti-HIV negative
positive 6
o NAT anti-HIV
window period anti-HIV ( 4
window period 3 )
o VL > 100,000 copies/mL p24Ag
/ anti-HIV inconclusive (negative or weakly
positive ELISA)
early HIV infection

early HIV infection

o
o
o
early HIV infection

early HIV infection

5
142
3.22 acute HIV infection
3.15.2

40 30-50

1-3
3 45-50%
pegyrated interferon/
ribavirin 1 30-35
pegyrated interferon/ribavirin

6
143
96
74
70
(erythematous maculopapular rash)
70

54
32
32
27

14
13
(thrush)
12
( aseptic meningitis, peripheral neuropathy, facial
12
palsy, Guillain-Barre's syndrome, brachial neuritis cognitive impairment)
2557
3.23
HIV
Backbone: TDF + 3TC FTC

3TC FTC TDF
HBV
FTC, 3TC - hepatic

TDF
flare
- entecavir ( 3TC
entecavir 1 mg/day) hepatic

flare
HIV FTC, 3TC TDF, 3TC

TDF
FTC
TDF FTC 3TC

TDF
AZT d4T VL < 50 copies/mL

TDF

- FTC, 3TC TDF eGFR
3.13 eGFR < 30 mL/min/1.73m2
entecavir ( 3TC entecavir
1 mg/day) TDF
- TDF
ABC
- > 40 > 50
liver ultrasound -
144
145
HIV/HBV co-infection HBsAg

6
HBV
o liver function test, alfa-fetoprotein, HBeAg
HBV DNA
ultrasound liver

o
o HBV
o HAV HAV
IgG
HIV/HBV co-infection 3.23

o CD4 < 500 cells/mm3
o CD4 > 500 cells/mm3 HBV
DNA < 2,000 IU/mL 6
o CD4 > 500 cells/mm3 HBV DNA

40
o fibroscan > 7.2 kPa APRI > 0.5
FIB-4 > 1.45
anti-HCV
- anti-HCV
- anti-HCV HCV RNA
spontaneous clearance
2557
- HCV RNA
(LFT) ultrasound /
(liver stiffness) transient elastography
HBsAg, anti-HBc HAV Ab
- (HCV genotype)

(crystal metamphetamine)

anti-HCV CD4 < 100 cells/mm3
HCV RNA anti-HCV acute
HCV HCV RNA
HCV RNA HCV RNA 6
spontaneous clearance
HIV/HCV co-infection
1.
2. d4T, ddI HIV/HCV co-infection
ribavirin AZT, d4T, ddI
AST ALT 1 3
> 5 upper limit
laboratory reference range
HAV HBV

146
ALT 10 upper limit

ALT 5 upper limit
3. HBsAg anti-HBs
CD4 > 350 cells/mm3 HIV RNA < 50 copies/mL
4. ultrasound liver 6-12
fibroscan > 14kPa APRI > 1.5 FIB-4 > 3.25
3.24
*
- 18
- 6
- HCV RNA 5,000
IU/mL
-
3 HIV RNA < 50
copies/mL
-
- (decompensated cirrhosis)
- interferon ribavirin
-
-
-

* -
- AZT, d4T ddI
ribavirin
147
2557
3.15.3

50

1.

(
CD4)

CD4
2. (pharmacokinetic)
glomerular filtration rate
1%

creatinine clearance Child-Pugh class

3.
albumin
cytochrome P450

AZT
TDF PIs
148
4.

3.25
3.25
NVP
boosted PIs, d4T ddI
Cognitive impairment
TDF
ATV/r EFV

ATV/r DRV/r
TDF
ATV IDV

d4T
ddI non-cirrhotic
portal hypertension

EFV
EFV
149
d4T, ddI
AZT
NVP, EFV boosted

PIs
ABC, ddI, LPV/r
IDV/r
TDF
ATV IDV
2557
5.

6.
2
2
2
5

EFV EFV
3.15.4

(MSM) (TG)
adherence
(retention)
MSM TG

//

150
151
MSM TG
( syphilis MSM
51.9% (41/79) vs 4.3% (721/16,784)) ( 15%
26% 23% 42%)

MSM TG
6

(cardiovascular disease)

erectile
dysfunction

TG

( fosampinavir
ampinavir )

2557
DMPA 3.11

adherence

TG

/
/ MSM TG

MSM TG

152
153

(digital rectal examinations)
2557
3.15.5

2 (AIDS-related
malignancies) Kaposis sarcoma Non-Hodgkins
(Non-Hodgkins lymphoma)
(primary central nervous system lymphoma)
2
(non-AIDS-related malignancies)

(oncogenic virus) human
herpes virus (HHV) 8, Ebstein-Barr virus (EBV), human papillomavirus

2
2
154
155

CD4
CD4 200 cells/mm3
CD4 < 200 cells/mm3

CD4 VL

/ CD4

(drug-drug interaction)
protease inhibitors
taxanes, vinca alkaloids, etoposide gefitinib
2557
AZT
d4T ddI
peripheral neuropathy

human papillomavirus
3.15.6

3.26
156
3.26
VL 2-3
(elective)
NNRTIs NNRTIs boosted PIs
10-14
NNRTIs 7-10
NRTIs

PIs
157
2557
3.15.7
methadone

HCV
methadone
adherence HIV/HCV coinfection
3.15.2 methadone
3.27 1
3.27 PIs methadone
Boosted PIs
DRV/r, IDV/r
R-methadone* 16% methadone

withdrawal
methadone
LPV/r
methadone 26-53% methadone

withdrawal
methadone
ATV/r
R-methadone* 16% methadone

withdrawal
methadone
Unboosted PIs
ATV
IDV
NFV
methadone 40%
methadone
withdrawal
methadone
158
NNRTIs
EFV
methadone 52%
methadone
withdrawal
methadone
NVP
methadone 50%
methadone
withdrawal
methadone
ETR
RPV
Integrase strand transfer inhibitors (INSTIs)
DTG
EVG/COBI
RAL
* R-methadone = active form methadone

3.15.8
TDF
proximal tubular dysfunction persistent proteinuria
(urine dipstick > 1 urine protein/creatinine (UP/C) > 30 mg/mmol),
glycosuria eGFR
phosphaturia
TDF
159
2557

hemodialysis (HD), peritoneal dialysis (PD) [kidney
transplantation (KT)] ESRD

(chronic kidney disease:

CKD)
1. Screening/Detection proteinuria, urine
sediment BUN, Cr eGFR
2. Diagnosis/Treatment/Delayed Renal Progression

3. Counseling
counseling
o

counseling
o
glomerular disease
160
o
o
161
CKD
CD4

PD
Tenckhoff PD elective
unplanned HD PD
HD
AV fistula

AV fistula
elective HD unplanned HD AV
fistula tunneled cuffed catheter AV graft
2557
o
CKD

HIV CKD
unplanned
HD
o

o
.
3.16

CD4

CD4

3.28
(live-attenuated vaccine)
measles, mumps, varicella zoster yellow fever
162
3.28
2 :
HAV (MSM)
( HBV/HCV) clotting factor
concentration HAV
serum HAV IgG
2 : 2 6-12
Hepatitis B
vaccine
(HBV)
3 HBV HBsAg,
anti-HBs, anti-HBc
3 : , 2 1 , 3
2 2 4
( 2 3 1 6 )
anti-HBs 3 1
anti-HBs 10 IU/L 1
anti-HBs 1
2
anti-HBs 1
Human
3 HPV 4 (quadrivalent)
papillomavirus
9-26
vaccine (HPV)
19-26 MSM
HPV
(anal cancer)

Influenza
1
nasal spray
Tetanus and 1 1 10
diphtheria
Tetanus, diphtheria and pertussis (Tdap) Td
toxoid (Td)
TT 1
Tetanus
Toxoid (TT)
163
Hepatitis A
vaccine
(HAV)
2557
23-valent
1
pneumococcal
polysaccharide
vaccine
(PPSV-23)
13-valent
1
pneumococcal
conjugate
vaccine
(PCV-13)
CD4 > 200 cells/mm3

1 5
65 65
PCV-13 PPSV-23
1
CD4 > 200 cells/mm3

PPSV-23 PCV-13
2
Influenza
Tetanus,diphtheria,pertussis (Td/TT/Tdap)
(Varicella)
(HPV)
(HPV)
Measles, mumps, rubella (MMR)
PCV13
PPSV-23
Meningococcal*
(hepatitis A)
(hepatitis B)
()
27-64
19-27
65
Boost with 1 dose of Td (or TT) every 10 years

Td (or TT) Tdap 1
3 doses
(0, 2, 6 )
3 doses
1 dose
1 dose (age > 50 years)
1 dose (with re-vaccination)
1 dose
For high risk persons
2 doses
:
HAV
(
HBV/HCV) clotting factor concentration
HAV
serum HAV IgG
3 doses
HBV
HBsAg, anti-HBs, anti-HBc
(optional vaccine)
*
10
(meningitis belt)
(anatomic functional asplenia)
164
3.17 (Treatment as Prevention)
165
(Treatment as Prevention: TasP)

observational cohorts mathematical models

HPTN 052 randomized controlled trial
CD4 count 350-550 cells/mm3
CD4
96

CD4 ( 7)
public health benefit
clinical benefit

2555-2559 MSM 41 ( 32)
( 11) ( 10)
90
( 7)
CD4
2 3 .. 2559

(
5) CD4

CD4 NVP
adherence
CD4
2557
3.18

(comprehensive and continuum care)

166
167

17-30

2557
168

(Management of HIV-Infected Children
and Adolescent)
169
Management of HIV-Infected Children and Adolescent
.. 2556
15 7,296
70 30
15
5000
.. 2556 2.1
100

2557
4.1

Pneumocystis jiroveci (PCP) 4-6

DNA PCR 2 1 2-4
DNA PCR 3 1
2 4
3
4.1.1
170
4.1.2
AZT
CBC 1

PCP

171

1)
%CD4 > 25%
%CD4 < 15%
6 %CD4 > 15%

CD4
2)

immunoglobulin (TIG)
(RIG)

4.1
172
HBV1
--5
--3
BCG

1
(HBV2)
OPV1
or
IPV1
DTwPHBV1
OPV2
or
IPV2
DTwPHBV2
OPV3
or
IPV3
DTwPHBV3
JE1, JE2
1
MMR1
OPV or
IPV
1
DTwP
1
1 2 4 6 9 12 18
JE3
OPV or
IPV
2
DTwP
2
dT
4-6 11-12
MMR2
4.1
2557
4
2557
173
(Rota)13
12 (HPV)
11
(PCV PPSV23)
10 (influenza)
9 (VZV)
8 (HAV)
7 (Hib: PRP-T, PRP-OMP)

--
( 4 DTaP, 7 Tdap)3
Rota 1 Rota 2
PCV1 PCV2
Hib2
(Rota 3)
pentavalent
PCV3
Hib3
DTaP3
DTaP1 DTaP2
Hib1
1
2
4

JE4 (4-5
JE3)
DTaP
2
4-6
VZV2
PCV4
12-15
Tdap
11-12
HPV 3
9-26
PPSV23 2 5
VZV1
2-2
HAV1, HAV2 6-12
Hib4
DTaP
1
9
12
18
2557
Hib
PRP-T
2-6
0, 2, 4,
7-11
0, 2,
> 12-59
12-18 2
PCV
2 - 6
3 6-8
12-15
7 - 11
2 6-8
12-15
12 - 23
2 6-8
24 - 59
-
-
1
2 6-8

4.1
1. BCG
BCG
BCG
BCG
2.
DTP-HBV 2, 4, 6
3. DTwP DTaP (Tdap) 7
1
174
175
4. IPV OPV IPV

5. -- (clinical stage C
%CD4 < 15%) %CD4 > 15%
- 9-12 2 4-6
( 9 )
1 ( 12 )
1
- 2 2
- 4
3
- --- (MMRV)

6. 3 1 0,
1 , 1 1 3 4-5
(
6 %CD4 > 15%
2 3-12 )
7. 2
1 12-18 2

8. 1 2
6-12
2557
9. 1 %CD4 > 15% 2 doses

1 2 4-6
2 4 3
---
(MMRV)
10.
9 2 1
3 dose (0.25 mL)
11. (PCV) PCV13
PCV10 2 3
2 12-15
PCV PPSV23 2
PCV 2 PPSV23
1 5 14-59 PCV7
4 PCV13 1 PCV7
8
6-18 PCV13 1 dose PCV7
PPSV23
12. 3 0, 1-2, 6 9
26
11-12
13. 2, 4 ( 6
pentavalent vaccine)
176
4.2 1-6
JE1
DTP-HB2, OPV/IPV2, JE2
DTP-HB3, OPV/IPV3
12
DTP-HB4, OPV/IPV4, JE3
DTP-HB1, OPV/IPV1, MMR, BCG
177
4.2 4.3 %CD4 > 25% > 200 cells/mm3

> 5 %CD4 < 15%
6 %CD4 > 15%
CD4
CD4
2557
4.3 7-18
HBV1, JE1
dT2, JE2, OPV/IPV2, HBV2
HBV3
12
dT3, OPV/IPV3, JE3
dT1, OPV/IPV1, MMR, BCG
PCP

( 6)
4.1.3

8
(functional cure)
PCP

PCR (
2)
178
179
1. HIV DNA PCR

1.1 (
4
HIV RNA > 50 copies/mL ) HIV DNA
PCR 3 1 2 4

HIV DNA PCR
( 4-6

) 1
PCR
3

1.2 HIV DNA PCR 2
1 2-4 1
HIV DNA PCR

1 HIV DNA PCR 2-4

3 4
2. anti-HIV 18
2.1 anti-HIV
6-18
anti-HIV 18
anti-HIV antibody antigen
2557
(HIV Ag/Ab; 4th generation)

antibody 18
( weakly positive)
PCR 2
antibody
18 antibody
antibody (3rd generation)
antibody 24 anti-HIV

2.2 HIV DNA PCR
2 3
anti-HIV 18

anti-HIV

anti-HIV
180
4.2
< 1
CD4, %CD4
> 1 (CDC category B, C
WHO stage 3, 4) CD4
CD4
o 1-< 3 %CD4 < 25%
CD4 < 1,000 cells/mm3
o 3-< 5 %CD4 < 25%
CD4 < 750 cells/mm3
o 5-15 CD4 < 350 cells/mm3
2NRTIs + NNRTI Boosted PI

2 NRTIs
o 12 AZT/3TC ABC/3TC
o > 12 TDF/3TC
NNRTI boosted PI
o < 3 LPV/r
o 3 EFV
181
2557
4.2.1
1. (medical evaluation)
1.1)
immune reconstitution inflammatory syndrome (IRIS)
(TB)
CXR

PPD skin test
latent TB infection
HBsAg, anti-HBs

TDF
anti-HCV

182
cytomegalovirus (CMV)
CMV (CMV retinitis) < 5 %CD4 5%
CD4 count < 50 cells/mm3 6

floater

VDRL RPR
183
1.2) CD4
2

TMP-SMX

TMP-SMX
1.3)

NNRTI
1.4)

CBC, differential count
CD4 CD4
CD4
2557
ALT, AST NVP

TDF urine analysis
glycosuria, proteinuria BUN, creatinine estimated
GFR (eGFR)
urine pregnancy test
EFV
Plasma HIV viral load (VL)

VL 1-< 3 CD4
VL > 100,000
copies/mL 4.4
(genotype)

LPV genotype
NRTI NNRTI
NNRTI 3
2. (ARV counseling)
2.1)

2.2) ( 6 )

184
2.3)

2.4)

2.5) (adherence counseling)

4.11
1.

