9-Infections de l-immunodéprime

IV#9%INFECTIONS%DE%L’ID%
1!
!
Pharmaetudes!
1!
Infections%de%l’immunodéprimé%
%
1. Rappels%Immunodépression%:%
!
2. Infections%cutanées%et%muqueuses%opportunistes%:%
%
2.1 %%Candidose%:%
!"#!$%&'()!*+!#%(,-+.)(/,!/00/1)2,($)+!#&!0#2$!-1342+,)+!*2!5"678!9&!:;./$+!&))+(,)!$21)/2)!#+$!
:242+2$+$!</1/0=&1;,>?!@$/0=&'+!/2!A&'(,B!:&($!1&1+:+,)!#+$!A/(+$!1+$0(1&)/(1+$!<)1&.=3+?!
C1/,.=+?!0/2:/,B8!9+$!-/1:+$!01/-/,*+$!/2!(,A&$(A+$!*($$3:(,3+$!$/,)!1&1+$!*&,$!#+!5"678!D##+$!$/,)!
1+,./,)13+$!.=+E!#+$!0&)(+,)$!&;&,)!#+$!-&.)+21$!*+!1($42+$!=&C()2+#$!F!,+2)1/03,(+?!
(::2,/$2001+$$+21$?!.&)=3)31($:+!A&$.2#&(1+!01/-/,*!13.+,)?!.=(121'(+!13.+,)+!<.&1*(&42+?!'&$)1/G
(,)+$)(,&#+B?!&,)(C(/)(42+$!H!#&1'+!$0+.)1+!/2!)/>(./:&,(+!(,)1&A+(,+2$+8!
!
2.2 %%Herpès%:%
9+$!(,-+.)(/,$!=+103)(42+$!$/,)!-1342+,)+$!*&,$!#+!5"678!D##+$!0+2A+,)!I)1+!#/.&#($3+$!/2!
$;$)3:(42+$8!7A+.!#&!01/'1+$$(/,!*+!#%(::2,/*301+$$(/,?!+##+$!0+2A+,)!$+!:&,(-+$)+1!$/2$!-/1:+!
*%2#.J1+$!.=1/,(42+$8!9+!*(&',/$)(.!0+2)!$+!-&(1+!$21!2,!3)&#+:+,)!.;)/#/'(42+!<.;)/*(&',/$)(.!*+!
KE&,LB!/2!$21!2,+!C(/0$(+!<-('8!M&!H!M*B8!9%+--+)!.;)/0&)=/'J,+!*2!A(12$!*+!#%=+10J$!<N5O!F!Herpès'
simplex'A(12$B!+)!*2!A(12$!*+!#&!A&1(.+##+!+)!*2!E/,&!<OPO!F!A&1(.+##&GE/$)+1!A(12$B!+$)!(*+,)(42+8!9+$!
.+##2#+$!$/,)!&2':+,)3+$!*+!)&(##+?!0#21(,2.#33+$!+)!./:0/1)+,)!*+$!(,.#2$(/,$!(,)1&,2.#3&(1+$!+,!
QA+11+!*30/#(R8!9+!=&#/!+$)!0#2)S)!A($(C#+!$21!#+$!0130&1&)(/,$!-(>3+$8!
!
3. Infections%opportuniestes%du%système%nerveux%central%:%
9+$!$;:0)S:+$!,+21/#/'(42+$!$/,)!-1342+,)$!&2!./21$!*2!5"67!<TU!H!MUV!*+$!.&$!H!#&!0=&$+!013./.+!
+)!WUV!&2!$)&*+!*2!5"67B8!5+#/,!#&!)=3/1(+!*2!Q.=+A&#!*+!K1/(+R?!#%(,-+.)(/,!*2!$;$)J:+!,+1A+2>!
.+,)1&#!+$)!#(3+!H!2,+!*($$3:(,&)(/,!013./.+!*2!O"N8!9+$!.+##2#+$!(::2,+$!(,-+.)3+$!)1&A+1$+,)!#&!
C&11(J1+!=3:&)/G+,.30=&#(42+!+)!*3A+1$+,)!#+!O"N!*&,$!#+!.+1A+&2?!(,-+.)&,)!#+$!.+##2#+$!:(.1/'#(&#+$!
<#(',3+!:/,/.;)&(1+G!:&.1/0=&'(42+!*2!.+1A+&2B!+)!$+!:2#)(0#(&,)!0/21!#+21!01/01+!./:0)+8!9+!
$;$)J:+!,+1A+2>!.+,)1&#!./,$)()2+!*/,.!#+!*+2>(J:+!$&,.)2&(1+!*2!O"N?!&01J$!#+!$;$)J:+!#;:0=/X*+8!
9+!01/C#J:+!:&Y+21!1+$)+!#%(:0+1:3&C(#()3!*+!#&!C&11(J1+!=3:&)/G+,.30=&#(42+!&2>!&,)(G13)1/A(1&2>8!
72!$)&*+!*2!5"67?!.=+E!#+$!0&)(+,)$!&;&,)!*+$!$;:0)S:+$!,+21/#/'(42+$!<30(#+0$(+?!.30=&#3+$?!
