HIV Related Respiratory Conditions

exp date isn't null, but text field is

A multitude of different manifestations of respiratory complications may occur in patients with HIV infection. These include bacterial pneumonias, pulmonary tuberculosis, Pneumocystis jiroveci pneumonia (PCP) and pulmonary Kaposi's sarcoma. All HIV infected patients should be screened for TB at every visit using the standard TB screening tools.

Management depends on the severity of the condition, location and mobility of the patient. Outpatient management in adults is preferred wherever possible. Only severe cases requiring investigations and inpatient admission should be referred for admission.

Treat initially as for other respiratory conditions. For acute infection (less than 2 weeks) that does not warrant admission:

	Medicine	Adult dose	Frequency	Duration
	amoxicillin po	500mg	3 times a day	7 days
or	erythromycin po (in penicillin allergy)	500mg	4 times a day	7 days
or	doxycycline po (in penicillin allergy)	100mg	twice a day	7 days

If severe symptoms i.e. respiratory distress, cyanosis, tachycardia, hypotension or altered mental state, consider admission:

Medicine	Adult dose	Frequency	Duration
ceftriaxone iv	2g	bd	7 days

• use 2gm BD iv if there are features of septicaemia - low BP tachycardia or meningitis
• A stat dose may be given at primary care level prior to transfer. Note: Switch to oral amoxicillin to complete the course
• If there is no response, get a chest x-ray and follow management guidelines in the chapter on respiratory conditions.

Then start on prophylactic cotrimoxazole:

Medicine	Adult dose	Frequency	Duration
Cotrimoxazole	960mg	Once a day	Until CD4>350 or VL is less than 1000