1

1
CD4

(functional cure) 1
CD4 WHO .. 2556
5
CD4
1-5
185
4.2.2
2557
2.
2
2.1 CDC classification system .. 2537
category N, A, B C
1 CDC category B C
2.2 WHO staging system .. 2549 WHO stage 1, 2, 3
4 1
WHO stage 3 4
WHO stage 1 2 7 20
3. CD4 CD4 cell count

5 5 %CD4
CD4 cell count 5
CD4 cell count CD4 %CD4
CD4 cell count %CD4
HIV prognostic marker collaborative

4,000
2,500 CD4 %CD4

CD4 %CD4 1
4.4 CD4 %CD4
CD4 %CD4
6
186
4.4
< 1
1 - < 3
5 -15
CDC
category B, C
WHO stage
3, 4
CDC
category B, C
WHO stage
3, 4
CD4
%CD4
CD4
CD4
CD4 < 25% < 1,000
cells/mm3
-
CD4
CD4
< 25% < 750 < 350 cells/mm3
cells/mm3
-

CD4 350-500
cells/mm3

< 1
1 %CD4 15-24%
CD4 %CD4
3 %CD4 < 15%
187
CDC
category B, C
WHO stage
3, 4
-
category A
VL > 100,000
copies/mL
3 - < 5
2557
4.2.3

4.5 (
)
4.5
< 1
1 - < 3
3-12
> 12
AZT ( ABC*) AZT ( ABC*) AZT ( ABC*) TDF **+ 3TC +

(preferred
+ 3TC + LPV/r + 3TC + LPV/r + 3TC + EFV EFV
regimens)
AZT ( ABC) + AZT ( ABC*) + AZT ( ABC) +
(alternative
3TC + NVP
3TC + NVP
3TC + NVP
regimens)
d4T+ 3TC + LPV/r d4T+ 3TC + LPV/r TDF + 3TC + EFV
TDF + 3TC + NVP
AZT ( ABC) +
3TC + EFV
TDF + 3TC + NVP
TDF + 3TC + RPV
d4T+ 3TC + NVP d4T+ 3TC + NVP d4T+ 3TC + EFV AZT ( ABC) +
d4T + 3TC + NVP 3TC + NVP
* ABC > 3 hypersensitivity
HLA-B*5701
( 4.0) ABC
HLA-B*5701
ABC 6
2 (1) (2) (3)
(4)
creatine phosphokinase
lymphopenia
LPV/r 14 42
LPV/r 3
NVP LPV/r 12
HIV RNA < 50 copies/mL LPV/r NVP
LPV/r
NVP 6 HIV RNA
VL < 50 copies/mL
LPV/r
188
AZT d4T lipodystrophy
(Hb < 8-9 g/dL) d4T 6

AZT
NVP AZT + 3TC + NVP (GPO-VIR Z250)
EFV EFV 3
NVP EFV
3 - 3 3.5
** TDF 2
RPV EFV NVP VL > 100,000 copies/mL

3 AZT/3TC/NVP 6

HIV DNA PCR 1
HIV DNA PCR 1
HIV DNA PCR
AZT/3TC/LPV/r HIV DNA
PCR 2

HIV DNA PCR 1
6
HIV DNA PCR 2 2 4
HIV DNA PCR 3
HIV DNA PCR 2 4
AZT/3TC/LPV/r
189
4.2.4
3

2557
4.2.5

2-8
IRIS CD4 CD4
cryptococcus CMV IRIS

CD4
drug interaction
rifampicin EFV, NVP ritonavir boosted
PI
(drug interaction)
IRIS
CD4
CD4 IRIS
19 4
2
TB, NTM Mycobacterium avuim intracellularae complex (MAC),
Pneumocystis jiroveci (PCP), cryptococcosis, CMV
cryptosporidiosis, microsporidiosis, JC virus

2-8
CD4 /
190

CD4
8

rifampicin
NNRTIs PIs
EFV, NVP ritonavir-boosted PIs
191

2-4
4-8
5
CD4 ( 6)
5
%CD4 5% CD4 count < 50 cells/mm3
6
floater
IRIS CMV
2557

1)
CD4
2-8

IRIS CD4
CD4
2)
3 2 NRTIs NVP
ABC 2 NRTIs rifampicin (
3 NRTIs VL > 100,000
copies/mL)
3 2NRTIs + EFV ( EFV
rifampicin EFV 25
EFV) EFV
NVP EFV
NVP triple NRTIs AZT
d4T + 3TC + ABC 2NRTIs + RAL
rifampicin
ritonavir boosted PIs
rifampicin
CD4 (< 15%)
rifampicin quinolones
aminoglycoside PIs CD4

rifampicin 2
maintenance rifampicin PIs
192
PIs rifampicin 2 (
rifampicin )

3.3
(immune tolerance)

TDF, 3TC
TDF 3TC
3TC
3TC TDF

(hepatic flare)
193

NNRTIs
NVP

PIs ( NNRTI) CD4

(> 15%) PIs
PIs rifampicin 2
PIs maintenance
rifampicin quinolones aminoglycoside
CD4 (< 15%) rifampicin
PIs
2557
4.3

plasma HIV VL
6
6-12
CD4
6
5 plasma HIV VL < 50 copies/mL CD4
> 500 cells/mm3
CD4

4.3.1
2-3
2-3
1) (new clinical events)
IRIS
2) (secondary
sex characteristics)
3) (neuro development)
2
194
4.3.2
195
1) (safety monitoring) ( 4.6)

1.1) CBC 6 AZT
3 WBC
1.2) chemistry liver enzymes (ALT), lipid profiles (cholesterol
triglyceride), serum creatinine fasting blood sugar 6
NVP ALT 2-4
1.3) urine analysis 6 TDF
2) (immunological and virological monitoring)
2.1) CD4 %CD4 6
> 5 < 50 copies/mL, CD4
> 500 cells/mm3
CD4
2.2) plasma HIV viral load
6
viral load 6 1
virological failure
CD4
2.3) HIV genotypic drug resistance mutations

4
VL > 1,000 copies/mL genotype

wild type
4
2557
4.3.3
1)

2)

2
3) (adherence assessment)

3

196
1-6

2-4

LPV/r
< 2

< 42
1-2
EFV

absence
LPV/r
1)
4.6
4.6
4.4

4 mcg/mL
197
198
2) Mitochondrial dysfunction
Lactic acidosis
1-20
metabolic
NRTIs acidosis
routine serum
d4T, ddI
(anion gap >16) lactate
serum lactate
> 5 mmol/L
Pancreatitis
serum

NRTIs
amylase routine serum

ddI, d4T
lipase
amylase
3TC
lipase
d4T, ddI

d4T ddI
hyporeflexia

serum lactate
IV fluid fluoride-oxalate
tube
4

NRTIs
TDF ABC
AZT 3TC
ddI
d4T
serum amylase

NRTIs AZT
ABC
NRTIs
AZT ABC
4
2557
199

(BMI)
lipoatrophy
/
d4T
AZT ABC

TDF
NRTIs
d4T ddI AZT
3)
lipohypertrophy
Fat maldistribution

NRTIs
/
PIs
d4T NNRTI
PIs boosted PIs
d4T
PIs
d4T
(waist-
to-hip ratio
z-score)
3.5
waist-to-hip ratio
(
)
-
http://
www.rihes.cmu.ac.th/Ped_
HIV/10-BMI-WHR_z_score/
index.html
200
Hyperglycemia, insulin-
resistance, diabetes

NRTIs
d4T, ddI, AZT
PIs
LPV/r (ATV/r, DRV/r
)
Insulin
resistance
FBS 100-125
mg/dL
FBS
fasting blood 6
sugar > 126
mg/dL
random BS
> 200 mg/dL

oral
glucose
challenge test
(OGTT)

3 60

10 impaired
OGTT

metformin

4) metabolic syndrome insulin resistance ( type 2 diabetes impaired fasting glucose 100 mg/dL
impaired glucose tolerance test) 2 130/85 mmHg BMI
(triglycerides 150 mg/dL HDL cholesterol < 40 mg/dL) albuminuria metabolic syndrome
atherosclerosis
4
2557
Hyperlipidemia
cholesterol, LDL fasting
fasting
cholesterol cholesterol, HDL,

PIs atherosclerosis > 200 mg/dL LDL TG
fasting LDL 6
NNRTIs EFV TG > 130 mg/dL

6-12 TG
NVP
pancreatitis
fasting TG
> 500 mg/dL
NRTIs
> 200 mg/dL
ARV ATV/r
d4T
NNRTIs ()
fibrate
8-10
LDL > 190 mg/dL LDL
>160 mg/dL

statin
4) metabolic syndrome ()
fibrate
TG > 500 mg/dL

gemfibrozil 150-300
mg 2
statin -pravastatin
8-13 20 mg
14-18 40 mg
10 mg
4
atorvastatin
> 6 10-20 mg
201
202
liver enzyme ALT / AST /

(hepatotoxicity)
() AST ALT
NVP
ARV NVP ARV

ARV
6 ALT
NVP AST > 5-10 fluconazole
NNRTIs NVP
10 upper normal limit
(NVP EFV) upper normal hepatitis A, B, C EBV
hypersensitivity limit 2-4 CMV
NRTIs
ALT
lactic acidosis
AST 5-10
upper normal limit

6 lactic
acidosis
AZT, d4T, ddI
5)
4
2557

PIs
buffered ddI
ARV adherence
bilirubin
liver
enzyme
indirect
bilirubin
/

AZT
PIs

Indirect
hyperbilirubinemia
ATV, IDV
5) ()
203
204
CBC: absolute CBC 6

neutrophil
AZT

count < 500
CBC
MAC
cells/mm3
3
(severe < 250 6
ARV
3
cells/mm )
6

absolute neutrophil
(< 250 cells/mm3)
(neutropenia)
AZT
Hb <7-8 g/dL AZT
MAC, TB

CBC 6 AZT ARV

AZT
d4T TDF
heart failure
CBC
3
6
6
AZT
6)
4
2557
205
ARV
TMP-SMX

steroid

NVP

EFV

antihistamine

systemic
(
)
7) Allergic reaction/ Hypersensitivity
maculo-papular
rash 2-4 2 - 8

2-3

NVP systemic hypersensitivity

ABC
TMP-SMX,

systemic

Stevens Johnson

syndrome (SJS)/
erythema multiforme

(EM) major/toxic

epidermal necrolysis
TMP(TEN)
(blister/bulla) SMX
1-2
NNRTIs
systemic
ARV
NVP
TMP-SMX, NVP
AZT,
2
ddI, LPV/r, ATV

ABC hypersensitivity

(rechallenge)
206

UA hematuria
IDV, ATV
( )
UA

microscopic
hematuria ARV
IDV
Creatinine
6
Impaired renal function U/A, Cr.

eGFR
2
eGFR < 60 mL/min/1.73 m

6
Cr. Schwartz
Fanconi syndrome
eGFR
(
TDF
, acute tubular aminoacid,
)
IDV necrosis, interstitial nephritis, glucose uric

renal
proximal renal tubulopathy, serum glucose
TDF FEP = [(urine
cortical atrophy nephrogenic DI, Cr. acidosis,
phosphate/serum
acute renal , sodium, potassium
phosphate)/(urine
failure phosphate phosphate wasting
creatinine/plasma
phosphate
creatinine)] x 100
urine fractional excretion of

phosphate
8)
4
2557
207
(osteopenia
osteoporosis)

TDF, d4T
PIs
9)
(bone
mineral density)
12
x-ray absorptiometry)
(BMD
z-score)
-1
Serum
Vitamin D
-2 Z-score
DXA (dual energy

steroid medroxyprogesterone

ARV

(peak bone mass)

2557
4.5

(Immune reconstitution inflammatory syndrome: IRIS)
IRIS CD4
VL

6
2-12
NTM, herpes simplex, cryptococcus
Mycobacterium tuberculosis CMV
IRIS 2 paradoxical (worsening) type
unmasking type paradoxical type

unmasking type

IRIS

NSAIDs corticosteroid
208
209
Immune restoration syndrome (IRS) immune reconstitution inflammatory

syndrome (IRIS)
CD4 VL

IRIS
(typical manifestation) herpes zoster,
mucocutaneous herpes simplex
(atypical manifestation) nontuberculous
Mycobacteria, , herpes simplex cytomegalovirus meningoencephalitis
(
%CD4 = 5%) IRIS 19 1-6
( 2-12 )
Mycobacterium tuberculosis, NTM ( Mycobacterium bovis BCG strain ),
herpes simplex cryptococcus acute
respiratory distress syndrome ( nontuberculous Mycobacteria),
herpes simplex, meningoencephalitis IRIS
CD4 15% VL

210
(OI)

(common childhood illness)
CD4
/ viral load
(2)
(clinical events)
(1)
IRIS 4.1
4.1 IRIS
IRIS unmasking
(4)
IRIS paradoxical
(worsening)
(3)
(6, 7)
(5, 7)
4
2557
(7) : corticosteroid
prednisolone (1-2 mg/kg/day) 1-4
NSAIDS
211
(1) (clinical events):

herpes zoster,
mucocutaneous herpes simplex
NTM, , herpes simplex
cytomegalovirus meningoencephalitis
(2) : %CD4 ( 5
2% 7% ) / VL (>2 log10
< 50 copies/mL)
(3) paradoxical (worsening) type: IRIS
IRIS cryptococcal meningitis IRIS

(4) unmasking type: IRIS

NTM human herpes virus

(5) :
cryptococcal
associated IRIS

(6) :
Mycobacterium tuberculous NTM
2557
4.6
virological failure
immunological failure clinical failure
(VL)

immunologic failure clinical failure
virologic failure
CD4

1-2 single dose NVP

NNRTIs
4.6.1
3 1) virological failure 2) immunological failure

3) clinical failure
VL CD4
virological failure immunological failure clinical failure
VL CD4 CD4

212
213
VL VL 2
virological failure immunological failure
clinical failure
Virological failure 2
1.1
VL > 200 copies/mL
6
VL > 50 copies/mL
12
1.2 VL VL (viral rebound) virological
failure VL > 1,000 copies/mL VL 50-1,000
copies/mL
VL 1-3
VL 50 copies/mL virological failure
NNRTI NNRTI
VL NRTI
Immunological failure
2.1 12
< 5 %CD4 < 15%

%CD4 5% 12 (
%CD4 6% 12
11% )
5 CD4 < 200 cells/mm3
CD4 50 cells/mm3 12
2.2
2557
%CD4 5%
( %CD4 14%
9%)
5 CD4
immunological failure CD4 2
1 immunological failure
virological failure
treatment failure
virological failure
Clinical failure
3.1 brain growth,
cognitive function motor function
3.2
3.3 AIDS defining condition

clinical failure
virological failure immunological failure
clinical failure immunologic failure

214
4.6.2
4.2
4.2
6
%CD4,
CD4
VL
plasma HIV VL
215
2557
4.7

second-line
AZT + 3TC TDF 3TC
TDF + 3TC AZT 3TC
NVP EFV LPV/r
LPV/r DRV/r
3 NRTIs, NNRTIs, PIs
boosted darunavir, ETR, RAL

4.3
216
4.3
adherence

CD4 < 200 cells/mm2
1
CD4 plasma HIV VL

adherence

adherence
HIV genotyping VL > 1,000 copies/mL

genotyping

217
2557
4.7.1 HIV genotyping
1) HIV genotyping plasma VL > 1,000

copies/mL
4 4 (
)
2) NRTIs 3TC
(mutation) NRTIs

thymidine analog mutations (TAMs) TAMs < 4
NRTIs NRTIs
TAMs > 4 NRTIs
TDF ABC
multi-NRTI mutations 69 insertion NRTIs
multi-NRTI mutations Q151M complex NRTIs
TDF
K65R TDF
AZT TDF K65R
3) 3TC
NRTIs M184V
M184I 3TC 3TC
M184V
(less viral fitness)
1-2 3TC thymidine analog AZT
TAMs
218
219
4) NNRTIs NVP EFV

(major
mutation) cross resistance
NVP EFV
ETR NNRTIs

ETR mutation score
update of the drug resistance mutations in HIV-1
5) PIs ritonavir boosted PIs
5
LPV/r ATV/r DRV/r
6) HIV genotyping 2
mutations
no evidence of resistance, possible resistance resistance
genotyping

NRTIs PIs possible resistance resistance
3TC
3-4
2557
4.7.2
2NRTIs + 1NNRTI
2NRTIs + 1NNRTI (NVP

EFV)
1. 2NRTIs resistance testing
4.7
AZT TDF 3TC
( 3TC )
TDF + AZT AZT TDF K65R
AZT 2 TDF + ABC
ABC . ABC
TDF K65R
ABC + 3TC
TDF ABC AZT 3TC
ABC + 3TC ABC
2NRTIs AZT + d4T TDF + ddI
d4T + ddI
ddI
()
2. boosted PI
LPV/r boosted PI RTV

boosted PI
ATV/r
ATV > 6
IDV/r LPV/r ATV/r
IDV/r
IDV/r viral suppression IDV/r LPV/r
ATV/r
220
double-boosted PIs (LPV/r + SQV LPV/r + IDV)

TDF
2 TDF + NRTI LPV/r
ATV/r double-boosted PIs

double-boosted PIs viral suppression
boosted PI + 2-3 NRTIs
4.7.3

2NRTIs + 1PI
221
2 NRTIs + LPV/r virological failure

1. 2NRTIs resistance testing
4.7.2 4.7
AZT + 3TC TDF + 3TC
TDF + AZT TDF
2 ABC TDF
ABC + 3TC TDF + AZT
TDF + 3TC K65R
AZT + 3TC
TDF + 3TC AZT + 3TC
2. 2NRTIs
NNRTI
NNRTI EFV NVP
NRTI
NRTI 3TC TDF
NRTI 2NRTIs + NNRTI
DRV/r
NNRTI DRV/r 2NRTIs
2557
4.7
(first-line regimen)
AZT + 3TC + NVP
EFV
(salvage regimen)
genotype
TDF + 3TC + LPV/r1
1 NRTI + DRV/r
(ETR / RAL / MVC)
TDF ABC + 3TC AZT + 3TC + LPV/r2

+ NVP EFV
1 NRTI + DRV/r
(ETR / RAL / MVC)
AZT + 3TC + LPV/r
(second-line regimen)
1 NRTI + boosted PI
NNRTI: TDF + 3TC + EFV3 (ETR / RAL / MVC)
( DRV/r
NRTI )

NNRTI: TDF + 3TC + DRV/r3
ABC + 3TC + LPV/r 1 NRTI + boosted PI

NNRTI: TDF + AZT + EFV4 (ETR / RAL / MVC)
( DRV/r
NRTI )