)1/2C#+$!:+,)&2>?!$;,*1/:+!:3,(,'3?!$(',+$!,+21/#/'(42+$!-/.&2>B?!#+$!3)(/#/'(+$!#+$!0#2$!
-1342+,)+$!$/,)!#&!)/>/0#&$:/$+?!#&!.1;0)/./../$+!/2!#&!*3:+,.+!*2!5"678!6+!,/:C1+2$+$!&2)1+$!
3)(/#/'(+$!(,-+.)(+2$+$!+)!,/,!(,-+.)(+2$+$!0+2A+,)!I)1+!+,!.&2$+!:&($!,+!$+1/,)!0&$!&C/1*3+$!(.(!F!
(,-+.)(/,!H!Z[O?!H!OPO!<E/,&G!A&1(.+##+B?!N5O!<=+10J$B?!#+2./+,.30=&#()+!:2#)(-/.&#+!01/'1+$$(A+!</2!
9D[\B!#(3+!&2!A(12$!]Z?!,+21/$;0=(#($?!#;:0=/:+$8!
!
3.1 %%Cryptococcose%neuro#méningée%:%
Cryptococcus'neoformans'+$)!2,!.=&:0(',/,!+,.&0$2#3!<&2)1+-/($!&00+#3!Torula'histolyticaB!013$+,)!
*&,$!#+$!$/#$!+)!#+$!*3Y+.)(/,$!*+!.+1)&(,$!/($+&2>8!"#!+$)!*3.1()!0&1)/2)!*&,$!#+!:/,*+8!

!
2!
6&,$!#&!:&Y/1()3!*+$!.&$?!.+))+!(,-+.)(/,!$21A(+,)!.=+E!*+$!0&)(+,)$!(::2,/*301(:3$!/2!*3C(#()3$!
<5"67?!=3:/0&)=(+?!.=(:(/)=31&0(+?!./1)(./)=31&0(+?!&#.//#/*30+,*&,.+B8!9+$!.1;0)/./42+$!/,)!2,!
)1/0($:+!02#:/,&(1+!+)!,+21/G!:3,(,'38!D,!+--+)?!(#$!$/,)!(,=&#3$!+)!.&0)3$!0&1!#+$!:&.1/0=&'+$!
&#A3/#&(1+$8!D,!.&$!*%(::2,/*301+$$(/,.+##2#&(1+!Z6^?!#+!.=&:0(',/,!$+!*($$3:(,+!0&1!$+0)(.3:(+!
=/1$!*2!0/2:/,?!;!./:01($!*&,$!#+!$;$)J:+!,+1A+2>!.+,)1&#8!72!./21$!*2!5"67?!#&!.1;0)/./../$+!
,+21/G:3,(,'3+!+$)!#%(,-+.)(/,!-/,'(42+!#&!0#2$!-1342+::+,)!1+,./,)13+8!K1/($!);0+$!*%&))+(,)+$!
$/,)!*3.1()+$!F!*+$!:3,(,'()+$!0/2A&,)!I)1+!-2#:(,&,)+$!+)!:/1)+##+$?!2,+!:3,(,'/G+,.30=&#()+!/2!
2,!.1;0)/./../:+!0/2A&,)!$+!)1&*2(1+!0&1!*+$!$(',+$!.#(,(42+$!-/.&2>!+)!*($.1+)$!
9+!*(&',/$)(.!1+0/$+!01(,.(0&#+:+,)!$21!#%+>&:+,!*2!9Z_8!N&C()2+##+:+,)?!#+!9Z_!+$)!.#&(1!&A+.!2,+!
=;0+101/)3(,/1&.=(+?!2,+!=;0+1#+2./.;)/$+!+)!2,+!=;0/'#;./1&.=(+8!"#!0+2)!I)1+!,/1:&#8!9%+>&:+,!
*(1+.)!&01J$!./#/1&)(/,!H!#%+,.1+!*+!.=(,+!+$)!13&#($3!&2!#&C/1&)/(1+!*+![;./#/'(+8!521!#+$!3)&#+:+,)$!
.;)/#/'(42+$!./#/13$!0&1!#+![``?!$(!#+$!.1;0)/./42+$!$/,)!&C/,*&,)$?!#+!*(&',/$)(.!+$)!&($3!<-('8!^&B!F!
#+$!#+A21+$!*+!)&(##+$!(,3'&#+$!<+,A(1/,!#&!)&(##+!*%2,!#;:0=/.;)+B!$+!'1/20+,)!$/2A+,)!+,!&:&$!+)!
&*=J1+,)!-&.(#+:+,)!&2>!*3C1($!/2!&2>!#;:0=/.;)+$8!D##+$!0+2A+,)!&00&1&a)1+!./::+!*+$!
#;:0=/.;)+$!13)1&.)3$8!9&!.&0$2#+!0/#;$&..=&1(*(42+!+$)!./#/13+!0&1!#+!C#+2!7#.(&,!<-('8!^CB?!.+!42(!
0+2)!&(*+1!&2!*(&',/$)(.!$%(#!;!&!0+2!*+!.1;0)/./42+$!/2!*+$!#;:0=/.;)+$!<-('8!^*B8!9+$!.2#)21+$!
-/,'(42+$!+)!#&!1+.=+1.=+!*%&,)('J,+$!$/#2C#+$!&(*+,)!&2!);0&'+!*+!#&!$/2.=+!+)!H!#&!1+.=+1.=+!*+!
