Advanced HIV Disease Management Guidelines - Zambia

GUIDELINES FOR MANAGEMENT OF ADVANCED HIV DISEASE IN ZAMBIA
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GUIDELINES FOR MANAGEMENT OF ADVANCED HIV DISEASE IN ZAMBIA
Advanced HIV Disease Guidelines: February 2021 Version Page - i
GUIDELINES FOR MANAGEMENT OF ADVANCED
HIV DISEASE IN ZAMBIA
©2021

GUIDELINES FOR MANAGEMENT OF ADVANCED HIV DISEASE IN ZAMBIA
Advanced HIV Disease Guidelines: February 2021 Version Page - ii
Table of Contents
Acronyms ............................................................................................................................................................ vii
FOREWORD ................................................................................................................................................... viii
ACKNOWLEDGEMENTS ......................................................................................................................... ix
Module 1: Introduction to the Management of Advanced HIV Disease .............................................................. 1
Introduction ..................................................................................................................................................... 1
Burden of Advanced HIV Disease in Zambia ................................................................................................. 1
Definitions of Terms ........................................................................................................................................ 2
Advanced HIV Disease ......................................................................................................................................... 2
Prophylaxis Therapy ........................................................................................................................................ 2
Pre-emptive Therapy ....................................................................................................................................... 2
Presumptive Treatment .................................................................................................................................... 2
Screening for Advanced HIV through CD4 Cell Count Testing ..................................................................... 3
Rapid ART Initiation in Advanced HIV Disease ............................................................................................ 4
Screening for Opportunistic Infections in Advanced HIV Care ...................................................................... 4
Prophylaxis in Advanced HIV Disease ........................................................................................................... 4
Advanced HIV Disease Package of Care ............................................................................................................. 5
Advanced HIV Disease Service Provision in Zambia .......................................................................................... 6
Module 2: Differentiated Service Delivery (DSD) for Advanced HIV Disease ................................................... 8
Defining High-Risk Patients (Recipients of Care) .......................................................................................... 8
Choosing DSD Models for Advanced HIV Disease ........................................................................................ 9
Management of Co-Morbid Chronic Conditions ................................................................................................ 11
Integrating HIV and NCD Services ............................................................................................................... 11
Differentiating Services: Identifying the “How” ............................................................................................. 11
Module 3: Cryptococcal Meningitis in Advanced HIV Disease......................................................................... 12
Introduction ................................................................................................................................................... 12
Risk Factors and Clinical Features ................................................................................................................ 12
Screening for Cryptococcal Disease .............................................................................................................. 12
Adjuvant Therapies ....................................................................................................................................... 17
Module 4: Tuberculosis in Advanced HIV Disease ........................................................................................... 19
Mycobacterium Tuberculosis (TB) in AHD: General Overview .................................................................. 19
Prevention of TB Through the use of TB Prophylactic Therapy ................................................................... 19
Screening and Diagnosis of Tuberculosis in Advanced HIV Disease ........................................................... 20
Lateral Flow Urine Lipoarabinomannan (LF-LAM) ...................................................................................... 20
Treatment of Tuberculosis in Advanced HIV Disease ....................................................................................... 21

GUIDELINES FOR MANAGEMENT OF ADVANCED HIV DISEASE IN ZAMBIA
Advanced HIV Disease Guidelines: February 2021 Version Page - iii
Choice of Drugs when Co-administering ATT and cART ............................................................................ 22
Monitoring of TB Treatment in Critical Ill Patients ........................................................................................... 23
Extrapulmonary Tuberculosis ........................................................................................................................ 23
TB Meningitis ................................................................................................................................................ 25
TB Pericarditis ............................................................................................................................................... 26
Spinal TB ....................................................................................................................................................... 27
TB Abdomen ................................................................................................................................................. 28
TB Lymphadenitis ......................................................................................................................................... 28
Pleural TB ...................................................................................................................................................... 29
Tuberculosis in Children................................................................................................................................ 30
TB Diagnosis in Children .............................................................................................................................. 32
Module 5: Severe Bacterial Infections in Advanced HIV Disease ..................................................................... 34
Prophylaxis for Severe Bacteria Infection in Advanced HIV disease ........................................................... 34
Module 6: Other CNS Condition in Advanced HIV Disease ............................................................................. 37
AIDS-related Cytomegalovirus Neurologic Disease .......................................................................................... 37
CMV Retinitis ............................................................................................................................................... 37
CMV Encephalitis ......................................................................................................................................... 38
CMV Polyradiculopathy ................................................................................................................................ 38
Herpes Simplex ................................................................................................................................................... 38
CNS Toxoplasmosis ........................................................................................................................................... 39
HIV Associated Neuro-cognitive Disorder (HAND) ......................................................................................... 40
Module 7: Pneumocystis Jiroveci Carinii and Other Respiratory Fungal Infections ......................................... 41
Other Common Fungal Pulmonary Infections in Advanced HIV Disease .................................................... 42
Module 8: Gastro-Intestinal Tract Conditions in Advanced HIV Disease ......................................................... 44
Oral and Oesophageal Candidiasis ................................................................................................................ 44
HSV Oesophagitis ......................................................................................................................................... 45
CMV Oesophagitis ........................................................................................................................................ 45
Diarrhoea in Advanced HIV Disease ............................................................................................................ 45
Bloody Stool .................................................................................................................................................. 46
Management of Acute Diarrhoeal Disease (ADD) ........................................................................................ 47
Management of Persistent Diarrhoea Disease (PDD) in AHD ...................................................................... 48
Cryptosporidiosis in AHD ............................................................................................................................. 48
Cytoisosporiasis in AHD ............................................................................................................................... 49
Microsporidiosis in AHD .............................................................................................................................. 50
CMV Colitis in AHD ..................................................................................................................................... 50
Mycobacterium Avium Complex (MAC) ..................................................................................................... 50