NNRTI: TDF + AZT + DRV/r
TDF + AZT ABC + 3TC TDF + ABC boosted PI
ATV/r
2
ABC + 3TC ABC boosted PI ATV/r
3
TDF + AZT ABC TDF TDF
2
4
TDF + 3TC AZT + 3TC K65R
1
222
4.7.4 3 NRTIs, NNRTIs PIs
salvage regimen
boosted darunavir (DRV/r) 3 RTV boost
50 mg 60 mg RTV
RTV boost 100 mg
ETR 6 ETR boosted PI ETR
2 NRTIs NNRTI
RAL 2
12 RAL (low
resistance threshold)
( active drug )
223
3
2 VL
< 50 copies/mL 6
genotypic resistance testing

adherence
4.7
NRTI 1 genotyping NRTI
mutations 3NRTIs
AZT/3TC ABC/3TC TDF
boosted PI DRV/r
NRTI PI mutation
1-2 ETR (
NNRTI), RAL ( integrase inhibitor), MVC ( CCR5 inhibitor)
2557
MVC 16 CCR5 receptor

(R5 virus) tropism
50-70 R5
MVC drug interaction MVC
EFV, ETR
PIs
integrase inhibitor EVG DTG
EVG boost RTV cobicistat
RAL
DTG RAL
EVG

CD4
NNRTIs
NNRTI ETR
CD4 3TC
mutation CD4
NRTI CD4
NNRTI PI NRTI AZT + 3TC
CD4 (
3 )
224
4.7.5
225
1) 1 3
adherence
PIs metabolic 2-3
lipid profile blood sugar 1-2
TDF urinalysis creatinine 6 CrCl
50 mL/min TDF TDF
2) CD4 3-6
VL 6 6
VL 6 > 50
copies/mL adherence viral load
3-6 VL
2557
4.8

%CD4 < 15%

, ,
-- --
CD4 (immune recovery)
> 25% > 350 cells/mm3 ( > 5 ) 6
%CD4 > 15% VL < 50 copies/mL 1

lymphoid tissue

(primary immune
response) memory cell

%CD4 < 15%
226
(revaccination)
%CD4 < 15%
CD4 > 25%
> 350 cells/mm3 ( > 5 ) 6 %CD4 > 15% VL
< 50 copies/mL 1 4.8
%CD4 > 15%

HBV3
HBV vaccine1
HBV1
JE vaccine2
MMR3
DTP, dT, Tdap4
HBV2
JE1
JE2
MMR1
2
1
1 dT 10
1.
1
3 doses ()
%CD4 < 15%
1 anti-HBs > 10 mIU/mL
2 anti-HBs
227
4.8

%CD4 < 15%
2557
anti-HBs < 10 mIU/mL 3 doses (

)
anti-HBs 10-100 mIU/mL 1 dose
anti-HBs > 100 mIU/mL
2.
2 doses 1 CD4
6 1
3. -- 1 MMR

4. -- (DTwP, DTaP Tdap) 7
DTwP DTaP > 7 dT Tdap
4.9

4
1)
2)
3)
4)

228
229
1)

2)

3)

/
4)

5)

2557
4.10

7

10

www.cqihiv.com
230
4.11

adherence

adherence
7
adherence
adherence
3 VL

4
.
.
.
.
231
2557

(adherence)

95

adherence

adherence
adherence
4
1 :

2 :
1-2

232
233
cotrimoxazole
2-4
3 :

(fixed dose combination)

4 :
4.1 ( 7 )

4.2

4.3
adherence
( visual
analog scale )
viral load

2557
4.12
4.13

(5Ds)
D1-Disclosure :

1)
7

2)

3)
4)
234
235
D2-Depression and self esteem :

13

D3-Drug :

D4-Dangers :
( 9-12 )

12-14

D5-Daily activity :

(life goals)

www.cqihiv.com
2557
4.14

1

(fully disclosed)

(
)

(IQ)
236
237
Prevention of Mother-to-Child HIV Transmission
25-40
.. 2531

.. 2543

.. 2556 0.6 0.8 .. 2551
PCR
3.8 .. 2551 2.1 .. 2555

PCR

4.6 .. 2551 2.8 .. 2555
HAART
CD4
2
2557

( 8
.. 2555 2)
20 HAART 14 CD4
HAART
25 HAART

HAART
4 < 1,000 copies/mL
2 HAART
4 1,000 copies/mL
( 5-15)

.. 2556 56 12

25 12
19
CD4
CD4 350 cells/mm3 19
31

0.2
1,600
.. 2556
12

238
..
2555 9 2,500
17 ( 10)
( 1.6 0.5-0.6
)

5.1
239
Key messages

(dual protection)
- CD4 VL
-
EFV, LPV/r
EE > 30

-

- VL < 50 copies/mL CD4 > 350
cells/mm3
2557
5.1.1
( 5.1)

VL
< 50 copies/mL
5.1
1.
2.
3.
1.
2.
1.
2.
3.
3.
240
VL < 50 copies/mL

VL < 50 copies/mL
VL < 50
copies/mL
VL < 50 copies/mL

(3-5 mL)
30
(intrauterine insemination,
IUI)
(ultrasound)

IUI 3-6 (in vitro
fertilization, IVF) (intracytoplasmic
sperm injection)

241

14
( 0.5-1 )

LH
LH
24-36
2557
(sperm washing)
IUI IVF
HIV
HIV (seminal fluid)

3
(timed natural conception)

VL < 50 copies/mL

6

TDF/FTC 1 24

4

4
5.1.2
WHO (spermicides)

242
(intrauterine device, IUD)

(copper IUD, Cu-IUD) (levonorgestrel IUD,
LNG-IUD)

depot medroxyprogesterone
acetate (DMPA) 150 3
DMPA
DMPA

NNRTIs PIs CD4
VL DMPA
243

2 Jadelle LNG 2 5
Implanon etonogestrel (ENG) 1 3
Implanon 24
2557
ethinyl estradiol (EE) LNG,

norethindrone (NET), norgestimate (NGM)
EE
30-35 EE 30 (ultra low
dose)
5.2
PIs
ATV
ATV/r
DRV/r
IDV
LPV/r
NFV
RTV
SQV
NNRTIs
EFV
ETR
NVP
RPV
RAL
EVG
EE , NET
EE , NET , NGM
EE , NET
EE , NET
EE , NET
EE , NET
EE
-
EE , NGM , LNG
EE , NET
EE , NET
EE , NET
EE
EE , NGM
30

EE: ethinyl estradiol, NET: norethindrone, LNG: levonorgestrel, NGM: norgestimate
EFV ritonavir-boosted PIs

5.2
EE 30
244
5.2

1.

2.

3.

5.1

5.2
245
Key messages

2557
4.

- : Hct/CBC, VDRL, HBsAg, blood gr, Rh, anti-HIV,
thalassemia screening ultrasound
- anti-HIV, VDRL, thalassemia screening (
thalassemia)
5. (
)

6.
- CD4 count 6
- VL 36 4
-
(anti-HCV) 3
-
-
246
PMTCT
window period
247
- 1
- window period 1
-
-
- CD4

32
(same day result)

CD4

5.3.5 3
( / )
5.1
2557
5.2
(b)
(b)
anti-HIV
reactive(a)

5.6

(c)
non reactive(a)

window period
positive

248
negative
positive

2 5.6
5.7

negative

5.2
249
(a)
(rapid test)
(b)
rapid test
anti-HIV
rapid test

(c)

rapid test

2557
5.3
Key messages

: CD4

o TDF + 3TC + EFV
o NNRTIs
: AZT + 3TC + LPV/r TDF + 3TC + LPV/r

o

- CD4 < 500 cells/mm3
-
-

o : AZT 4
(
)

CD4

250
5.3.1
1 5.3
5.3
*:
TDF + 3TC + EFV
CD4 count < 500 cells/mm3

HBV HCV

* TDF + 3TC + EFV

CD4 count ( TDF 300 mg 24 . + 3TC 300 mg + EFV 600 mg 24 .)
# TDF AZT + 3TC + LPV/r (TDF 300 mg 24 mg; AZT 200-300
mg 12 .; 3TC 150 mg 12 .; AZT + 3TC (300 + 150) 12 .; LPV/r (200/50)
2 12 .) 1
-
5.3
-
- AZT + single dose NVP
251
#:
TDF
AZT + 3TC + LPV/r
(
CD4 count)
2557
5.4 HAART
AZT
TDF (300 mg 24 .)
TDF AZT (300 mg 12 .)

LPV/r
EFV (600 mg 24 .)
EFV
LPV/r (200/50) 2 12 .
LPV/r EFV
NVP CD4 count < 250 cells/mm3

CD4 > 250 cells/mm3
NVP
LPV, EFV, NVP
boosted atazanavir (ATV/r 300/100 mg )
EFV, LPV/r, NVP ATV/r

AZT monotherapy
AZT NVP 200
mg 1 (SD NVP)
(HAART)
tail regimen
tail regimen* NVP
* tail regimen: AZT + 3TC 7 AZT + SD

NVP 4
tail regimen AZT + 3TC + LPV/r 4
VL (< 50 copies/mL)
VL 1,000 copies/mL
6 )
EFV
neural tube defect
( 6 )

ultrasound
252
5.3.2
253

AZT 300 mg 3 . AZT 600 mg
AZT
AZT
4
AZT VL < 50 copies/mL
3 NVP
NNRTIs
AZT monotherapy NVP 200 mg
1 dose
ergot methergine ( oxytocin )
LPV/r EFV severe vasoconstriction
254
3TC
TDF
-
3TC
- - CBC
- Hb < 8 g/dL Hct

< 24% AZT
TDF
- - -
NRTIs
-
TDF
-
-
FDA
pregnancy
category*
AZT
NRTIs
5.5
5
2557
FTC
d4T
ddl
-
FTC
- - -
-
NRTIs -

- lactic acidosis (
d4T
d4T/ddI
)
-
- -
- lactic acidosis ( NRTIs
ddI
d4T/ddI
)
FDA
pregnancy
category*
255
256
EFV
RPV
- ( -
)
antihistamine
- (
chlorpheniramine,

hydroxyzine topical
/
steroid 0.1% TA cream/
)
lotion ALT
LPV/r
- ALT > 2.5
upper limit
LPV/r
-
-
-
- NVP
-

2-4

2 .
EFV
-

FDA
pregnancy
category*
NVP
NNRTIs
-
EFV

EFV neural tube

defect 6

- ergot methergine
RPV
CD4 > 250 cells/mm3
5
2557
257
ATV
- -

2-4
-
-
glucose challenge
test
- indirect -
bilirubin
- urine sugar 50 g glucose challenge

test
-
- ergot methergine
- ATV
ATV/r 300/100 mg
TDF
- hyperbilirubinemia
ATV
* Food and Drug Administration (FDA) pregnancy category:

A (
2 3)
B
C
FDA
pregnancy
category*
Pls
LPV/r
2557
5.3.3
o CD4 count < 500 cells/mm3

o
o

PI

NNRTI

CD4 6
PI LPV/r
- 3
NNRTI EFV NVP
-
NNRTIs NRTIs
AZT TDF
3TC 7
< 4
- EFV NVP
LPV/r NRTI
4
: 3
258
5.3.4

(no ANC)
259
Key messages

o 4
o
o VL 36 > 50 copies/mL
o (acute HIV infection;
AHI)

o
- AZT 600 mg
2 . NVP 1 dose
2 NVP
- NVP 1 dose
(HAART)

AZT + 3TC + LPV/r
4 (tail) 3
o
HAART 4

- NVP EFV
AZT 600 mg AZT 300 mg 3 .
- NVP EFV
AZT 600 mg AZT 300 mg 3 .
NVP 200 mg 1 dose
2557
o 38
AZT NVP
4
:
o PMTCT AZT+3TC+NVP 6
25-40 5.2

4

AZT 300 mg NVP 200 mg
AZT 300 mg 3 AZT 600 mg
2 NVP
NVP

NNRTI-based HAART

NVP AZT +
3TC + LPV/r 4 NVP
NVP
NVP
AZT + 3TC + LPV/r
260

4
> 50 copies/mL
AZT 600 mg 1 300 mg 3 .
NVP 1 NVP
EFV ( NNRTI) VL
1,000 copies/mL
261
(standard risk)
HAART 4 VL
50 copies/mL AZT 4 mg/kg/dose 12 . 4
NVP (
5.6)
(high risk)
HAART 4 VL
> 50 copies/mL 3 AZT 4 mg/kg
12 . 3TC 2 mg/kg 24 . NVP 4 mg/kg 24 .
6
- PCR 1
NVP LPV/r AZT + 3TC + LPV/r
LPV/r AZT + 3TC + NVP DNA PCR
2
4

2557
48
48

5.7
5.3.5
1. HAART
VL
AZT AZT
wild type AZT
2. NVP
HAART AZT TDF + 3TC +
LPV/r CD4 NVP
3.
o 3
o acute retroviral syndrome (ARS)

VL < 50 copies/mL
o anti-HIV 32-34
6
o
o
262
263
( 1
window period VL )
()
1) < 36
o anti-HIV ( 4th generation)
2
32-34
o
(> 32 )

2) 36

window period (no ANC)
window period (6 )
1) 2) HIV DNA RNA PCR

4. anti-HIV inconclusive ()
ARS
2

ARS 3 ()
5. AHI
HAART

VL 50 copies/mL

2557
AHI 4-6
AHI 60-90
(ARS) 2-3

10 AHI
AHI
window period
inconclusive AHI
(4th generation immunoassay) window period
(15-20 ) rapid test window period 20-35
window period 10-15
NAT
2 ARS
AHI AHI
HIV IgG IgM inconclusive ( rapid test)
HIV antigen NAT
4-6 ARS
genotyping AHI

AHI (< 12 )

cesarean section
3
264
Intrapartum
Postpartum
+ AZT
300 mg 3 .
600 mg

o LPV/r-based HAART
o TDF + 3TC + EFV EFV

TDF + 3TC 7
AZT (syr) 4 mg/kg 12 .

4 ( 1 .
)
5.7 (
5.10
3
3)
Newborn ( + )
VL < 50 copies/mL + AZT 1

EFV 300 mg 3 .
600 mg

2 HAART
TDF (300 mg) + 3TC (300 mg) + EFV

(600 mg)
- (AZT + 3TC) 1 + LPV/r

(200/50) 2 12 .
- TDF (300 mg) + 3TC (300 mg)
+ LPV/r (200/50) 2
12 .
1 HAART ( CD4*)
Antepartum
5.6
265
266
Intrapartum
AZT 300 mg 3
. 600 mg TDF + 3TC + EFV
+ NVP
200 mg 1 CD4 > 500 cells/mm3
(SD
NVP)
AZT + 3TC + LPV/r
4 (tail) 3
2 .
AZT (syr) 4 mg/kg 12 . +

3TC (syr) 2 mg/kg 12 .+
NVP (syr) 4 mg/kg 24 .
6
5.7
Newborn ( + )
* CD4 < 200 cells/mm3 TMP-SMX 2 24 .

LPV/r-based HAART 1) NNRTI
AZT+SD NVP 2) CD4 > 500 cells/mm3
AZT VL < 50 copies/mL
/ : CD4 < 500 cells/mm3

AZT 300 mg 3
. 600 mg
Postpartum
2 .
3 (no ANC)
Antepartum
5
2557
5.7
AZT (10 mg/mL)* 3TC (10 mg/mL) NVP (10 mg/mL)

(g) () 4 mg/kg 2 mg/kg 12 4 mg/kg
12
(simplified dosing)
18 . (1.8 mL ) 9 . (0.9 mL )
18 . (1.8 mL )
3500-3999
16 . (1.6 mL ) 8 . (0.8 mL )
16 . (1.6 mL )
3000-3499
14 . (1.4 mL ) 7 . (0.7 mL )
14 . (1.4 mL )
2500-2999
12 . (1.2 mL ) 6 . (0.6 mL )
12 . (1.2 mL )
2000-2499
10 . (1.0 mL ) 5 . (0.5 mL )
10 . (1.0 mL )
1500-1999
8 . (0.8 mL ) 4 . (0.4 mL )
8 . (0.8 mL )
* 30-35 : AZT 2 mg/kg 12

8 2
* < 30 : AZT 2 mg/kg 12
8 4
5.4
CD4 < 200 cells/mm3
PCP TMP-SMX 2 1 TMP-SMX

2 TMP-SMX
folic acid 1 1
CD4 < 100 cells/mm3

cryptococcal meningitis fluconazole

6
267
4000-4499
2557
HAART
5.8
HAART
CD4 count
- - 6
Viral load
CBC
-
- AZT 4-8
- Hb < 8 g/dL Hct < 24% - Hb < 8 g/dL Hct < 24%
AZT TDF AZT TDF
Creatinine
-
- creatinine clearance
< 50 mL/min TDF
ALT
-
-
- 2.5 upper - 2.5 upper
limit NVP
limit NVP
EFV LPV/r
Urine sugar
50 g GCT
- LPV/r - LPV/r
24-28 LPV/r
blood sugar 4
140 mg/dL 100 g OGTT blood sugar 140 mg/dL
100 g OGTT
268
- 36 *
4
- TDF 3 6
- creatinine clearance <

50 mL/min TDF
AZT
-
- urine sugar
LPV/r
EFV
* HAART 8-12
VL < 1,000 copies/mL VL 36
4
VL > 50 copies/mL 3 AZT/3TC/NVP 6
50 g GCT (glucose challenge test) glucose

50 g 50% glucose 100 mL blood glucose glucose 1
100 g OGTT (oral glucose tolerance test)

8 fasting blood glucose glucose
100 g blood glucose 1, 2 3 glucose
5.9 100 g OGTT
blood glucose (mg/dL)
Fasting blood glucose
105
1 . glucose
190
2 . glucose
165
3 . glucose
145
OGTT
1) glucose 1

OGTT 4
2) glucose 2

269
2557
5.5
5.5.1

(artificial rupture of membranes)
oxytocin
4

scalp electrode forceps extraction vacuum extraction /
(episiotomy)

5.5.2
5.5.2.1 (elective caesarean section)

latent phase of labor
4 .
38

1. 38 VL 36
> 1,000 copies/mL VL
270
2.
4 VL
3.
4.