#+A21+$!+,!.&$!*%+>&:+,!*(1+.)!,3'&)(-8!9+!)1&()+:+,)!&,)(-/,'(42+!+$)!+--(.&.+8!
7!#%+>&:+,!,+21/0&)=/#/'(42+?!(#!+>($)+!2,+!:3,(,'()+!.=1/,(42+?!013*/:(,&,)!&2!,(A+&2!*+!#&!C&$+?!
0/2A&,)!$+!./:0#(42+1!*+!A+,)1(.2#()+8!9+$!#3$(/,$!0&1+,.=;:&)+2$+$!$/,)!*%&$0+.)!L;$)(42+?!
'3#&)(,+2$+$8!9+$!.=&:0(',/,$!$/,)!($/#3$!/2!$%&../:0&',+,)!*%2,+!13&.)(/,!(,-#&::&)/(1+!
:/*313+?!+$$+,)(+##+:+,)!:&.1/0=&'(42+?!0&1-/($!'('&,)/.+##2#&(1+!*&,$!#+$!:3,(,'+$!/2!&2)/21!*+$!
+$0&.+$!031(A&$.2#&(1+$8!
9+!01(,.(0&#!*(&',/$)(.!*(--31+,)(+#?!$21)/2)!*&,$!#+$!-/1:+$!+>)1&.313C1&#+$?!$+!0/$+!&A+.!
#%Histoplasma'duboisii'42(!,+!01+,*!0&$!#+!C#+2!7#.(&,8!
!
3.2 %%Toxoplasmose%cérébrale%:%
9&!)/>/0#&$:/$+!+$)!#&!01(,.(0&#+!.&2$+!*%+,.30=&#()+!-/.&#+!.=+E!#+!5"678!9+$!$(',+$!:3,(,'3$!$/,)!
1&1+$8!7A&,)!#%J1+!*2!5"67?!(#!$%&'($$&()!*%2,+!(,-+.)(/,!/00/1)2,($)+!1&1+!./:0#(42&,)!#+$!
(::2,/*301+$$(/,$!.+##2#&(1+$!./::+!#+$!)1&,$0#&,)&)(/,$!13,&#+$8!
Toxoplasma'gondii'+$)!2,!0&1&$()+!(,)1&.+##2#&(1+!$)1(.)8!9&!./,)&:(,&)(/,!&!#(+2!0&1!A/(+!/1&#+!A(&!#+$!
-J.+$!*+!.=&)!<#%=S)+!*3-(,()(-B!+)b/2!#%&C$/10)(/,!*+!A(&,*+!*%/A(,!<=S)+!(,)+1:3*(&(1+B!0+2!.2()+8!9+$!
//.;$)+$!+,)1&a,+,)!2,+!01(:/G!(,-+.)(/,!0/2A&,)!I)1+!$;:0)/:&)(42+!<$;,*1/:+!0$+2*/'1(00&#B!
3A/#2&,)!A+1$!2,+!.(.&)1(.+!$31/#/'(42+8!9+$!//.;$)+$!1+$)+,)!H!#%3)&)!#&)+,)!*&,$!#+$!)($$2$!<:2$.#+!
.&1*(&42+?!:2$.#+!$42+#+))(42+?!$;$)J:+!,+1A+2>!.+,)1&#B!+)!$+!13&.)(A+,)!&2!./21$!*%2,+!
(::2,/*301+$$(/,!.+##2#&(1+8!9+$!C1&*;E/X)+$!$/,)!#+$!-/1:+$!#&)+,)+$!+,L;$)3+$!+)!#+$!)&.=;E/X)+$!
./11+$0/,*+,)!H!#&!-/1:+!&.)(A+?!A(12#+,)+!+,)1&a,&,)!2,+!#;$+!.+##2#&(1+8!
6(--31+,)$!);0+$!*+!#3$(/,$!$/,)!*3.1()$!<-('8!c&!H!c=B!F!#+$!-/1:+$!,3.1/$&,)+$?!#+$!-/1:+$!
+,.30=&#()(42+$!*(--2$+$!Q,/,!,3.1/)(42+$R!+)!#+$!#3$(/,$!.(.&)1(.(+##+$8!
!
d/1:+$!,3.1/$&,)+$!!
9+$!-/1:+$!,3.1/$&,)+$!/2!3A/#2&,)!A+1$!2,!&C.J$!<-('8!c&!H!c*B!0/$+,)!2,!01/C#J:+!*+!*(&',/$)(.!
*(--31+,)(+#!&A+.!2,!#;:0=/:+!$21!#%(:&'+1(+8!9&!13'1+$$(/,!*+$!#3$(/,$!$/2$!)1&()+:+,)!&,)(G
)/>/0#&$:+!0+1:+)!*+!0/1)+1!#+!*(&',/$)(.8!D,!&C$+,.+!*+!130/,$+?!2,+!C(/0$(+!+$)!13&#($3+8!Z+$!
#3$(/,$!0+2A+,)!3A/#2+1!A+1$!#&!./,$)()2)(/,!*%&C.J$!/1'&,($3$8!"#!$%&'()!*+!-/;+1$!C(+,!#(:()3$!