3,500 4
(oligohydramnios)
scalp electrode, forceps extraction, vacuum extraction
prolonged rupture of membranes
271
5.5.2.2 (emergency caesarean section)

(postpartum morbidity)
AZT 600 mg ( NVP
200 mg ) 4
(prophylactic antibiotic)
ampicillin cefazolin
methergin
ergotamines PI
EFV potent CYP3A4 enzyme inhibitors
ergotamines (vasoconstriction)

2557
5.6
-
-
-

hypothermia
-
- 5.6
- vitamin K BCG HBV
5.7
5.7.1
1)
-

4-6 pap smear (
1 )
-
272
273
-

CD4 6
2)
3)

3.1)
3.2)
-

-
-
-
2
4)

5)
5.1
2557
5.7.2
5.6 5.7

18

AZT 3TC

1
4.8
TMP-SMX prophylaxis ( TMP 150 mg/m2/day SMX 750 mg/m2/
day) 3 4-6
PCR
6 1
%CD4 < 15%
274
5.8

(Early infant diagnosis EID)
DNA PCR
( 2 4)
5.10
(high risk)
HIV DNA PCR 3 1, 2 4
4

3 (AZT + 3TC +

NVP) 1
> 50 3
copies/mL
6

NVP LPV/r ( 4)
* (DBS)
(
)
HIV DNA PCR 1-2
DNA PCR

anti-HIV 18
( 2 4)
1 HIV DNA PCR
2

275
(standard risk)
HIV DNA PCR 2 1
(HAART) 2-4
> 4
AZT 4
50 copies/mL
2557
276

(Opportunistic Infections: Prophylaxis and
Treatment)
277
Opportunistic Infections: Prophylaxis and Treatment
20 1,243
.. 2551-2555 ( 62)
/
( 50) PCP (
26.3) cryptococcus ( 8.3)

primary prophylaxis, secondary prophylaxis
2557
6.1 (Tuberculosis)
6-9
12
directly observed therapy (DOT)

CD4
CD4 50 cells/mm3 2
CD4 > 50 cells/mm3
2 2-8
rifampicin
rifampicin EFV
EFV NVP RAL
protease inhibitor
rifampicin
278
279

CD4 < 200 cells/mm3

rifampicin
paradoxical reaction IRIS
acid fast bacilli (AFB)

nontuberculous
mycobacteria (NTM)

DOT

2557
(
.. 2556 )

AFB
2
NTM

needle aspiration tissue biopsy
pancytopenia bone marrow aspiration

(molecular method)
polymerase chain reaction
(PCR) real-time PCR
NTM
280
6-9
2
9

12 9-12
2 4 isoniazid, rifampicin, ethambutol,
pyrazinamide isoniazid rifampicin 2
4-7

281
(primary infection)

tuberculin

interferon gamma release assay
(IGRA) indetermine

tuberculin skin test (TST) IGRA
TST IGRA
2557
Isoniazid (I, INH)
5-8 mg/kg (300 mg)
Rifampicin (R)
10 mg/kg (450-600 mg)
Ethambutol (E)
15-20 mg/kg (800-1,200 mg)
Pyrazinamide (Z)
20 -30 mg/kg (1,000-2,000 mg)
pyridoxine 25-50 mg isoniazid
(multi-drug resistant TB)

INH rifampicin 3-4 1

Streptomycin (S)
15 mg/kg ( 1,000 mg)
Kanamycin
15 mg/kg ( 1,000 mg)
Amikacin
15 mg/kg ( 1,000 mg)
Ethionamide
15 mg/kg (500-750 mg/day) 2-3
Cycloserine
10 mg/kg (500-750 mg/day) 2-3
4-aminosalicylic acid (PAS)
200 mg/kg (8,000-12,000 mg/day) 2
Ofloxacin
600-800 mg/day
Levofloxacin
500-750 mg/day
Moxifloxacin
400 mg/day
steroid (meningitis)
(pericarditis) prednisolone 1 mg/kg/day 3
3
282
283
2
4 isoniazid + rifampicin + pyrazinamide + ethambutol
isoniazid rifampicin 2 pyrazinamide
ethambutol 6-9
(disseminated) miliary
isoniazid rifampicin 12
miliary
endobronchial TB prednisolone 2 mg/kg/day
( 10 mg) 4-6
Isoniazid (INH) 10-15 mg/kg ( 300 mg)

Rifampicin 10-20 mg/kg ( 600 mg)
Pyrazinamide 30-40 mg/kg ( 2,000 mg)
Ethambutol 15-20 mg/kg ( 1,000 mg)

3-6 2 (bactericidal)

Amikacin 15 mg/kg ( 1,000 mg) Kanamycin 15 mg/kg (

1,000 mg)
Ethionamide 15-20 mg/kg ( 1,000 mg) 2-3
Capreomycin 15-30 mg/kg ( 1,000 mg)
Cycloserine 10-20 mg/kg ( 1,000 mg) 1-2
Ofloxacin 15-20 mg/kg ( 800 mg) levofloxacin 7.5-10 mg/kg
( 750 mg)
PAS 200-300 mg/kg ( 10 g/day) 2-3

NNRTI thyroind function ethionamide PAS
2557

streptomycin, kanamycin, amikacin
ethionamide quinolones, cycloserine PAS
(intensive phase)
2 2
INH rifampicin
DOT

steroid

INH rifampicin ethambutol
pyrazinamide 3-5
284
ALT
> 3
2 2SIRE/7IR,9IRE, 9RZE
1 2SIE/16IE,18-24IE +
quinolone
ethambutol metabolites pyrazinamide

creatinine clearance < 30 mL/min

3
streptomycin
hemodialysis
285
INH, rifampicin pyrazinamide

alkaline phosphatase bilirubin
transaminase enzyme rifampicin
AST ALT > 5 > 3
INH, rifampicin pyrazinamide
ethambutol, quinolones, streptomycin
AST ALT < 2 total
bilirubin < 1.5 mg/dL INH, rifampicin
pyrazinamide
1
2557
Rifampicin
CYP450 efflux multi-drug transporter
P-glycoprotein NNRTIs PIs
NNRTIs EFV NVP
PI
1. PI NNRTIs ( EFV NVP) integrase
inhibitor ( RAL)
2. NNRTIs integrase inhibitor

2IEZ + quinolone/10-16IE + quinolone
streptomycin 2

CD4
CD4
< 50 cells/mm3
> 50 cells/mm3
* 2
2-8
286

2
rifampicin
rifampicin
1. EFV 600 mg
2. NVP 200 mg 2 lead-in
3. RAL 400 mg 2
NRTIs 2
287

2-8
IRIS CD4
CD4 6
6
- CD4 (< 15%) 2-4
- CD4 (15%-25%)
4-8
- CD4 (> 25%) 8
2557
rifampicin
NNRTIs EFV EFV
NVP
NNRTIs PIs
1. %CD4 < 15% ( CD4 count < 200

cells/mm3 6 ) rifampicin
quinolones aminoglycoside (amikacin kanamycin)
rifampicin PIs 12-18
continuation phase 3 2IZE + levofloxacin (
ofloxacin amikacin kanamycin)/10-16 IZ ( E) + levofloxacin (
ofloxacin)
2. (
3TC monotherapy M184V) intensive phase
rifampicin 2
continuation phase 3 rifampicin quinolone
IZ ( E) + levofloxacin ( ofloxacin) PIs
PIs rifampicin 2 (
rifampicin ) 12-18
3. triple NRTIs AZT d4T +
3TC + ABC rifampicin
NNRTIs PIs
288
289
(IRIS)
TB IRIS
paradoxical TB IRIS
unmasking TB IRIS
paradoxical TB IRIS
CD4

3
IRIS
2-4

(non-steroidal drugs systemic
corticosteroids)
IRIS prednisolone 1
mg/kg/day 2
4-8
2557

(latent TB infection)

10
10
WHO

INH 6-9

tuberculin TST
tuberculin 5 mm TST
TST

INH 6-9
isoniazid preventive
therapy (IPT) TLTI (treatment latent tuberculous infection)
TST tuberculin

TST
48-72
(anergic)
randomized controlled trials

IPT
290
TST

IPT
1. INH
meta-analysis INH IPT
2. (active TB) (latent
TB)
3.
4. IPT
CD4
291
INH

TST
TST (induration 5 mm)
INH

(LTBI)
INH 9-12 TST
2557
INH 300 mg 9
INH 10 mg/kg ( 300 mg) 9-12
CD4 2 (pyrazinamide
+ rifampicin)

INH rifampicin 1020 mg/kg ( 600 mg)
46

.. 2556

292
6.2

(primary and
secondary prophylaxis) ()
293

co-trimoxazole PCP

CD4 < 200 cells/mm3 %CD4 < 14 %
oropharyngeal candidiasis AIDS-defining illness (
) PCP
primary prophylaxis cryptococcosis, penicilliosis,
histoplasmosis MAC

CD4
(
prophylaxis)
2557
6.2.1 Pneumocystis pneumonia (PCP)
PCP
Pneumocystis jirovecii

PCP 3-6

1 CD4
P. jirovecii
30-65
A. Primary prophylaxis
CD4 < 200 cells/mm3 %CD4 < 14%

oropharyngeal candidiasis AIDS-defining illness ()

PCP PCP 4-6
CD4 PCP

12
CD4
1-5 %CD4 < 15% CD4 < 500 cells/mm3
6 CD4 < 200 cells/mm3 CD4
clinical CDC category C
294
CD4 200 cells/mm3 3

primary prophylaxis CD4 200
cells/mm3
primary prophylaxis 6
CD4 3
1-5 %CD4 15% CD4 500 cells/mm3
6 CD4 200 cells/mm3 1
1 CD4
295

trimethoprim-sulfamethoxazole (TMP-SMX)
single-strength (SS) tablet (TMP 80 mg-SMX 400 mg) 1-2
2 toxoplasmosis
TMP 5 mg/kg 150 mg/m2/day SMX 750 mg/m2/day

( TMP 320 mg SMX 1,600 mg) 1-2 3
TMP-SMX
- dapsone 100 mg atovaquone 1,500 mg
- 1 dapsone 2 mg/kg ( 100 mg)

4 mg/kg ( 200 mg)
- 1-3 > 2 atovaquone 30 mg/kg
4-24 45 mg/kg
clindamycin primaquine

PCP
2557
B. Treatment

TMP-SMX TMP 15-20 mg/kg/day SMX 75-100 mg/kg/day

1 . 3-4 21

TMP-SMX

(desensitization)
70

Clindamycin 600 mg 6 . 900 mg
8 . 300 mg 6 . 450 mg 8
. primaquine 30 mg 21
Pentamidine isethionate 3-4 mg/kg
1 . 21
PaO2 < 70 mmHg alveolar-arterial (A-a) gradient 35 mmHg
prednisolone ( 72 )
40 mg 2 5 40 mg
5 20 mg 11
prednisolone 1 mg/kg 12 . 1-5 0.5-1 mg/kg
12 . 6-10 0.5 mg/kg 21
methylprednisolone 1 mg/kg 6 1-7
1 mg/kg 12 . 8-9 0.5 mg/kg
12 . 10-11 1 mg/kg
12-16
296
C. Secondary prophylaxis
PCP
primary prophylaxis
CD4 200 cells/mm3 3

CD4
< 200 cells/mm3
297
1)
PCP
TMP-SMX kernicterus
bilirubin
2)
PCP
TMP-SMX TMP-SMX

50
TMP-SMX 5-7 pentamidine
isethionate 4 mg/kg/day 60-90
dapsone 2 mg/kg/day atovaquone 30-40 mg/kg/day
2 21 TMP-SMX
rapid desensitization desensitization
2557
PCP CD4 > 200 cells/mm3 secondary

prophylaxis CD4
primary prophylaxis PCP
prophylaxis 1 prophylaxis
PCP PCP CD4
6.2.2 Cryptococcosis
Cryptococcosis Cryptococcus neoformans

3
PCP

cryptococcal antigen CD4 100 cells/mm3
cryptococcal antigen cryptococcus


fluconazole
primary prophylaxis
(optional)
primary
prophylaxis
298
CD4 < 100 cells/mm3

C. neoformans
cryptococcal antigen ()
Fluconazole 400 mg
CD4 100 cells/mm3 3
299
B. Treatment
Induction phase: 2

Amphotericin B 0.7-1.0 mg/kg/day fluconazole
800 mg/day
(meningitis)
Amphotericin B 1.0 mg/kg/day

fluconazole

Fluconazole 1,200 mg/day

amphotericin B
Consolidation phase: 8-10

Fluconazole 400-800 mg/day
2557

Itraconazole 400 mg/day 2
cryptococcal antigen
(cryptococcal
antigenemia) consolidation phase
1)
fluconazole itraconazole teratogenic effect
2 amphotericin
B
2)
meningitis disseminated infection induction amphotericin
B 1.0-1.5 mg/kg fluconazole 12 mg/kg
10-12 mg/kg ( 800 mg)
14 consolidation fluconazole 12 mg/kg
10-12 mg/kg/day 8
secondary prophylaxis
CSF cryptococcal antigen titer

fluconazole 12 mg/kg 6-12 mg/kg ( 600 mg)

amphotericin B 0.7-1.0 mg/kg
cryptococcosis induction
consolidation secondary prophylaxis
300

fluconazole 200-400 mg/day
fluconazole 6 mg/kg ( 200 mg)

itraconazole 200 mg/day
itraconazole 5 mg/kg ( 200 mg)
301
cryptococcosis
cryptococcosis
1 CD4 100 cells/mm3 3
(undetectable HIV VL)
CD4 100 cells/mm3

6
12
3
CD4 100 cells/mm3 6
2557
6.2.3 Candidiasis
Candidiasis mucocutaneous candidiasis

oropharyngeal candidiasis, cervicovaginal candidiasis, esophageal candidiasis
diaper dermatitis invasive candidiasis

oropharyngeal candidiasis CD4
< 100 cells/mm3, HIV VL , WBC < 500 cells/mm3
esophageal candidiasis herpes simplex virus CMV esophagitis
B. Treatment
1. Oropharyngeal candidiasis

Clotrimazole oral troches 10 mg 4-5 7-14
Fluconazole 100 mg 7-14

Nystatin oral solution 500,000 5 7-14
Itraconazole capsule 100 mg 7-14
Itraconazole oral solution 100 mg 7-14
Amphotericin B 0.3-0.5 mg/kg/day 7-14
2. Esophageal candidiasis

302
1)
fluconazole itraconazole
teratogenic effect amphotericin B
2)
Orpharyngeal candidiasis
clotrimazole troches 10 mg 4-5 oral polyenes ( nystatin) 46 mL
4-5 fluconazole 6-12 mg/kg ( 400 mg)
itraconazole () 2.5 mg/kg/dose
2 7-14 ketoconazole 5-10 mg/kg/day 1-2
14 ( ketoconazole )
303

Itraconazole capsule 200 mg 2 14-21
Itraconazole oral solution 200 mg 2 14-21
3. Cervicovaginal candidiasis

Clotrimazole vaginal cream 5 mg/day clotrimazole vaginal suppository
tablet 100 mg 3-7
Fluconazole 200 mg

Miconazole cream 5 mg/day miconazole vaginal suppository tablet 100
mg 7
Itraconazole capsule 200 mg 3
Itraconazole oral solution 200 mg 3
2557
Esophageal candidiasis fluconazole 6-12 mg/kg ( 600

mg) itraconazole 2.5 mg/kg 2 5 mg/kg
14-21 amphotericin B 0.3-0.7 mg/kg
7

/

fluconazole 100-200 mg itraconazole 100-200 mg
fluconazole 3-6 mg/kg ( 200 mg) itraconazole

5 mg/kg ( 200 mg)
CD4 200 cells/mm3

6 %CD4 15% 6
304
6.2.4 Toxoplasmic encephalitis
CD4 < 100 cells/mm3

IgG antibody toxoplasma
< 6 %CD4 < 15%
6 CD4 < 100 cells/mm3

TMP-SMX SS tablet 2
TMP-SMX 150/750 mg/m2/day 6/30 mg/kg/day
1-2

TMP-SMX SS tablet 1 2 3
Dapsone 50 mg pyrimethamine 50 mg
folinic acid (leucovorin) 25 mg
Dapsone 200 mg pyrimethamine 75 mg folinic acid 25 mg
305
Toxoplasmic encephalitis Toxoplasma gondii

CD4
congenital toxoplasmosis
retinitis, neurologic impairment
hydrocephalus, intracranial calcification,
bone marrow suppression

2557
TMP-SMX primary prophylaxis PCP

toxoplasmosis dapsone

1 dapsone 2 mg/kg ( 25 mg)
pyrimethamine 1 mg/kg ( 25 mg) leucovorin
5 mg 3
1-3 > 2 atovaquone 30 mg/kg
4-24 atovaquone 45 mg/kg
pyrimethamine 1 mg/kg ( 25 mg)
+ leucovorin 5 mg 3
CD4 200 cells/mm3 3

6 CD4 200 cells/mm3

3 1-5 %CD4 15% 3
1
B. Treatment

Pyrimethamine 200 mg 1 50 mg/day (. 60 kg)
75 mg/day (. > 60 kg) sulfadiazine 1,000 mg (.
60 kg) 1,500 mg (. > 60 kg) 4 folinic acid
10-25 mg/day 6

TMP-SMX TMP 5-10 mg/kg/day SMX 25-50 mg/kg/day
2
Pyrimethamine clindamycin 600 mg
6
Pyrimethamine azithromycin 1,000-1,250 mg/day
306
307
1)

hyperbilirubinemia kernicterus
2)
congenital toxoplasmosis pyrimethamine 2 mg/kg/day
2 1 mg/kg/day 2-6 1 mg/kg
3 sulfadiazine 50 mg/kg/dose 2
folinic acid 10 mg pyrimethamine 12
toxoplasmosis

acquired CNS ocular systemic toxoplasmosis pyrimethamine
2 mg/kg/day ( 50 mg) 3 1 mg/kg/day (
25 mg) folinic acid 10-25 mg/day sulfadiazine
25-50 mg/kg/dose ( 1-1.5 g/dose) 4 6

sulfadiazine clindamycin 5-7.5 mg/kg/dose
4 ( 600 mg/dose) pyrimethamine folinic acid
TMP 5-10 mg/kg/day SMX 25-50 mg/kg/day
2
prednisolone dexamethasone CSF protein
(>1,000 mg/dL)
pyrimethamine
CBC
2557
toxoplasma

pyrimethamine 25-50 mg/day sulfadiazine
500-1,000 mg 4 folinic acid 10-25 mg/day
sulfadiazine 85-120 mg/kg/day 2-4
pyrimethamine 1 mg/kg 15 mg/m2 ( 25 mg)
folinic acid 5 mg 3

pyrimethamine 25-50 mg/day clindamycin
600 mg 8 . folinic acid 10-25 mg/day
TMP-SMX SS tablet 2
clindamycin 20-30 mg/kg/day 4
pyrimethamine 1 mg/kg folinic acid 5 mg 3

CD4 200 cells/mm3 6
CD4 200 cells/mm3
6 CD4 200 cells/mm3 1-5
%CD4 15% 6 6
1
308
6.2.5 Penicilliosis histoplasmosis
penicilliosis histoplasmosis
cryptococcosis
cryptococcosis
primary prophylaxis 2
(optional)
CD4 100 ( penicilliosis) 150 (

histoplasmosis) cells/mm3

309
Penicilliosis histoplasmosis
CD4 100 ( penicilliosis) 150 ( histoplasmosis)
cells/mm3 penicilliosis
papulonecrotic skin lesions histoplasmosis

Wright stain
histoplasmosis
penicilliosis
65 penicilliosis
2557

itraconazole 200 mg
itraconazole 5 mg/kg
itraconazole histoplasmosis penicilliosis
fluconazole cryptococcosis
CD4 100 ( penicilliosis)

150 ( histoplasmosis) cells/mm3 6
CD4
B. Treatment
Induction phase


Itraconazole 200 mg 3 3 200 mg
2 14
Consolidation phase

Itraconazole 200 mg 2 10-12

Amphotericin B 0.4-0.5 mg/kg/day
10-12
310
penicilliosis histoplasmosis

itraconazole 200 mg itraconazole 5
mg/kg

fluconazole 400 mg
Amphotericin B 0.6-0.7 mg/kg
malabsorption
fluconazole 6 mg/kg ( 200 mg)
311
1)
itraconazole
itraconazole teratogenic effect amphotericin
B
2)
2.1) Histoplasmosis itraconazole 6-8 mg/kg/day
3-12
amphotericin B 1 mg/kg
4-6 itraconazole 5 mg/kg
2.2) Penicilliosis amphotericin B 0.7 mg/kg

2 itraconazole 10 mg/kg/day
2 10
amphotericin B 2
2557
CD4 100 ( penicilliosis)

150 ( histoplasmosis) cells/mm3 6
CD4
6 CD4 100 cells/mm3

( penicilliosis) 150 cells/mm3 ( histoplasmosis)
1-5 CD4 15% itraconazole
1 6
6.2.6 Cytomegalovirus (CMV) infection
CMV
CD4 < 50 cells/mm3

CMV

1
(congenital infection)

congenital CMV
microcephaly, intracranial calcification, bone marrow
suppression

CMV retinitis
CD4 < 50 cells/mm3
312

fundus screening
CMV retinitis 4-6
5
%CD4 5% CD4 count < 50 cells/mm3 6
floater
CMV IRIS
B. Treatment

Ganciclovir 5 mg/kg 12 . 2-3

3-6
Valganciclovir 900 mg 2 2-3

Ganciclovir intravitreous 2,000 g/dose 1
Ganciclovir implant 4.5 mg

vitreous 6-8 ganciclovir
retinitis
CMV
313

CD4
100 cells/mm3
2557
CD4
CMV
CMV
ganciclovir
CD4 HIV RNA
1)
2)
CMV CMV retinitis ganciclovir
5 mg/kg/dose 12 . 2-3
5 mg/kg/dose 5-7 secondary
prophylaxis congenital CMV infection ganciclovir 6 mg/kg/dose
12 . ( )
CMV retinitis

valganciclovir 900 mg ganciclovir 5
mg/kg/dose 5-7

ganciclovir 5 mg/kg/dose
Ganciclovir intravitreous 2,000 g 1 2-4 ( )
314
retinitis
CMV retinitis 3-6
CD4 100 cells/mm3 3-6
CD4 100 cells/mm3
6 CD4 100 cells/mm3 1-5
%CD4 15% 6
6
3-6

MAC nontuberculous mycobacterium
CD4 < 50 cells/mm3 MAC

mycobacteria
MAC

clarithromycin azithromycin
CD4 < 50 cells/mm3 2 MAC
clarithromycin MAC

315
6.2.7 Mycobacterium avium complex (MAC) infection
2557
MAC
primary
prophylaxis MAC
(optional)
CD4 < 50 cells/mm3

- 6 CD4 < 50 cells/mm3
- 2-5 CD4 < 75 cells/mm3
- 1-2 CD4 < 500 cells/mm3
- 1 CD4 < 750 cells/mm3
clarithromycin 500 mg 2 azithromycin 1,0001,250 mg

clarithromycin 7.5 mg/kg/dose 2 azithromycin
20 mg/kg ( 1,250 mg) 5 mg/kg (
250 mg)
CD4 100 cells/mm3

3 CD4 50
cells/mm3
6 CD4 100 cells/mm3 2-5
CD4 200 cells/mm3 3
< 2 6
316
Treatment

Clarithromycin 500 mg 2 ethambutol 15 mg/kg/day

Azithromycin 500 mg ethambutol 15 mg/kg/day
1)
clarithromycin
azithromycin
2)
clarithromycin 7.5-15 mg/kg/dose ( 500 mg/dose)
2 azithromycin 10-12 mg/kg/dose ( 500 mg/day)
ethambutol 15-25 mg/kg/dose ( 2,500 mg/day)
1
quinolone ciprofloxacin 10-15
mg/kg/dose ( 1,500 mg/day) 2
levofloxacin 500 mg aminoglycoside amikacin 15-30
mg/kg/dose (1,500 mg/day)
317
( 4-8
) quinolones
(ciprofloxacin 500-750 mg 2 levofloxacin 500 mg
moxifloxacin 400 mg ) amikacin 15 mg/kg
2557
: clarithromycin CYP3A4
CYP3A4
PIs clarithromycin
rifampicin, ergot alkaloids, carbamazepine, cisapride azithromycin
rifampicin
B. Secondary prophylaxis
disseminated MAC
MAC 12
MAC CD4
CD4 100 cells/mm3 6

CD4 100 cells/mm3
6 CD4 100 cells/mm3 2-5

CD4 200 cells/mm3 6
6 MAC 1
2
318
319
Tuberculosis
Drug susceptible
2 HRZE/4-7IR
isoniazid 5-8 mg/kg (300 mg)
PO
rifampicin 10 mg/kg (450-600 mg)
PO
ethambutol 15-20 mg/kg (800-1,200 mg)
PO
pyrazinamide 20-30 mg/kg
(1,000-2,000 mg)
PO
Second line drug
Streptomycin 15 mg/kg
( 1,000 mg) IM
Kanamycin 15 mg/kg
( 1,000 mg) IM
Amikacin 15 mg/kg ( 1,000 mg)
IM
Ethionamide 15 mg/kg (500-750 mg/day)
PO 2-3
Cycloserine10 mg/kg (500-750 mg/day)
PO 2-3
4-aminosalicylic acid (PAS) 200 mg/kg
(8,000-12,000 mg/day)
PO 2
Ofloxacin 600-800 mg/day
PO
Levofloxacin 500-750 mg/day
PO
Moxifloxacin 400 mg/day
PO
6.1
320
Cryptococcosis
(cryptococcal
meningitis or
disseminated)
Pneumocystis
pneumonia (PCP)
900 mg IV 8 . 300 mg PO
6 . 450 mg PO 8 .
+ primaquine 30 mg PO
21
Pentamidine isethionate 3-4 mg/kg IV
21
mg single PO
strength, SS Tablet) Atovaquone 1,500
PO 2 mg PO
Consolidation phase
Fluconazole 400-800 mg/day PO Itraconazole 400 mg/day PO
8-10
8-10
Induction phase:
Fluconazole 200- Itraconazole 200 mg
Amphotericin B 0.7-1.0 mg/kg/day IV Fluconazole 1,200 mg/day IV or PO 400 mg PO PO
+ fluconazole 800 mg/day IV or PO 14
Atovaquone 1,500
14
mg PO
Amphotericin B 1.0 mg/kg/day IV
14
SMX) TMP 15-20 mg/kg/day

SMX 75-100 mg/kg/day
3-4 21
Trimethoprim-sulfamethoxazole (TMP- Clindamycin 600 mg IV 6 . TMP-SMX (80-400 Dapsone 100 mg
6
2557
321
Clotrimazole vaginal cream 5 mg/day Miconazole cream 5 mg/day

clotrimazole vaginal suppository miconazole vaginal suppository tablet
tablet 100 mg 100 mg 7
3-7
Itraconazole capsule 200 mg/day PO
Fluconazole 200 mg PO
3
Itraconazole oral solution 200 mg/day
PO 3
- Cervicovaginal
candidiasis
Nystatin oral solution 500,000

5 7-14
Itraconazole capsule 100 mg/day PO
7-14
PO 7-14
Amphotericin B 0.3-0.5 mg/kg/day IV
7-14
Fluconazole 200 mg/day PO Itraconazole capsule 400 mg/day

14-21
2 14-21
2 14-21
Amphotericin B 0.3-0.5 mg/kg/day IV
14 -21
Clotrimazole oral troches 10 mg

4-5 7-14
Fluconazole 100 mg/day PO
7-14
- Esophageal
candidiasis
Candidiasis
- Oropharyngeal
candidiasis
322
Penicilliosis/
Histoplasmosis
Toxoplasmosis
Pyrimethamine 25-50
mg/day PO
+ clindamycin 600
mg PO 8 . +
folinic acid 10-25
mg/day PO
TMP-SMX SS tablet
2 PO
Fluconazole 400 mg
PO
Amphotericin B 0.60.7 mg/kg/day IV
Pyrimethamine 200 mg PO 1 TMP-SMX (TMP 5-10 mg/kg/day) IV Pyrimethamine 25 50 mg/day (. 60 kg) 75 or PO 2 6

50 mg/day PO
mg/day (. > 60 kg) PO Pyrimethamine + + sulfadiazine
+ sulfadiazine 1,000 mg (. 60 kg) clindamycin 600 mg IV PO 6 500-1,000 mg PO
1,500 mg (. > 60 kg) PO
4 + folinic
4 + folinic acid 10-25 mg/day Pyrimethamine + acid 10-25 mg/day
PO 6
azithromycin 1,000-1,250 mg/day PO PO
Induction phase
Itraconazole 200
Amphotericin B 0.6-0.7 mg/kg/day IV Itraconazole 200 mg PO 3 mg PO
7-14
3 200 mg
2 14
Consolidation phase
Itraconazole 200 mg PO 2 Amphotericin B 0.4-0.5 mg/kg/day IV
10-12
10-12
Fluconazole 800 mg PO
10-12
6
2557
Clarithromycin 500 mg PO 2 Azithromycin 500 mg PO +

+ ethambutol 15 mg/kg/day
ethambutol 15 mg/kg/day

quinolones:
ciprofloxacin 500-750 mg
PO 2
levofloxacin 500 mg PO
moxifloxacin 400 mg PO +
amikacin 15 mg/kg IV IM
MAC
Ganciclovir 5 mg/kg 12 .
Ganciclovir intravitreous 2,000 g/dose Valganciclovir 900 Ganciclovir 5 mg/kg
IV 2-3
1 mg PO
IV
Valganciclovir 900 mg PO 2
Ganciclovir
2-3
Ganciclovir implant 4.5 mg
intravitreous 2,000
6-8
g 1 2-4
( retinitis)
CMV
323
324
Tuberculosis Drug-susceptible TB
Intensive phase
- INH 10-15 mg/kg/dose ( 300 mg)
- Rifampicin 10-20 mg/kg/dose ( 600 mg)
- Pyrazinamide 30-40 mg/kg/dose ( 2,000 mg)
- Ethambutol 15-20 mg/kg/dose ( 1,000 mg)
- PI rifampicin quinolones
aminoglycoside
Continuation phase
- INH 10-15 mg/kg/dose ( 300 mg)
- Rifampicin 10-20 mg/kg/dose ( 600 mg) 2
6-9
miliary
12
- PI continuation phase
rifampicin quinolones pyrazinamide ethambutol
12-18
- Prednisolone 2 mg/kg/day ( 60 mg) 4-6
miliary
endobronchial TB
Drug-resistant TB ()
3-6 18-24
Second-line drug
- Amikacin 15 mg/kg/dose (
1,000 mg)

- Kanamycin 15 mg/kg/dose (
1,000 mg)

- Ofloxacin 15-20 mg/kg/dose (
800 mg) levofloxacin 7.510 mg/kg/dose ( 750 mg)
- Ethionamide 15-20 mg/kg/day

( 1,000 mg) 2-3
- Cycloserine 10-20 mg/kg/day (

1,000 mg) 1-2
- Para-aminosalicylic acid 200-300
mg/kg/day ( 10 g)
3-4
6.2
6
2557
325
- TMP-SMX TMP 15-20 mg/kg/ - Pentamidine isethionate 4 mg/kg/day - TMP 5 mg/kg - Dapsone 2 mg/kg
day SMX 75-100 mg/kg/day 150 mg/m2/day (
60-90 SMX 750 mg/ 100 mg) 4 mg/
dapsone 2 mg/kg/day m2/day ( TMP kg
atovaquone 30-40 mg/kg/day 320 mg SMX ( 200 mg)
1 . 4 21 1-2 1,600 mg)
21
1-2 3
secondary
prophylaxis
- corticosteroids PaO2 < 70 mmHg room air alveolar-arterial (A-a) gradient > 35 mmHg
72 prednisone 1 mg/kg/dose 2 1-5 0.51 mg/kg/dose 2
6-10 0.5 mg/kg/dose 11-21 methylprednisolone 1 mg/kg/dose
6 1-7 1 mg/kg/dose 2 8-9 0.5
mg/kg/dose 2 10-11 1 mg/kg/dose
1216
- TMP-SMX rapid desensitization
Cryptococcosis
- Fluconazole 12 mg/kg/dose - Amphotericin B 0.7-1.0 mg/kg IV - Fluconazole 6 mg/kg - Itraconazole 5 mg/kg
- Localized disease, 6-12 mg/kg/dose (
isolated pulmonary 600 mg)

disease

PCP
326
- Esophageal
candidiasis
Candidiasis
- Oropharyngeal
candidiasis
- CNS disease,
Disseminated
- Fluconazole 6 mg/kg - Itraconazole 5 mg/kg

( 200 mg)
( 200 mg)
- Fluconazole 3-6 mg/kg - Itraconazole 5

- Itraconazole ( ( 200 mg) mg/kg ( 200
) 2.5 mg/kg/dose 2 mg)
ketoconazole 5-10 mg/kg/day
1-2
- Clotrimazole troches 10 mg 4-5

nystatin 46 mL 4-5
fluconazole 612 mg/kg/dose
( 400 mg) 7-14
- Fluconazole 6-12 mg/kg/dose ( - Amphotericin B 0.3-0.7 mg/kg/dose