./:0/1)&,)!2,!.+,)1+!,3.1/)(42+!+,)/213!*%2,+!./42+!Y&2,e)1+!+)!*%2,!#($+13!@*3:&)+2>8!
!
d/1:+!+,.30=&#()(42+!*(--2$+!Q,/,!,3.1/)(42+R!!
f,+!-/1:+!0&1)(.2#(J1+!1+,./,)13+!.=+E!#+$!0&)(+,)$!&))+(,)$!*2!5"67?!+$)!#&!-/1:+!+,.30=&#()(42+!
*(--2$+!Q,/,!,3.1/)(42+R?!/C$+1A3+!0&1-/($!*&,$!2,!./,)+>)+!$+0)(.3:(42+!!

IV#9%INFECTIONS%DE%L’ID%
3!
!
Pharmaetudes!
3!
9%(:&'+1(+!+)!#%+>&:+,!:&.1/$./0(42+!$/,)!=&C()2+##+:+,)!,/1:&2>8!7!#%+>&:+,!:(.1/$./0(42+?!(#!
+>($)+!2,+!+,.30=&#()+!Q:(.1/,/*2#&(1+R!.&1&.)31($3+!0&1!2,+!*($$3:(,&)(/,!*+!,/*2#+$!:(.1/'#(&2>8!
9+!*(&',/$)(.!*(--31+,)(+#!0+2)!$+!0/$+1!&A+.!2,+!+,.30=&#()+!H!.;)/:3'&#/A(12$8!
!
93$(/,$!.(.&)1(.(+##+$!!
9+$!#3$(/,$!.(.&)1(.(+##+$!)/>/0#&$:(42+$!$/,)!*+!0#2$!+,!0#2$!-1342+,)+$!+)!$%/C$+1A+,)!&01J$!#+!
)1&()+:+,)?!=&C()2+##+:+,)!$/2$!-/1:+!*+!#3$(/,$!L;$)(42+$!/2!#(,3&(1+$?!#/.&#($3+$!+)!H!0&1/($!/.1+8!
N($)/#/'(42+:+,)?!(#!$%&'()!*%2,+!,3.1/$+!&,.(+,,+!*3)+1'3+!+,)/213+!*%2,+!'#(/$+!&$)1/.;)&(1+?!*+!
#(0/0=&'+$!+)!*+!*30S)$!:(,31&2>!<./,)+,&,)!*2!-+1!+)!*2!.&#.(2:B8!
!
g;$)+!($/#3!!
D,-(,?!(#!0+2)!+>($)+1!*+$!L;$)+$!($/#3$!*&,$!#+!0&1+,.=;:+!.313C1&#!
!
3.3 %%Autres%:%
Z[O!
N+10+$!
9;:0=/:+$!
!
4. Infections%pulmonaires%opportunistes%:%
D,A(1/,!hcV!*+$!5"67!,/,!)1&()3$!0&1!N77_K!(Highly'Active'Antiretroviral'Therapy)'$/2--1+,)!
*%&))+(,)+$!02#:/,&(1+$?!*/,)!#+$!0#2$!-1342+,)+$!$/,)!#+$!0,+2:/0&)=(+$!C&.)31(+,,+$?!#&!
0,+2:/.;$)/$+!02#:/,&(1+?!#+$!(,-+.)(/,$!-/,'(42+$?!#&!)2C+1.2#/$+!+)!#+$!:;./C&.)31(/$+$!,/,!
)2C+1.2#+2$+$!*/,)!#+![7Z!<Mycobacterium'avium'complexB8!9+$!01(,.(0&2>!*(&',/$)(.$!*(--31+,)(+#$!
$/,)!#+!$&1./:+!*+!g&0/$(!+)!#&!0,+2:/0&)=(+!(,)+1$)()(+##+!#;:0=/X*+!<9"\B8!6+02($!#%&AJ,+:+,)!*2!
N77_K?!/,!/C$+1A+!:/(,$!*%(,-+.)(/,$!/00/1)2,($)+$!+)!*+!$&1./:+$!*+!g&0/$(!:&($!#+$!(,-+.)(/,$!
C&.)31(+,,+$!+)!#+$!#;:0=/:+$!$/,)!0#2$!130&,*2$8!D,!-/,.)(/,!*+$!0&;$!*%/1('(,+?!*%&2)1+$!
(,-+.)(/,$!0+2A+,)!I)1+!1+,./,)13+$!.=+E!#+$!0&)(+,)$!(::2,/*301(:3$!F!#&!#+($=:&,(/$+!<&2$$(!
/C$+1A3+!*&,$!#+!$2*!*+!#&!d1&,.+B?!#%(,-+.)(/,!H!Histoplasma'capsulatum'var'capsulatum?!#&!
./..(*(/(*/:;./$+?!#%&,'2(##2#/$+?!888!
9+$!$(',+$!+)!#+$!$;:0)S:+$!,+!$/,)!0&$!$03.(-(42+$?!0/2A&,)!$+!)1&*2(1+!0&1!2,+!-(JA1+?!2,+!)/2>?!
2,+!*;$0,3+!/2!2,+!=3:/0);$(+8!9+$!:&,(-+$)&)(/,$!$2C&('2i$!/2!.=1/,(42+$!/1(+,)+,)!0#2)S)!A+1$!
2,+!0,+2:/.;$)/$+!02#:/,&(1+?!2,+!)2C+1.2#/$+?!2,+!:;./C&.)31(/$+!,/,!)2C+1.2#+2$+?!2,+!
:;./$+?!2,!$&1./:+!*+!g&0/$(!+)!2,!#;:0=/:+!:&#(,!,/,!=/*'L(,(+,8!Z/::+!*&,$!)/2$!#+$!
/1'&,+$?!#+!*+'13!*%(::2,/*301+$$(/,!&(*+!&2!*(&',/$)(.8!D,!+--+)?!#&!0,+2:/.;$)/$+!02#:/,&(1+?!
#+$!:;./C&.)31(/$+$!,/,!)2C+1.2#+2$+$!+)!#+!$&1./:+!*+!g&0/$(!$/,)!1&1+:+,)!/C$+1A3$!&A+.!2,!)&2>!
*+!Z6^!$2031(+21!H!MUU!b!j#?!)&,*($!42+!#&!)2C+1.2#/$+?!#+$!0,+2:/0&)=(+$!-/,'(42+$!/2!#+$!
#;:0=/:+$!1+$)+,)!0/$$(C#+$8!9%&$0+.)!1&*(/#/'(42+!,%+$)!0&$!,/,!0#2$!$03.(-(42+!:&($!0+2)!-/21,(1!
42+#42+$!/1(+,)&)(/,$!3)(/#/'(42+$8!f,+!1&*(/'1&0=(+!,/1:&#+!*/()!-&(1+!1+.=+1.=+1!+,!01(/1()3!2,+!
0,+2:/.;$)/$+!02#:/,&(1+!/2!2,+!)2C+1.2#/$+8!9+!9k7!./,$)()2+!2,!+>&:+,!.#3!*2!*(&',/$)(.8!"#!
$%&'()!*%!2,+!21'+,.+?! ,3.+$$()&,)!*+!,/:C1+2$+$!./#/1&)(/,$!<[``?!\&0&,(./#&/2?!P(+=#?!
`/:/1(G`1/./))!+)?!0/21!2,!*(&',/$)(.!1&0(*+!*+!0,+2:/.;$)/$+!02#:/,&(1+?!#+!C#+2!*+!)/#2(*(,+B8!"#!
-&2)!&0013.(+1!#&!42&#()3!*2!9k7!<0&1!#+!*+'1+*+!./,)&:(,&)(/,!C1/,.=(42+!/2!:&#0('=(+,,+B?!#+!01/-(#!
.;)/#/'(42+!#3$(/,,+#!<*/::&'+!&#A3/#&(1+?!=3:/11&'(+!&#A3/#&(1+?!888B!+)!#&!-/1:2#+8!9%+--+)!
.;)/0&)=/'J,+!A(1&#!0+2)!I)1+!1+.=+1.=3!$21!#+$!./#/1&)(/,$!*+![``!+)!*+!\&0&,(./#&/28!
!
4.1 %%Pneumopathies%bactériennes%:%

!
4!
9+21!(,.(*+,.+!&2':+,)+!+,!0&1&##J#+!H!#&!C&($$+!*+$!Z6^8!9+$!$;:0)S:+$!$/,)!&('2$!+)!$21!#&!
1&*(/'1&0=(+?!(#!+>($)+!*+$!(,-(#)1&)$!#/C&(1+$!/2!$+':+,)&(1+$8!9+$!3)(/#/'(+$!#+$!0#2$!-1342+,)+$!$/,)!
#+!Streptococcus'pneumoniae'+)!#%Haemophilus'influenzae8!9+!9k7!+$)!1&1+:+,)!13&#($3!:&($!(#!0+1:+)!
#+!*(&',/$)(.!C&.)31(/#/'(42+!+)!&--(1:+!#+!.&1&.)J1+!0&)=/'J,+!*+$!C&.)31(+$!#/1$42%+##+$!$/,)!
0=&'/.;)3+$!0&1!#+$!0/#;,2.#3&(1+$!,+2)1/0=(#+$!<-('8!h&B8!9&!013$+,.+!*+!C&.)31(+$!-(#&:+,)+2$+$!<-('8!
hCB!*/()!I)1+!$(',&#3+?!0/2A&,)!./11+$0/,*1+!H!2,+!,/.&1*(/$+!*/,)!#%(*+,)(-(.&)(/,!C&.)31(/#/'(42+!
,3.+$$()+!*+$!*3#&($!*+!.2#)21+$!0#2$!#/,'$8!
!
4.2 %%Pneumocystose%pulmonaire%:%
9+!Pneumocystis'(*+,)(-(3!0&1!Z=&'&$!+,!TWUW?!&!3)3!(,()(&#+:+,)!./,-/,*2!&A+.!2,+!)1;0&,/$/:(&$+!
02($!1+./,,2!./::+!2,+!,/2A+##+!+$0J.+!*+!01/)/E/&(1+8!D,!TWll?!#%&,&#;$+!'3,3)(42+!&!0+1:($!*+!