600 mg) itraconazole
2.5 mg/kg/dose 2
3
Induction therapy:
- Amphotericin B 1-1.5 mg/kg/dose

fluconazole 12 mg/kg/dose
10-12 mg/kg/dose ( 800
mg)
14
Consolidation therapy:
- Fluconazole 12 mg/kg/dose
10-12 mg/kg/dose ( 800
mg)
8
6
2557
327
- Sulfadiazine 85-120 - Clindamycin 20-30

- Pyrimethamine 2 mg/kg/day
- sulfadiazine
2 1 mg/kg/ clindamycin 5-7.5 mg/kg/dose ( mg/kg/day mg/kg/day
day 2-6 600 mg/dose) 4 2-4 4
pyrimethamine 1
1 mg/kg/dose 3 pyrimethamine folinic acid
sulfadiazine 50 mg/kg/dose - TMP 5-10 mg/kg/day SMX 25-50 pyrimethamine 1 mg/kg mg/kg
2 folinic acid 10 mg mg/kg/day 15 mg/m2 ( folinic acid 5 mg
pyrimethamine 2
25 mg) 3
12
folinic acid 5 mg
3
- TMP 5 mg/kg
- Pyrimethamine 2 mg/kg/day ( 50
150 mg/m2/day
- Acquired CNS
SMX 750 mg/m2/
ocular or systemic mg) 3 1
mg/kg/day ( 25 mg)
day ( TMP 320
toxoplasmosis
sulfadiazine 25-50 mg/kg/dose
mg SMX 1,600
mg) 1-2
( 1-1.5 g/dose) 4
3
folinic acid 10-25 mg/day
6
- dexamethasone
CSF protein ( > 1,000 mg/
dL)
( pyrimethamine
CBC )
Toxoplasmosis
- Congenital
toxoplasmosis
328
- Ganciclovir 6 mg/kg/dose
12 . 6
- itraconazole 6-8 mg/kg/day

3-12
amphotericin B 1 mg/kg
4-6
itraconazole 5 mg/
kg
- Amphotericin B 0.7 mg/kg/dose
2
(
) itraconazole 10 mg/kg/day
2 10
- Disseminated CMV - Ganciclovir 5 mg/kg/dose

or CMV retinitis
12 . 2-3
5 mg/kg/dose
57
Cytomegalovirus
(CMV)
- Congenital CMV
Penicilliosis
Histoplasmosis
- Ganciclovir 5
mg/kg/dose

57

- Itraconazole 5 - Fluconazole 6 mg/kg

mg/kg
( 200 mg)
- Itraconazole 5 - Fluconazole 6 mg/kg

mg/kg
( 200 mg)
6
2557
- Disseminated
diseases
- quinolone
ciprofloxacin 10-15 mg/kg/dose (
1,500 mg)
2 levofloxacin 500 mg
amikacin 15-30 mg/kg/
dose (1,500 mg)
Mycobacterium avium - Clarithromycin 7.5-15 mg/kg/dose ( - Azithromycin 10-12 mg/kg/dose (

complex (MAC)
500 mg/dose) 2 500 mg)
( severe or
ethambutol 15-25 mg/kg/dose ( clarithromycin
Disseminated disease)
2,500 mg)
1
329
2557
6.3 CD4
Opportunistic
infections
PCP
Primary prophylaxis
Secondary prophylaxis
CD4 200 cells/mm3 3 CD4 200 cells/mm3 3
Toxoplasmosis CD4 200 cells/mm3 3 CD4 200 cells/mm3 6
Cryptococcosis CD4 100 cells/mm3 3 secondary prophylaxis

1 CD4 100 cells/mm3
3
Penicilliosis/
CD4 100 ( penicilliosis) CD4 100 ( penicilliosis)
Histoplasmosis 150 ( histoplasmosis) cells/mm3 150 ( histoplasmosis) cells/mm3
6
6
MAC
CD4 100 cells/mm3 3 MAC 12

CD4
100 cells/mm3 6
CMV retinitis
330
CMV retinitis
3-6 CD4 100 cells/mm3
3-6
6.4 CD4
Secondary prophylaxis
< 1:
1-5 : CD4 500 cells/mm3 15%
3
6 : CD4 200 cells/mm3 3
( primary prophylaxis)
< 1 :
1- 5 : CD4 15% 6
6 : CD4 200 cells/mm3 6
6
TE
6 CD4 100 cells/mm3
6 undetectable viral load
3
12
Penicilliosis/
6 itraconazole
Histoplasmosis
1 CD4 100 cells/mm3
( penicilliosis) 150 cells/mm3
( histoplasmosis) 6
MAC
< 2 :
< 2 :
3
2-5 : CD4 200 cells/mm 3 2-5 : CD4 200 cells/mm3 6
> 6 : CD4 100 cells/mm3 3 > 6 : CD4 100 cells/mm3 6
6 6
MAC
1
CMV
< 1 :
1-5 : CD4 15% 6
6 : CD4 100 cells/mm3
6
6
*** retinitis 3-6
relapse
immune restoration uveitis
331
Opportunistic
Primary prophylaxis
infections
PCP
< 1 :
1-5 : CD4 500 cells/mm3
15% 3
6 : CD4 200 cells/mm3 3
6
Toxoplasmosis < 1 :
1-5 : CD4 15% 3
6 : CD4 200 cells/mm3 3
6
Cryptococcosis
2557
332
(HIV Prevention)
333
HIV Prevention

(comprehensive HIV
prevention package)
2557
7.1

(Antiretroviral-based HIV prevention)
7.1.1 (Treatment as Prevention)
HPTN 052 randomized controlled trial

1,763 9

CD4 96

CD4
5 observational cohorts mathematical models

(Treatment as Prevention TasP)
TasP
(cost effective)
Asian Epidemic Model

.. 2555 2559 43,040
41
11 10
mathematical model
90

CD4 count
2 3 ( 8,000
2,600 ) .. 2559
.. 2555 2559 ( 7.1)
334
7.1
Baseline scenario
VCT 90% in KPs and treat at any CD4
12,000
12,000
10,000
10,000
8,000
8,000
6,000
6,000
4,000
4,000
2,000
2,000
2010 2012 2014 2016 2018 2020 2022 2024
Extramarital
Female from Husband
Sex worker
2010
2012 2014
Male from wife

Male from sex worker
2016
2018
2020
2022
2024
Male sex with male

Injection Drug User
CD4
335
HIV Prevention
7.1
90
CD4
() baseline scenario ()
TasP 1)

2)
2557


TasP

50 250,000
20

CD4
50 CD4 < 100 cells/mm3 ( NAP Database)

TasP

TasP
336
7.1.2 (Pre-Exposure Prophylaxis)

(Pre-Exposure Prophylaxis PrEP)
FTC/TDF
44 (iPrEx) 63
(TDF2) 75
(Partners PrEP) TDF 67
(Partners PrEP) 49 (Bangkok TDF
Study)
PrEP ( 7.1) 92
2 PrEP
Adherence
PrEP

adherence
Partners PrEP Serodiscordant

FTC/TDF
heterosexual couples TDF
75%
67%
81%
90%
86%
TDF2
Heterosexual men FTC/TDF

and women
63%
79%
78%
iPrEX
Men who have sex FTC/TDF

with men
44%
51%
92%
Bangkok TDF People who inject TDF

drugs
49%
84%
74%
FEM-PrEP
Women
FTC/TDF
6%
VOICE
Women
FTC/TDF
TDF
-4%
-49%
35-38% No protection
< 30%
No protection
No protection
337
HIV Prevention
7.1 PrEP
adherence
2557
PrEP
CAPRISA 004 TDF 1% 39

PrEP

PrEP
PrEP
750-2,000
PrEP
- : PrEP

Post-Exposure Prophylaxis

3
- PrEP: FTC/TDF
PrEP

338

PrEP FTC/TDF
HBV HBV

PrEP /
- : PrEP

2
PrEP
PrEP PrEP:
- PrEP FTC/TDF 200/300 mg 1
3
339
HIV Prevention
PrEP PrEP
PrEP:
- anti-HIV
nucleic acid testing anti-HIV
- creatinine creatinine clearance

calculated creatinine clearance 60 mL per minute (Cockroft-Gault formula)
- HBV HBsAg anti-HBs
HBV HBV
- urine pregnancy test

PrEP
-
2557
-

Methadone Maintenance
Treatment (MMT)
- anti-HIV 2-3

- creatinine 3
6
- urine pregnancy test
-
PrEP:
- PrEP PrEP
4

- anti-HIV PrEP
PrEP
anti-HIV
- active hepatitis B PrEP
hepatitis B
340
- PrEP

- anti-HIV PrEP
2
PrEP PrEP
- TDF
7.1.3 (Post-Exposure Prophylaxis)
341
HIV Prevention
HIV Post-Exposure Prophylaxis

(PEP) 2
-
HIV occupational PEP (HIV oPEP)
(body fluids)
( ) ( )

- HIV
non-occupational PEP (nPEP) body fluids

body fluids

2557
7.1.3.1

(HIV occupational Post-Exposure Prophylaxis: HIV oPEP)

-

body substances

- (occupational exposures)

- (percutaneous injury)

- (contact of mucous membrane)

- (contact of non-intact skin)
(dermatitis)

0.3 ( 95
0.2-0.5) 0.09 ( 95
0.006-0.5) 0.09
342
* 72
unknown source
HIV oPEP
343
HIV Prevention

- HIV oPEP 7.1
HIV oPEP 7.2 HIV oPEP
(1-2 ) 72 . *
4
- HIV oPEP source
source known HIV + ve case
source VL resistance testing ()
- source VL detectable VL source NNRTIbased regimen TDF + 3TC FTC + boosted PI
source PI-based regimen NNRTI resistance
TDF + 3TC FTC + RAL ( 7.3)
- source undetectable VL source
7.3
- HIV oPEP
7.2
standard precaution

72 . anti-HIV 1
3 ( HCV
anti-HIV 12 )

/

HIV oPEP CBC,
Cr SGPT /
2557
7.2 body fluids
body uids
body uids

70%
alcohol betadine
solution
5% chlorhexidinegluconate
body uids
0.9% NSS

0.9% NSS
anti-HIV
24 .
source anti-HIV
source
source
anti-HIV -ve
source
HIV
source
source
anti-HIV +ve
HIV
oPEP
344
body uids
source
HIV
body uids
HIV
oPEP
7.3
7.2 HIV oPEP

HIV oPEP
Source
Anti-HIV (same-day result)1
Baseline
CBC, Cr, SGPT
HIV PCR or VL
HBsAg
Anti-HBs
Anti-HCV
345
HIV Prevention
anti-HIV source known HIV + ve case anti-HIV source

HIV oPEP
HIV oPEP anti-HIV 12
source HCV infection
2
anti-HIV HIV PCR or VL AHI

3

4
acute hepatitis B infection
5
3 6 source HBV / HCV infection
6

1
2557
7.3 HIV oPEP* HIV nPEP

**
TDF 300 mg + 3TC 300 mg + RPV 25 mg

TDF 300 mg + FTC 200 mg ATV/r 300/100
mg
LPV/r 400/100
mg 12 .
boosted PI ATV/r
LPV/r ergotamine
cafergot
TDF 300 mg + 3TC 300 mg + RAL 400 mg

12 .
TDF 300 mg + FTC 200 mg EFV 600 mg
EFV
ergotamine cafergot

AZT 300 mg 12 . TDF

CrCl < 60 mL/min
*
3
** source patient drugresistant HIV
7.1.3.2

(HIV non-occupational Post-Exposure Prophylaxis: HIV nPEP)

body fluids

7.4
346
7.4
10,000
67
30
50
10
6.5
HIV Prevention
8-12

cervical ectopy

347
2557
10,000

- HIV nPEP 7.5
- HIV nPEP HIV
nPEP 7.6 HIV oPEP

HIV nPEP
( 1-2 ) 72 .
* 4 HIV oPEP
- HIV nPEP
HIV oPEP 7.3
- HIV nPEP
72 . anti-HIV
1 3

/

HIV nPEP CBC, Cr SGPT
/
* 72
unknown source
HIV nPEP
348
7.5 HIV nPEP

HIV
nPEP
1.
nPEP
2.
1 nPEP
HIV
nPEP
2.1 HIV
HIV > 1,500 copies/mL
2.2

2.3
2.4
3. (
nPEP
)

(
lancet
)

body fluids
349
HIV Prevention
HIV

body fluids
2557
7.6 nPEP nPEP
Baseline
Anti-HIV (same-day result)2
CBC, Cr, SGPT
HIV PCR or VL
HBs Ag
Anti-HBs
Anti-HCV
VDRL or RPR
Pregnancy test
(for child-bearing age female)9
10
identify source anti-HIV, VDRL RPR

() anti-HIV source
nPEP nPEP
2
anti-HIV 12 source HCV infection
3
anti-HIV HIV PCR or VL acute HIV infection

4

5
acute hepatitis B infection
6
3 6 source HBV / HCV infection
7

8

VDRL or RPR
9

10
350
7.2 (Male circumcision)
351
HIV Prevention
()

.. 2539

randomized
controlled trials 3

3 .. 2548 -2550

51-60 .. 2550 WHO
UNAIDS

58 6

herd immunity
2557

1) Langerhans, CD4+,
macrophage

2)
keratin (micro injuries)

3)
4)

keratinization glans
(OR uncircumcised to circumcised = 9.1) (balanitis)

(posthitis)
HSV-2 (HR 0.72; 95% CI, 0.56-0.92) high-risk human
papillomavirus (HR HPV) (RR 0.65; 95% CI, 0.46-0.90 RR 0.67; 95% CI, 0.510.89) HR HPV (RR, 1.39;
352
95% CI, 1.17-1.64) syphilis chancroid

HR HPV

(phimosis)
353
HIV Prevention

1 3

3

Shang Ring
2

Shang Ring
2557

3
- (
)

354
355
HIV Prevention

-

risk compensation WHO

American Academy of Pediatrics
.. 2555

American College of Obstetricians
and Gynecologists
-
2557

"risk
compensation"
7.3

2 -5
3-11

(cost effectiveness strategy)

356
357
HIV Prevention

.. 2555
/ 5.35

5.33

50-70 70-80 85-90

Test and Treat

.. 2555
urine PCR (polymerase chain
reaction) Chlamydia trachomatis (CT) 6.6
Neisseria gonorrhoeae (NG) 2.9 CT NG
11.4 16.1 (venue-base
female sex worker)
(NG) 2.4
(CT) 9.2 11.1 12
99.4
()
( )
( .. 2553)
2557
1.
()
2.

()

()

358
17
(STIQUAL program)
3,405
41.03 1

15.4

359
HIV Prevention

test

nucleic acid amplification test

2557
7.4

.. 2531

(ISO) .. 2533
3 49 mm., 52 mm. 54 mm.
WHO 0.05-0.08 mm.

( 87)
HSV-2 ( 92)
syphilis chlamydia ( 26)
gonorrhea ( 62) trichomonas
HPV
HPV
98 88
15
polyurethane
7
5.5

sperm
polyurethane
latex ()

360
361
HIV Prevention

15 -24 8.83
80
2.31
89.2 21.52
33 0.8
78.8

www.
aidsstithai.org/female
362
7.

6.
ky-jelly
5.

4.
3.
2.

1.
7
2557
HIV Prevention
5.
4.

3.
2.
1.

363
364
8.

7.

6.
5.
4.
3.
2.
1.

(:
)
7
2557
365
HIV Prevention
1.
()

2.
1 12 5
50 25
25

3.

(petroleum and derivatives)
2557

90
4. ISO
5

5

5. 2

366
7.5

.. 2554 UNAIDS 2.5

80
(The Thai working group)
.. 2552 11,753
8.1 ..
2532 30-50
1. (outreach programme)

2.

HBV HCV
367
HIV Prevention

(harm reduction)

2557
3.

4.

5.
6.

HBV HCV
7.

8.
9.

10. PrEP
368

369
Service Delivery Guidance
treatment cascade

NAP-plus treatment
cascade

VL 1
VL < 50 copies/mL 8.1
370
286,214
227,779
175,304
155,221
Started ART
Retained to ART
VL annual testing
VL suppressed
150,000
388,633*
Registered to care
459,509
25%
Estimated alive PLHA
0%
75%
300,000
50%
#-% HIV test, # HIV+ diagnosis

% HIV+ referred to care
% VL screening during the past 12 m
450,000
Retain
Treat
Test
Recruit
-
-
% of PLHA with VL failure

% switched to higher-class ART regimen
66% % of PLHA with VL suppression
62%
#-% lost to FU
#-% deaths
50% % retained to ART at 12, 24, 36 & 60 m
% CD4 <200/median CD4 at ART initiation
38% #-% ART-eligible not on ART
15%
100%

Cascade of HIV care and treatment services and key indicators
8.1
8
2557
Recruit-Test-Treat-Retain
- --
8.1 (Recruit)
1.

2.

3.
371
4

NAP-plus
website .

2557
(Recruit)
1. outreach worker
2.

(peer)

() drop-in center
(mobile clinic)

1. ( MSM TG MSW FSW PWID migrant
)
2.
3.

372
373
2 (mobile clinic)
1. mobile clinic
2. VCT SDR

mobile clinic
3. mobile
clinic

VCT SDR

drop-in center
mobile clinic

2557
3 (network building in community)
1. drop-in center ..
2.

drop-in center ..