#+!.#&$$+1!0&1:(!#+$!.=&:0(',/,$8!9&!$03.(-(.()3!*%+$0J.+!&!3)3!*3:/,)13+!+,!TWW^?!+>0#(42&,)!#+!
.=&,'+:+,)!*+!,/:8!9+!Pneumocystis'carinii'(,-+.)+!#+!1&)!+)!#+!Pneumocystis'jirovecii'<&,.(+,,+:+,)!
cariniiB!+$)!#%+$0J.+!(,-+.)&,)!#%=/::+?!*3,/::3+!+,!=/::&'+!&2!0&1&$()/#/'2+!).=J42+!m))/!
](1/A+.8!f,+!-/1:+!30(*3:(42+!(,-+.)+!#+$!+,-&,)$!*3,2)1($?!013:&)213$8!
7A&,)!#+!5"67?!#&!0,+2:/.;$)/$+!(,-+.)&()!#+$!0&)(+,)$!$/2--1&,)!*%!(::2,/*3-(.(+,.+$!.+##2#&(1+$!
&.42($+$!/2!./,'3,()&#+$?!$21)/2)!#+$!#+2.3:(42+$!+)!#+$!0&)(+,)$!#+2./03,(42+$8!
"#!$%&'()!*%2,+!*+$!(,-+.)(/,$!#+$!0#2$!-1342+,)+$!*2!5"67?!:I:+!$(!$/,!(,.(*+,.+!&!C&($$3!&A+.!#+!
)1&()+:+,)!013A+,)(-!/2!#+!N77_K8!
Z/,)1&(1+:+,)!H!#&!0,+2:/.;$)/$+!02#:/,&(1+!/C$+1A3+!*&,$!#+!.&*1+!*2!5"67?!#+$!$;:0)S:+$!$/,)!
&('2$!.=+E!#+$!0&)(+,)$!(::2,/*301(:3$!Q,/,G5"67R8!9%=;0/>3:(+?!#+$!(,-(#)1&)$!(,)+1$)()(+#$!*(--2$!
$2(A($!*%&))+(,)+!&#A3/#&(1+!+)!#+!)&2>!*+!Z6^!(,-31(+21!H!MUU!b!j#!/1(+,)+,)!A+1$!#+!*(&',/$)(.8!9+!
*(&',/$)(.!*(--31+,)(+#!$+!0/$+!&A+.!#&!)2C+1.2#/$+?!#+$!&2)1+$!(,-+.)(/,$!-/,'(42+$?!#+!#;:0=/:+!/2!#+!
$&1./:+!*+!g&0/$(8!9+!*(&',/$)(.!1+0/$+!$21!#&!:($+!+,!3A(*+,.+!*+$!0,+2:/.;$)+$!*&,$!#+$!.1&.=&)$!
(,*2()$!/2!#+!9k7!<-('8!n&!H!n*B8!9+!,/:C1+!*+!0,+2:/.;$)+$!0+2)!I)1+!13*2()!+,!.&$!*+!)1&()+:+,)!
013A+,)(-8!
521!#+$!./#/1&)(/,$!&2!C#+2!*+!)/#2(*(,+!<nCB!+)!*+!`1/./))!<n.B?!#+$!0,+2:/.;$)+$!'1/203$!+,!&:&$?!
$/,)!&11/,*($?!+,!.1/($$&,)!/2!+,!'1&(,!*+!.&-38!9+!/2!#+$!M!0/(,)$!.+,)1&2>!$/,)!:(+2>!A($2&#($3$!$21!
#&!./#/1&)(/,!*+!`1/./))8!
9+!*(&',/$)(.!*(--31+,)(+#!+$)!1+013$+,)3!0&1!#+$!=3:&)(+$!+)!#+$!0+)()+$!#+A21+$8!6&,$!#+$!.1&.=&)$!
(,*2()$?!#&!./,)&:(,&)(/,!C&.)31(+,,+!+)!$21)/2)!-/,'(42+!<:2'2+)!C2..&#B!0+2)!1+,*1+!#+!*30($)&'+!
*(--(.(#+?!:&($!#+!Candida'&!2,+!)&(##+!0#2$!(,3'&#+!+)!C/21'+/,,+!&A+.!2,!./##+)!3)1/()!<-('8!n*B8!
9&!0,+2:/.;$)/$+!02#:/,&(1+!0+2)!+,)1&a,+1!2,+!*3)1+$$+!1+$0(1&)/(1+?!*+$!L;$)+$!1+$0/,$&C#+$!*+!
0,+2:/)=/1&>?!/2!2,!$;,*1/:+!/C$)12.)(-8!
!
4.3 %%Tuberculose%pulmonaire%:%
9&!)2C+1.2#/$+!+$)!#%(,-+.)(/,!C&.)31(+,,+!#&!0#2$!130&,*2+!&2!:/,*+8!9+$!0&)(+,)$!O"No!/,)!2,+!
$2$.+0)(C(#()3!&..12+!+)!#&!013A&#+,.+!*+!#&!)2C+1.2#/$+!&))+(,)!p?lV8!Z=+E!#+$!0&)(+,)$!&))+(,)$!*2!
5"67?!#+!1($42+!*+!)2C+1.2#/$+!+$)!:2#)(0#(3!0&1!MUU!H!cUU!0&1!1&00/1)!H!#&!0/02#&)(/,!'3,31&#+8!
9%&00&1()(/,!*+!$/2.=+$!:2#)(13$($)&,)+$!&..1/a)!#+!01/C#J:+!30(*3:(/#/'(42+8!
9+$!:&,(-+$)&)(/,$!.#(,(42+$!*30+,*+,)!*2!)&2>!*+!Z6^8!Z#&$$(42+:+,)?!(#!+>($)+!2,+!)/2>?!2,+!-(JA1+!
01/#/,'3+?!*+$!$2+21$!,/.)21,+$?!2,+!0+1)+!*+!0/(*$?!2,+!&,/1+>(+!+)!*+$!=3:/0);$(+$?!:&($!.+$!
$;:0)S:+$!,+!$/,)!0&$!$03.(-(42+$!.=+E!#+$!0&)(+,)$!O"No8!6+!0#2$?!#+$!$;:0)S:+$!$/,)!+,./1+!0#2$!
&);0(42+$!&2!-21!+)!H!:+$21+!*+!#%&''1&A&)(/,!*+!#%(::2,/*301+$$(/,8!D,!+--+)?!(#!+>($)+!:/(,$!
*%&))+(,)+$!#/C&(1+$!$2031(+21+$!/2!*+!#3$(/,$!.&A()&(1+$8!6+$!(,-(#)1&)$!*(--2$?!2,+!&))+(,)+!#/C&(1+!
(,-31(+21+!/2!*+$!&*3,/0&)=(+$!0+2A+,)!I)1+!1+,./,)13$8!9%"6_!$+!,3'&)(A+8!9+!9k7!0+2)!013$+,)+1!
2,+!#;:0=/.;)/$+!Z6l!<Z6^!.=+E!#+$!0&)(+,)$!(::2,/./:03)+,)$B8!"#!0+2)!+>($)+1!*+$!
:&,(-+$)&)(/,$!+>)1&02#:/,&(1+$!<0&1!+>+:0#+!21/G'3,()&#+$B!/2!2,+!*($$3:(,&)(/,!'&,'#(/,,&(1+!+)!

IV#9%INFECTIONS%DE%L’ID%
5!
!
Pharmaetudes!
5!
:3*2##&(1+8!f,+!0,+2:/.;$)/$+!02#:/,&(1+!0+2)!I)1+!&$$/.(3+8!9&!1&*(/'1&0=(+!*2!)=/1&>!0+2)!I)1+!
,/1:&#+!<TUV!*+$!.&$!qB8!
9&!:($+!+,!3A(*+,.+!*+!C&.(##+$!&.(*/G&#.//#/13$($)&,)$!<k77_B!+,!.;)/#/'(+!<-('8!lB!/2!+,!.2#)21+!,%+$)!
0&$!$2--($&,)+!.&1!(#!0+2)!+>($)+1!2,+!./#/,($&)(/,!0&1!*+$!:;./C&.)31(/$+$!,/,!)2C+1.2#+2$+$!<[7ZB8!
9%(*+,)(-(.&)(/,!*+!#%+$0J.+!+)!#%&,)(C(/'1&::+!$/,)!+$$+,)(+#$8!
!
4.4 %%Pneumopathie%à%cytomégalovirus%(CMV)%:%
Z=+E!#%&*2#)+!(::2,/./:03)+,)?!#&!01(:/G(,-+.)(/,!0&1!#+!.;)/:3'&#/A(12$!0+2)!I)1+!0#2$!/2!:/(,$!
$;:0)/:&)(42+!<$;,*1/:+!:/,/,2.#3/$(42+?!0#+21/G0,+2:/0&)=(+?!:;/.&1*()+?!&1)=1()+?!
+,.30=&#()+?!$;,*1/:+!*+!`2(##&(,Gk&113B!:&($!1&1+:+,)!-&)&#+8!9&!'231($/,!$21A(+,)!$&,$!$342+##+?!
0&1-/($!&A+.!2,+!&$)=3,(+!Q0/$)GA(1&#+R8!9+!A(12$!1+$)+!H!#%3)&)!#&)+,)!*&,$!#%/1'&,($:+!+)!$+!13&.)(A+!
+,!.&$!*%(::2,/*301+$$(/,!K8!Z=+E!#+$!0&)(+,)$!(::2,/*301(:3$!&01J$!)1&,$0#&,)&)(/,!<:/+##+!/2!
/1'&,+$B!/2!&))+(,)$!*2!5"67?!#%(,-+.)(/,!0+2)!I)1+!'1&A+!A/(1+!-&)&#+?!$+!:&,(-+$)&,)!0&1!2,+!-(JA1+?!
2,+!#+2./03,(+?!2,+!=30&)()+?!2,+!0,+2:/0&)=(+?!2,+!@$/0=&'()+?!2,+!'&$)1()+?!2,+!./#()+!/2!2,+!
13)(,()+8!9+!.;)/:3'&#/A(12$!+$)!#%(,-+.)(/,!/00/1)2,($)+!A(1&#+!#&!0#2$!$3AJ1+!*&,$!#+!5"67!<&))+(,)+!
'&$)1/G(,)+$)(,&#+?!02#:/,&(1+!+)!*2!$;$)J:+!,+1A+2>B8!6&,$!#+!9k7?!(#!-&2)!1+.=+1.=+1!&A+.!$/(,!#+$!