..
telemedicine skype
4
1.
2.
( outreach worker website /
)

374
1.
2.

3 8.2
375
2557
8.2

7
6
1.
2.
3. ()
VCT SDR
4. UIC
(unified identification code)
376
377
/

8.3
1.

2.

3.
-
-

-
4.

5.

2557
8.3
378
8.2 (Test)
1. VCT VCT
2.
3.
4. ()
(Test)
1 (SDR)
1. ( .. drop-in center)
2.
( .. drop-in center)
3. mobile clinic

.. mobile clinic
(community based HIV testing)
379
2557
(concentrated
epidemic)
WHO
1) (facility-based HIV counseling and
testing; HCT)
(CITC)
(PITC)

CD4 drop-in center (DIC)

99 (HIV opt
out testing) HCT
(normalize HIV testing)

2) (community-based HCT)

HCT

(KPs)

HCT

380

CD4

2
(1) drop-in center

(2)

1.

2.

381
2557
3.
4.

1.
2. -
-
3.
(
)
4.
5.
-
-
-

-
()
1.
2.

3. CD4
4.
382
383
1.
2.

2
1)

2)

2557
3 (friendly service)
1.
2.
1.
1
-

-
2
-
-
-
-
-
2.
3
-
/
4
-
3.
5
-
-
384
3. () 6
-
-

hot line,
website, facebook,
7
-
-

8
-
-
-
5. 9
-

385
4.
2557
1.

8.1 6
8.3 (Treat)
1.
2.
3. CD4
4. VL 1
386
(Treat)
1 (friendly service)
1.
2.
8.2 3
387
1.
2.
(chronic and treatable disease)

(holistic care)

2557

9
(
.. 2554 )

HIVQUAL 10 3
1) 2) /
3)

http://www.cqihiv.com/
(.)
(disease specific certification;
DSC for HIV and STI)
3 CD4 Viral load, Genotype
1. CD4 3
2. VL 1
3. VL 2
4.
drug resistance testing 4
2
NAP-plus
.
388
1. CD4 CD4 < 200

cells/mm3
2.
3.
4.
3 4
NAP-plus .
1.
2.
3.
4. VL < 50 copies/mL
5.

6
389
8.4 (Retain)
2557
(Retain)
1 (retention in care)
1.

8.4
8.4
Re-Engagement
in Care
Loss to Follow up
Retention in Care
HIV
Diagnosis
390
Linkage
to Care
ART
Receipt
ART
Adherence
Outcomes
391
2
1) (individual barriers)

2) (structural barriers)

1)

adherence
2)

treatment literacy

2557
3)

4)

5) (case manager retention
specialist)

case management
6)

392

3-5
31 18
393
2 Adherence
1.
2. 100%

adherence 95%

adherence

adherence
treatment literacy
adherence
stigma discrimination
2557
treatment literacy

(treatment literacy or TL)

7
1.
2.
3.
4.
5.
6.
7.
7
7
(key message)
adherence
treatment literacy
1.
TL

(key message)
2.

3.

1.
2.
3.
4.
5.
394
395
3 (task shifting and task sharing)
1. .. VCT
WHO

8.1
396

-

on site

(mobile HCT)
-
-
- ./.
.
()

- ././.

./.
()
8.1

routine lab
(coaching onsite)

CD4 ( point of care CD4 .),
VL, DR
-
-
- coaching onsite
-
-
-
./.
8
2557
1.
./.
2.
3. HCT
./.
-
- STI ( syndromic
screening and treatment)

-
-
1. / 1
VL suppression ( 50 copies/mL)

2.

treatment literacy

STI
( syndromic screening and treatment)

./.
397
2557
4 (drug resistance
monitoring & prevention)
1. VL < 50 copies/mL
85
2.
85
3. 1
4.
5. drug resistance
2
(1) (2)

(early warning indicators; EWI)
(3)

8.2
(priority) (4) (5)
398
-
-
-
- adherence
-
Drug stock out

EWI: T-EWI6
Lost follow-up
EWI: T-EWI3a - T-EWI3b, T-EWI4
Poor adherence
EWI: T-EWI5a - T-EWI5b
* NAP case management audit software NAPDAR

8.6
-
-
-
-
ARV regimen
(
)
EWI: T-EWI2a - T-EWI2h
- - VL
- > 50 1,000 copies/mL
VL suppression/failure
EWI: T-EWI1a - T-EWI1f
EWI
8.2
399
2557

(visit
adherence drug adherence)
VL
drug resistance testing

1.

-

-
-

400

CD4

401
2557
8.5
1.
2. sensitivity training
3.
1.
(stigma)

402
403
:

(
)

:

2557

()

2
1.

8.5
404
8.5
Recruit
Test
Treat
Retain
Universal
Precaution (UP)
1)

/
/

405
2557
2)
-

10

- (universal precaution: UP)
UP

- (friendly services)

406
407

3)
/
/

4)


2557
1.
21 2552

3 Zero

408
/
PDCA (Plan Do Check Act)

8.6
8.6
(
)
409
2557
8.6

1.
1.

2.

2
treatment cascade
( 8.1) 8.1-8.5
8.3

410
8.3
( )
NAP (NAT)
12
(%)
NAP (NAT)
NAP (SUM/SUM table)
(Recruit)
NAP (SUM)
NAP (SUM)
NAP
(SUM/SUM table)
CD4
(CD4 3 )
NAP (SUM)
(Treat)
NAP ( )
CD4
NAP (NAT)
NAP
(SUM/SUM table)
(Retain)

( )
NAP (NAT/EWI)
NAP (NAT/EWI)
viral load < 50 NAP (NAT/EWI)

copies/mL
NAP (NAT/EWI)
*
NAP (web reports
NAPDAR), RIHIS, STI mini record HIVQUAL-T, STIQUAL, PEDQUAL, VCTQUAL
411
2557
(effective continuous quality

improvement)

()

8.7
8.7

( )
-
( )

process, outcomes, impact
412
death
ARV resistance

(Recruit)
(Test)
1. (HIV counseling handbook) ..
2556
2.
.. 2557
3.
.. 2556

4. .. 2556
.
413
1.
.. 2556

2.

.. 2556
3.
.. 2552

4.
ISBN: 978616-11-1245-5
5.
/ .. 2551

2557
(drug resistance monitoring & prevention)

1.
.. 2556
.
1. (Real life) /
.. 2551
International HIV/AIDS Alliance
(AIDS Net)
2. (Life-Skills Activities Manual on
HIV and AIDS) .. 2550

1. http://thaiplus.net/
2. : http://www.tmc.or.th/privilege.php
3. : http://www.tnc.or.th/law/page5.html
4.
.. 2547
()
5.
.. 2555

6.
.. 2555
http://www.thailandaids.org/main/index.php/2014-02-17-04-23-20
1.
( ) .. 2556
.
414
Appendix
415
2557
416
417
Appendix
1. standard precaution
HD
1.1
.

.
.
1.2
. ()
(1)
(2) (non-intact
skin)
.

( )
.

.
1.3 (mask, eye protection, face shield)

2557
1.4 (gown)

1.5

2.
2.1
2.2
.
.
(two-handed technique)
(one-handed technique)
418
419
Appendix
3. Check lists infection control practices

3.1 standard precaution
3.2 supply standard precautions
dialysis station
3.3
aseptic hand rub
3.4 alcohol
common clean area
3.5 sterile
sterile non-sterile equipment
biohazard container
3.6 Intravenous medication single use

vial
3.7 (common supply cart) clean supply treatment
area dialysis
station
3.8 (cart)
3.9 Waste container priming solution

cross contamination
hemodialysis disposable
waste container
2557
4.
4.1
4 5% sodium hypochlorite (dakine solution), sodium
dichloroisocyanurate (MEDIKLEN), glutaraldehyde (cidex) chlorhexidine gluconate
(savlon) HIV

sodium hypochlorite

MEDIKLEN, cidex savlon
4.2 hemodialysis
hemodialysis
.
.
.
waste container priming solution
. Dialysate hemodialysis
autoclave (incinerate)
dialysate hemodialysis
dialysate

(septic tank)

420

30

421
Appendix

7-14 (
7-14 )
422
Abacavir
(ABC)
300 mg
300 mg 12 . alcohol 1.5 ./ Hypersensitivity reaction (HSR) HLA-B*5701

600 mg
dehydrogenase 1226 . positive
glucuronyl transferase
HLA ABC

82%

HSR

ABC
Nucleoside reverse transcriptase inhibitors (NRTIs)
()
1.
(Dose and Route of HIV Medication in Adults)
2557
Appendix

17 ./
> 60 .
300 mg
Tenofovir
disoproxil 300 mg
fumarate
(TDF)
60 kg
50%
1.5 ./
400 mg
> 20 .
TDF:
250 mg
< 60 kg:
250 mg
TDF:
200 mg
- (
.
2 . )
Didanosine Videx EC:

(ddI)
125, 200, 250,

400 mg
()
, Fanconi syndrome, proximal tubulopathy

osteomalacia
TDF
HBV-coinfected

Retinal changes, optic neuritis
Lactic acidosis with hepatic steatosis +/- pancreatitis
()

noncirrhotic portal hypertension;
esophageal varices
MI
Insulin resistance/
423
424
macrocytic anemia
neutropenia

Lactic acidosis/severe hepatomegaly with hepatic
steatosis ()
Hyperlipidemia
Insulin resistance/
Lipoatrophy
Myopathy
Lamivudine
150 mg 12 . 57 ./
(3TC)
150 300 mg 300 mg
1822 . HBV-coinfected 3TC

70%
Zidovudine 300 mg 12 . GAZT 1.1 ./

(ZDV)
100, 250 300 200 mg 12 .
GAZT 7 .
mg

()
2557

FTC
Atripla:
FTC 200 mg +EFV 600
mg + TDF 300 mg
Complera:
FTC 200 mg +RPV 25
mg +TDF 300 mg
Truvada Teno-EM:
FTC 200 mg +TDF 300
mg
Emtricitabine 200 mg
(FTC) 200 mg
10 ./
> 20 .
86%
Appendix
()

Hyperpigmentation/skin discoloration

HBV-coinfected FTC
425
426
25, 100, 200 mg 12 .

200 mg

CYP3A4, 44 .
2C9, 2C19
3A4 ; 2C9
2C19
, Stevens-Johnson syndrome
HSR

Etravirine
(ETR)

(europsychiatric symptoms)
Increased transaminase levels

, cannabinoid benzodiazepine

Teratogenic in non-human primates and potentially
teratogenic in humans
600 mg 40-55 .
50
200 mg
CYPs 2B6 3A4

600
CYP3A4
mg
EFV with
1 (
)
TDF + FTC EFV 600 mg +
( 3TC) FTC 200 mg +
TDF 300 mg
EFV 600 mg +
3TC 200 mg +
TDF 300 mg
Efavirenz
(EFV)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
()
2557
Appendix
Nevirapine 200 mg CYP450 2530 .

(NVP)
200 mg
14 (lead-in period); 3A4 2B6

200 mg 80%
(glucuronidated
12 .
400 mg
metabolites, < 5%
400 mg (Viramune XR) ); 10%
lead-in

7

lead-in

28
()
, Stevens-Johnson syndrome
fatal hepatic
necrosis
- ARV-nave CD4 > 250
cells/mm3
- CD4 > 400 cells/mm3
NVP CD4
50%
427
428
25 mg 25 mg CYP3A4 substrate
50 .
Atazanavir
ATV 300 mg + RTV 100 CYP3A4 inhibitor 7 .
(ATV)
200 300 mg mg
substrate
ATV 400 mg

TDF
Protease inhibitors (PIs)

1
RPV + TDF RPV 25 mg +
+ FTC
TDF 300 mg +
FTC 200 mg
Rilpivirine
(RPV)
()
Indirect hyperbilirubinemia
PR interval prolongation: first degree
symptomatic AV block
conduction defects
PR prolongation
Hyperglycemia
Fat maldistribution
Cholelithiasis
Nephrolithiasis
Renal insufficiency
Serum transaminase elevations
Hyperlipidemia RTV boosting

EFV
2557
LPV/r 400 mg/100 mg CYP3A4 inhibitor 5-6 .

LPV 200 mg + 12 .
substrate
RTV 50 mg LPV/r 800 mg/200 mg
LPV 100 mg + PI
RTV 25 mg

Appendix
Lopinavir
Boosted
(LPV/r)
GI intolerance, , ,

Asthenia
Hyperlipidemia ( hypertriglyceridemia)
Serum transaminase elevation
Hyperglycemia
Insulin resistance/
Fat maldistribution

PR interval prolongation
QT interval prolongation torsades de
pointes
Darunavir 75, RTV CYP3A4 inhibitor 15 .

(10%): DRV sulfa
(DRV)
150, 300, 600,
substrate
( Stevens-Johnson syndrome, toxic epidermal
800 mg

RTV necrolysis, acute generalized exanthematous
DRV 600 mg + RTV 100
pustulosis erythrema multiforme

mg 12 .
RTV

)

Serum transaminase elevation
800 mg

+ RTV 100 mg
Fat maldistribution
()
429
430
EVG 150 mg +
cobi 150 mg +
TDF 300 mg +
FTC 200 mg
1
EVG: CYP3A,
~13 .
UGT1A1/3
CrCl < 70 cobi: CYP3A, CYP2D6
mL/min
(minor)

bone mineral density

HBV-coinfected FTC
TDF
Elvitegravir
(EVG)

cobi/TDF/
FTC
HSR constitutional
symptoms organ dysfunction ()

Dolutegravir 50 UGT1A1
~14 .
(DTG)
mg
INSTI INSTI mediated glucuronidation
Mutations

INSTI CYP3A4
rifampicin EFV
50 mg 12 .

INSTI
50 mg

()
2557
400 mg 12 .
UGT1A1-mediated
rifampicin glucuronidation
800 mg 2

431
Appendix
Stevens-Johnson syndrome, HSR

toxic epidermal necrolysis

CPK
rhabdomyolysis
14-18 .

Hepatotoxicity
Orthostatic hypotension
9 .
: cobi = cobicistat; CPK = creatine phosphokinase; CrCl = creatinine clearance; CYP = cytochrome P; HBV = hepatitis B virus; HSR = hypersensitivity
reaction; INSTI = integrase strand transfer inhibitor; UGT = uridine diphosphate gluconyltransferase
EFV ETR
600 mg 2
NRTIs, NVP
300 mg 2
Maraviroc
Boosted CYP3A4
(MVC)
150 300 mg PI ( PI substrate
MVC)
150 mg 2
CCR5 antagonist
Raltegravir
(RAL)
400 mg
()
2557

CDC Classification
1.
(CDC Classification System for HIV-Infected Children)

N 1 A
A 2
B C
1. 0.5 . 2 (
2 1 )
2.
3.
4.
5.
6.
B A C
1. (hemoglobin < 8 g/dL) (< 1,000 cells/L)
(<100,000 cells/L) 30
2.
3. 2 6
4. (cardiomyopathy)
432
5. cytomegalovirus 1
6.
7.
8. ( 2 1 )
9. 1
C AIDS surveillance case

definition
1. 2 2
septicemia (
)
2. candidiasis
3. coccidioidomycosis
4. cryptococcosis
5. cryptosporidiosis isosporiasis 1
6. cytomegalovirus 1

433
Appendix
10. (herpes zoster) 2 1 dermatome

11. leiomyosarcoma
12. Lymphoid interstitial pneumonia (LIP) pulmonary lymphoid hyperplasia
complex
13. (nephropathy)
14. nocardiosis
15. 1
16. toxoplasmosis 1
17.
2557
7. (encephalopathy) 1 3
2
-
-
(microcephaly) CT scan (brain atrophy)
- acquired symmetric motor deficit 2
(paresis) pathologic reflexes, ataxia (gait
disturbance)
8. (mucocutaneous ulcer)
1
1
9. histoplasmosis

10. Kaposis sarcoma
11. lymphoma primary
12. lymphoma Burkitts immunoblastic large cell lymphoma of B-cell immunologic phenotype
13.
14. Mycobacterium spp. M. tuberculosis
(
)
15. Mycobacterium avium complex Mycobacterium kansasii
(
)
16. Pneumocystis carinii pneumonia (PCP)
17. progressive multifocal leukoencephalopathy
18. Salmonella (non typhoid) septicemia
434
19. toxoplasmosis 1
20. wasting syndrome
- 10
- 1 2 percentile line
( percentile 5 95, 75, 50, 25, 5 percentile)
- percentile 5 2
30 ( 2 /
30 ) 30
penicilliosis
C
2.
CD4
1 :
< 12
1-5
6-12
CD4 count %CD4 CD4 count %CD4 CD4 count %CD4

25
1,000
25
2 : 750-1,499 15-24
500-999
15-24
<500
<15
3 :
1,500
<750
<15
500
25
200-499 15-24
<200
<15
435
Appendix
CD4
CD4 lymphocytes 1 2
3
2.
2557

(staging) 3.
3. (staging)
N: A: B: C:
1.
N1
A1
B1
C1
2.
N2
A2
B2
C2
3.
N3
A3
B3
C3
1. stage
staging