(,.#2$(/,$!A(1&#+$!<,2.#3&(1+$!b!(,)1&.;)/0#&$:(42+$B!$21!#&!./#/1&)(/,!*+![``!<-('8!WB!+)!*+!
\&0&,(./#&/28!9+$!.+##2#+$!(,-+.)3+$!,+!$/,)!0&$!)/2Y/21$!);0(42+$!+)!#%(::2,/:&142&'+!+$)!0#2$!
$+,$(C#+8!
9+!.;)/:3'&#/A(12$!&!3)3!+,!/2)1+!(,.1(:(,3!*&,$!#+$!1+Y+)$!&('2$!+)!.=1/,(42+$!*+$!)1&,$0#&,)$!&(,$(!
42+!*&,$!#&!13&.)(/,!*2!'1+--/,!./,)1+!#%=S)+!<`ONB8!
7$0+1'(##/$+!
9%&$0+1'(##/$+!,%+$)!0&$!1&1+!*&,$!#+!5"678!9&!-/1:+!(,A&$(A+!/2!*($$3:(,3+!+$)!$21)/2)!/C$+1A3+!.=+E!
#+$!0&)(+,)$!,+2)1/03,(42+$!/2!*3C(#()3$!<)/>(./:&,+$?!&#.//#/*30+,*&,)$B!/2!(::2,/*301(:3$!
<)1&,$0#&,)&)(/,!*%/1'&,+$?!,3/0#&$(+$!=3:&)/#/'(42+$?!5"67B8!9%(,-+.)(/,!0+2)!$+!01/0&'+1!&2!
$;$)J:+!,+1A+2>!.+,)1&#!A(&!#+$!$(,2$!*+!#&!-&.+?!0&1!A/(+!=3:&)/'J,+!/2!A(&!#%/1+(##+!(,)+1,+8!
9+$!-(#&:+,)$!C1&,.=3$!H!&,'#+!&('2!$/,)!13'2#(+1$!+)!$+0)3$?!.+!42(!0+1:+)!*+!#+$!*(--31+,.(+1!*+$!
*3.=+)$!!
!
4.5 %%Anguillulose%:%
9%&,'2(##2#/$+!(Strongyloïdes'stercoralis)'+$)!2,+!&--+.)(/,!)1/0(.&#+!/2!$2C)1/0(.&#+8!\&1:(!#+$!
0&1&$()+$?!.%+$)!.+#2(!42(!(,*2()!#+$!$;,*1/:+$!#+$!0#2$!A&1(3$8!9+$!-/1:+$!'1&A+$!$/,)!/C$+1A3+$!.=+E!
#+$!0&)(+,)$!(::2,/*301(:3$8!"#!$%&'()!*2!$+2#!=+#:(,)=+!13&#($&,)!*+$!(,-+.)(/,$!*($$3:(,3+$8!9&!
03,3)1&)(/,!.2)&,3+!+,)1&a,+!2,!Q1&$=R!/2!2,!0121()8!9+!)1&,$()!#&1A&(1+!(,*2()!2,!$;,*1/:+!*+!
9r+--#+1?!*+$!*/2#+21$!&C*/:(,&#+$!/2!*+$!)1/2C#+$!*2!)1&,$()!#/1$!*+!#%(,$)&##&)(/,!*&,$!#+!*2/*3,2:!
/2!#+!Y3Y2,2:8!9+!*(&',/$)(.!+$)!0/$3!$21!#%+>&:+,!*(1+.)!*+$!$+##+$!/2!&01J$!.2#)21+8!9%+>&:+,!
.;)/#/'(42+!/2!=($)/#/'(42+!0+2)!:+))1+!+,!3A(*+,.+!)/2$!#+$!$)&*+$!*2!*3A+#/00+:+,)!<-('8!TT&!+)!
TTCB8!
D,!.&$!*%&))+(,)+!(,)+$)(,&#+?!#/1$42+!#+$!&,'2(##2#+$!$/,)!+,-/2(+$!*&,$!#&!:242+2$+?!#+!*(&',/$)(.!
&A+.!*%&2)1+$!=+#:(,)=+$!<+,!0&1)(.2#(+1!#&!)1(.=(,+B!0+2)!I)1+!*(--(.(#+8!
!
5. Infections%gastro#intestinales%opportunistes%:%
\#2$!*+!cUV!*+$!0&)(+,)$!&))+(,)$!*2!5"67!$/2--1+,)!*+!)1/2C#+$!*('+$)(-$8!9+$!$;:0)S:+$!#+$!0#2$!
-1342+,)$!$/,)!#&!*;$0=&'(+!/2!#%/*;,/0=&'(+?!#&!*/2#+21!&C*/:(,&#+?!*+$!$&(',+:+,)$!/2!*+$!
*(&11=3+$8!
!
s!Z/:0#(.&)(/,$!C2..&#+$!+)!@$/0=&'(+,,+$!!
9+$!#3$(/,$!C2..&#+$!$/,)!-1342+,)+$8!9&!.&,*(*/$+!C2..&#+!<:2'2+)B!)/2.=+!0#2$!*+!lUV!*+$!0&)(+,)$!