2.
B
B
436
2. (AIDS-Defining Illnesses CDC Classification)

4.
Appendix
Candidiasis of bronchi, trachea, or lungs

Candidiasis, esophageal
Cervical cancer, invasive
Coccidioidomycosis, disseminated or extrapulmonary
Cryptococcosis, extrapulmonary
Cryptosporidiosis, chronic intestinal (>1 month)
Cytomegalovirus disease (other than liver, spleen, or nodes)
Cytomegalovirus retinitis (with loss of vision)
Encephalopathy, HIV-related
Herpes simplex: chronic ulcer(s) (>1 month); or bronchitis, pneumonitis,
or esophagitis
Histoplasmosis, disseminated or extrapulmonary
Isosporiasis, chronic intestinal (>1 month)
Kaposis sarcoma
Lymphoma, Burkitts (or equivalent term)
Lymphoma, immunoblastic (or equivalent)
Lymphoma, primary, of brain
Mycobacterium avium complex or M. kansasii, disseminated or extrapulmonary
Mycobacterium tuberculosis, any site (pulmonary or extrapulmonary)
Mycobacterium, other species or unidentified species, disseminated or extrapulmonary
Pneumocystis pneumonia
Pneumonia, recurrent
Progressive multifocal leukoencephalopathy
Salmonella septicemia, recurrent
Toxoplasmosis of brain
Wasting syndrome due to HIV

Nocardiosis
Penicilliosis
Rhodococcosis
437
2557
(WHO Classification System for HIV-Infected Children)
1 (WHO clinical stage 1)

1.
2. (persistent generalized lymphadenopathy)
1. (unexplained persistent hepatosplenomegaly)
2. (papular pruritic eruptions)
3. (extensive wart virus infection)
4. (extensive molluscum contagiosum)
5.
6.
7. (unexplained persistent parotid enlargement)
8. linear gingival erythema
9.
10. (

11. (angular cheilitis)
1.
2. 14
438

1.
2. Pneumocystis jiroveci (PCP)

3. empyema
(pyomyositis)
4. (herpes simplex) 1
5.
6. Kaposis sarcoma
7. candida
439
Appendix
3. ( 37.5 oC )
1
4. (persistent oral candidiasis) 6-8
5. oral hairy leukoplakia
6. (acute necrotizing ulcerative
gingivitis or periodontitis)
7.
8.
9.
10. lymphoid interstitial pneumonitis
11. (chronic HIV-associated lung disease)
(bronchiectasis)
12. ( 8 g/dL)
(
500 cells/L) ( 50,000 cells/L)

2557
8. toxoplasmosis ( 1 )
9. HIV encephalopathy
10. cytomegalovirus ( 1
)
11. cryptococcosis
12. (disseminated endemic mycosis) histoplasmosis
coccidiomycosis
13. Cryptosporidium
14. Isospora
15. non-tuberculous Mycobacteria
16. lymphoma B-cell non Hodgkin lymphoma
17. progressive multifocal leukoencephalopathy
18. HIV-associated cardiomyopathy
440
441
Zidovudine (AZT) : 10 mg/mL

( 60 mL)
: 100 mg
: 300 mg
6 ():
180-240 mg/m2/dose 12 .
( 300 mg/dose)
> 4 ():
4-< 9 kg 12 mg/kg 12 .
9-30 kg 9 mg/kg 12 .
30 kg 300 mg 12 .
AZT
(- 6 )
35 4 mg/kg 12 .
30-< 35 2 mg/kg 12 .
2 3 mg/kg 12 .
< 30 2 mg/kg 12 . 4
3 mg/kg 12 .
Nucleoside analogue reverse transcriptase inhibitor (NRTI)
Appendix
5.
-
-
(
)
- d4T
(Dose and Route of HIV Medication in Pediatrics)
442
: AZT 300 mg +
3TC 150 mg
: 1 mg/mL
: 15, 20, 30 mg
Stavudine (d4T)
AZT + 3TC
(fixed dose
combination)
Lamivudine (3TC) : 10 mg/mL

( 60 mL)
: 150, 300 mg
-13 0.5 mg/kg 12 .

14 1 mg/kg 12 .
( 30 mg/dose)
30 kg 1 12 .
-
30
-
- AZT
-
30-60 kg

AZT 200 mg/dose
< 4 2 mg/kg 12 .
-
4 4 mg/kg 12 .
-
( 150 mg/dose)
( 30 )
16 50 kg -
300 mg 24 . ( CrCl < 50
mL/min)
2557
443
: 20 mg/mL
: 300 mg
Abacavir (ABC)
- .
2 .
-
- enteric coated
-
2 (
200 mg 200 mg
125 mg 1 25 mg 3 )
30 mL
ddI tablet
2 < 3 50 mg/m2 12 .
3-8 100 mg/m2 12 .
> 8 90-150 mg/m2 12 .
( 200 mg/dose)
240 mg/m2 24 .
( 400 mg/dose)
ddI-EC ( > 6 )
20-< 25 kg 200 mg 24 .
25-< 60 kg 250 mg 24 .
60 kg 400 mg 24 .
8 mg/kg 12 . ( 300 mg/dose) -

3 16 600 mg 24 .
-
- HLA-B* 5701
HLA-B* 5701 allele
ABC 48%
: 25, 125, 200 mg

enteric-coated
(ddI-EC): 200, 250,
400 mg
Didanosine (ddI,
dedioxyinosine)
Appendix
444
: 300 mg
2-< 12 8 mg/kg 24 .
-
2 12 35 kg 300 mg 24 . - ddI

Tenofovir weight band
14-< 20 kg: 150 mg
20-< 30 kg: 225 mg
> 30 kg: 300 mg
Nonnucleoside reverse transcriptase inhibitor (NNRTI)
Nevirapine (NVP) : 10 mg/mL
< 8 200 mg/m2 12 .

- Rifampicin NVP
: 200 mg
8 120-150 mg/m2 12 .
20-30% NVP
( 200 mg/dose)
- 2-4
(Lead-in) 14
24 . -

12 .
14

- EFV NVP
12 . lead-in
- rifampicin
NVP lead-in 7-10 (
14 ) rifampicin
NVP
Tenofovir (TDF)
2557
445
: 100 mg
Etravirine (ETR)
d4T 30 mg + 3TC 150

mg + NVP 200 mg
Fixed dose combined pill of NRTI and NNRTI
GPO-VIR S30
3.5-< 5 kg 100 mg 24 .
5-< 7.5 kg 150 mg 24 .
7.5-< 15 kg 200 mg 24 .
15-< 20 kg 250 mg 24 .
20-< 25 kg 300 mg 24 .
25-< 32.5 kg 350 mg 24 .
32.5-< 40 kg 400 mg 24 .
40 kg 600 mg 24 .
GPOvir S30
NVP 160-200 mg/m2
12 .
(Lead-in) NVP
14
GPO-VIR d4T+ 3TC
14

GPO-VIR 12 .
16-< 20 kg 100 mg 12 .
6 20-< 25 kg 125 mg 12 .
25-< 30 kg 150 mg 12 .
30 kg 200 mg 12 .
: 50, 200 mg
: 600 mg
3
(
3-36

)
Efavirenz (EFV)
Appendix
- 2-4
-
WHO
10-< 14 kg. 12 .
14-25 kg. 12 .
1
> 25 kg. 1 12 .
-
- 1-2

NNRTI ETR
- (
50%)
-
446
ABC 600 mg + 3TC > 12 > 12 > 40 kg: 1

300 mg
TDF 300 mg + FTC > 12 > 12 > 35 kg: 1

200 mg
TDF 300 mg + FTC > 12 > 12 > 40 kg: 1

200 mg + EFV 600
mg
Truvada
Ricovir-EM
Teno-EM
Atripla
GPO-VIR S30 - 2-4

NVP 160-200
mg/m2 12 .
-
(Lead-in) NVP GPOvir S30
14 - NVP
GPO-VIR Z250 AZT + AZT
3TC
Kivexa
AZT 250 mg + 3TC

150 mg + NVP 200
mg
GPO-VIR Z250
2557
447
:
100 mg
: 80 mg/mL
Ritonavir (RTV)
2 -12
LPV 300 mg/m2 + RTV 75 mg/m2 12 .
12 -18 :
LPV 230 mg/m2 + RTV 57.5 mg/m2 12 .
( LPV 400 mg + RTV 100 mg)
LPV/r
1
LPV 230 mg/m2
LPV 300 mg/m2
LPV/r NVP EFV
LPV/r 300/75 mg/m2 12 .
LPV/r
15-25 kg LPV/r 200/50 mg 12 .
> 25-35 kg LPV/r 300/75 mg 12 .
> 35 kg LPV/r 400/100 mg 12 .
HIV RNA < 50 copies/mL

> 1 PI
< 15 kg 3 mg/kg 12 .
15 kg 2.5 mg/kg 12 .
75 mg/m2 100 mg 12 .
: LPV 80 mg/mL + 2
RTV 20 mg/mL
: LPV 200 mg +
RTV 50 mg, LPV 100
mg + RTV 25 mg
(
15 kg)
Lopinavir +
ritonavir (LPV/r)
Protease inhibitor (PI)
Appendix
-
-
- (
> 25C)
-

- LPV/r 200/50 mg
LPV/r
LPV/r HIV RNA
< 50 copies/mL

> 25-35 kg: LPV/r 200/50 mg 12 .
> 35-50 kg: LPV/r 300/75 mg 12 .
> 50 kg: LPV/r 400/100 mg 12 .
: 100, 150,
200, 300 mg
: 75, 150, 400,

600 mg
Atazanavir (ATV)
448
Darunavir (DRV)
24 . - asymptomatic
RTV 100 mg .
indirect hyperbilirubinemia
15-< 20 kg ATV 150 mg/r 100 mg
20-< 32 kg ATV 200 mg/r 100 mg

. ATV 200 mg
32-< 40 kg ATV 250 mg/r 100 mg
300
40 kg ATV 300 mg/r 100 mg
20-50 kg
ATV 200 mg/r 100 mg
3 2
-
15-< 30 kg DRV 375 mg/r 50 mg
-
10 kg
30-< 40 kg DRV 450 mg/r 60 mg
> 40 kg ATV 600 mg/r 100 mg

. 300 mg

12-< 15 kg DRV 300 mg + RTV 50 100
mg 12 .
15-30 kg DRV 450 mg + 300 mg +
RTV 50 100 mg 12 .
30-40 kg DRV 450 mg + RTV 100 mg
12 .
40 kg DRV 600 mg + RTV 100 mg 12 .
darunavir-associated mutation

15-40 kg: DRV 600 mg + RTV 100 mg
> 40 kg: DRV 900 mg + RTV 100 mg
2557
Raltegravir
Chewable tablet 25,

100 mg
Film-coated tablet 400
mg
Chewable tablet 2-12

chewable tablet film
coat tablet
10-< 14 kg 75 mg 2
14-< 20 kg 100 mg 2
20-< 28 kg 150 mg 2
28-< 40 kg 200 mg 2
40 kg 300 mg 2
> 12 25
kg film-coated tablet 400 mg 1
2
Appendix
449
2557

creatinine clearance (CrCl) Schwartz formula:
CrCl or eGFR* (mL/min/1.73 m2) = k x height (cm) / serum creatinine
*eGFR = estimated GFR
Proportionality constant (k) for calculating
k Values
Pre-term babies (<1 year)
0.33
Full-term infants (<1 year)
0.45
Children (1-13 years)
0.55
Adolescent girls (>13 years)
0.55
Adolescent boys (>13 years)
0.70
450

4-12

1.
1)
8 4
8-10 1
2)
3)
4)
5)
6)
451
Appendix
2557
2.

5-10 2-3
5
2
- 8 g 1:2 ( 1 2 )
- 4-5 g 1:1 ( 1 1 )

-

3.
1)

2) 1-2 2-3
3-4 4
4-6 6-7 5
6 7-8 4
3)
452
453
Appendix
4)

5) 2

6)
4.
1)

2)
3)

4)
5) 2-3

2557
6)

2
2 1 2

ORS
5.
(g)
(mL/dose)
(dose/day)
(mL/day)
(kg/month)
3,000
75
450
3,400
85
510
2.3
4,200
105
630
2.8
5,000
125
750
3.5
5,800
145
870
6,600
160
960
4.3
7,400
185
1,110
7,800
195
975
4.5
8,200
205
1,025
4.6
8,600
215
1,075
4.8
10
9,000
225
900
11
9,400
240
960
4.3
12
9,800
240
960
4.3
(month)
: ()
.. ; 1
= 30 mL; 1 4.5 g; 50 kg/
454
6.
450 g 1 kg
450 g ()
1 kg ()

(
)

()
Appendix
455
2557


1.
anaphylaxis adrenaline
5 mL TMP 40 mg SMX 200 mg
2.
- 1 mL 9 mL ( A)
- A 1 mL 9 mL ( B)
- B 1 mL 9 mL ( C)
- C 1 mL 9 mL ( D)
6. rapid desensitization TMP-SMX
TMP/SMX(mg)
(mL)
0.004 / 0.02
0.04/0.2
0.4/2
4/20
40/200
160/800
20
456
1. .
.. 2553. 1. :
; 2553.
2. .
126 179 . 14 2552
[]. [ 22 .. 2557]. : http://thaimed.co.th/
files/law8_th.pdf
3. Henven PL, Mofenson LM, and the committee on Pediatric AIDS. Evaluation
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2. .

3. .

4. .

5. ...

6. ..

7. .

8. .

480
1. .

2. .

3. .

4. .

5. .

6. .

7. .
-
8. .
-
9. .
-
481
2557
2556-2557
1216/2556

2556 2557 29 .. 2556

1.
2556-2557
1.
2.

3.

4.
5.
6.

7.

8.
9.

10.

11.

12.

482
13.
14.
12
15.
16.
17.
18.
19.
20. /

21.
22.
23.

24.

25.
-
26.

27.
28.

29.

30.

31.

32.

12
(WHO Thailand)

(UNAIDS)
-
(TUC)

(UNICEF)
(PHPT)

(TTAG)

483
2557
2.
2556-2557
2.1

1.

2.

3.
4.
5.

6.

7.

8.

9.

10.
11.
12.
13.
14.
15.
16.

484
17.

18.

19.
20.
21.
22.

23.

2.2
1.

2.
3.

4.

5.

6.
7.

8.

9.

485
2557
10.
11.
12.
13.
14.
15.
16.
17.

18.

19.

20.
21.
22.
23.
24.

25.

2.3
1.

2.
3.
4.
5.
486
6.

7.

8.

9.

10.

11.
12.
13.
14.
15.
16.
17.
18.

19.

20.
21.
22.

23.
24.
25.
26.
27.

487
2557
2.4

1.
2.

3.

4.

5.

6.

7.

8.
9.
10.

11.
12.
13.

14.

15.

16.

17.
18.
-
19. -
20.

488
21.
22.
23.
-
2.5
1.

2.
3.
4.
5.
6.
7.
8.
9.

2.6
1.

2.

3.

4.

5.

489
2557
6.

7.
8.
9.

10.

11.

2.7

1.

2.

3.

4.

5.
6.

7.

8.

9.

490
2557

491
2557
492
493
2557
494
495
2557
496

แนวทางการตรวจรักษาและป้องกันการติดเชื้อเอชไอวี ประเทศไทย ปี 2557 ฉบับเต็ม PDF

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แนวทางการตรวจรักษาและป้องกันการติดเชื้อเอชไอวี ประเทศไทย ปี 2557 ฉบับเต็ม PDF

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2557

Thailand National Guidelines on

Treatment and Prevention 2014

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

3 (Management of HIV-Infected Adult) 65

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

Calcium channel blockers

Dihydropyridine calcium channel blockers

Depot medroxyprogesterone acetate

Nucleoside reverse transcriptase inhibitor

Nonsteroidal anti-inflammatory drugs

Proton pump inhibitors

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

Diphtherias, tetanus vaccine

Diphtherias, tetanus, acellular pertussis vaccine

Diphtherias, tetanus, pertussis vaccine

Diphtheria, tetanus, whole cell pertussis vaccine

Haemophilus influenza type B vaccine

Human papillomavirus vaccine

Injection polio vaccine

Japanese encephalitis vaccine

Measles, mumps, rubella vaccine

Oral polio vaccine

Pneumococcal conjugate vaccine

23-valent pneumococcal polysaccharide vaccine

Polyribose ribital phosphate-tetanus toxoid

Tetanus and diphtheria toxoid

Varicella-zoster virus vaccine

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

Plan do check act

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

(pre-exposure prophylaxis; PrEP)

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

2 nucleoside reverse transcriptase inhibitors (NRTIs) + NNRTI Boosted PI

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

CD4 350 cells/mm3

: AZT TDF + 3TC + LPV/r

: AZT + 3TC + NVP

CD4 350 cells/mm3

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

o CD4 > 50 cells/mm3

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

(HIV Laboratory for Diagnostic and Monitoring)

HIV Laboratory for Diagnosis and Monitoring

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

HIV Laboratory for Diagnosis and Monitoring

(same day result)

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

HIV Laboratory for Diagnosis and Monitoring

window period window

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014

HIV Laboratory for Diagnosis and Monitoring

ELISA (enzyme-linked immunosorbent assay)

%PPV:1 test %PPV: 2 tests %PPV:3 tests

Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2014