Perspective: Information, Inspiration and Advocacy for People Living with HIV/AIDS

PHS 01 Guidalines

Mycobacterium
avium Complex (MAAC)
Prevention: People with CD4+ cell counts of 50 or less
should start preventative therapy against MAC.
Clarithromycin or azithromycin are the drugs of choice,
but if they cannot be tolerated rifabutin should be considered. Before initiating MAC prevention, people should be
tested to ensure that MAC organisms are not present in
blood and that they do not have active tuberculosis. It is
important to consider potential drug interactions with
other medications when choosing a therapy. Many therapies to prevent and treat MAC have drug interactions
with commonly used anti-HIV drugs.
Maintenance: For maintenance therapy, people who have
not developed resistance to clarithromycin or azithromycin
should use one of these drugs in combination with at least
one other anti-MAC drug, such as ethambutol or rifabutin.
Prevention in Children: Children over 6 years of age
with CD4+ cell counts of 50 or less, aged 2-6 years with
CD4+ cell counts of 75 or less, aged 1-2 years with CD4+
cells of 500 or less and children under 12 months of age
with CD4+ cell counts of 750 or less should receive MAC
prevention therapy. Clarithromycin or azithromycin are
the drugs of choice.
Prevention During Pregnancy: Pregnant women with
CD4+ cell counts of 50 or less should receive MAC prevention therapy. Azithromycin is the drug of choice.
Herpes Simplex Virus
Prevention: Prevention against herpes simplex virus is not
recommended. However, people should use latex condoms
during sexual intercourse to reduce the risk of exposure
to this virus.
Maintenance: Maintenance therapy for herpes simplex
virus is not recommended. However, people with frequent
or severe recurrences may consider acyclovir. People with
herpes simplex virus that is resistant to acyclovir may
consider either intravenous foscarnet or intravenous
cidofovir.
Prevention in Children: Prevention of herpes simplex is
not recommended for children.
Prevention During Pregnancy: Prevention of herpes
simplex virus is not recommended for pregnant women.
However, some researchers believe that prevention with
acyclovir during the late stages of pregnancy may prevent
transmission of herpes simplex virus to the child. For
women with severe or frequent recurrences of herpes simplex virus, maintenance therapy with acyclovir may be
considered.

CytomegaIovirus (CMV)
Prevention: People with CD4+ cell counts of 50 or less
and who are CMV seropositive should consider oral
ganciclovir for CMV prevention. However, there is considerable controversy over this because studies have drawn
conflicting conclusions about the benefit of preventive
therapy for CMV.
Maintenance: For maintenance therapy, lifelong treatment
with intravenous (in the vein) ganciclovir, oral ganciclovir,
intravenous foscarnet, intravenous cidofovir, intravenous
ganciclovir + intravenous foscarnet or ganciclovir implants
is recommended. Intravitreal injections (direct injection
into the eye) of foscarnet or ganciclovir may also be considered.
Prevention in Children: Some researchers believe that
children should be tested for CMV soon after birth. Some
researchers also believe that children should be tested for
CMV yearly. There are no recommendations of specific
therapies for preventing CMV in children at this time.
Prevention During Pregnancy: Prevention of CMV disease for pregnant women is not recommended. People who
conceive while receiving oral ganciclovir for prevention
of CMV disease should stop this therapy. However, maintenance therapy is recommended for pregnant women.

Cryptococcal Disease
Prevention: People with CD4+ cell counts of 50 or less
may consider preventing cryptococcal disease with
fluconazole. However, some researchers believe that prevention of cryptococcal disease should not be recommended as the incidence of this disease is low and the use
of fluconazole may result in drug resistant candida and
cryptococcus. Avoiding areas where there are a lot of pigeon droppings may reduce the risk of cryptococcal disease.
Maintenance: For maintenance therapy, lifelong treatment
with fluconazole is recommended.
Prevention in Children: There are no specific recommendations for children on prevention of cryptococcal
disease, however lifelong maintenance therapy with
fluconazole is recommended for children who have had
cryptococcal disease.
Prevention During Pregnancy: Prevention of cryptococcal disease for pregnant women is not recommended.
People who conceive while receiving either itraconazole
or fluconazole as primary prevention for cryptococcal
disease should stop these therapies, as they may be toxic
to the developing fetus.

PI PERSPECTIVE

P INUM1BER 23 1 NOVEMBER 1 997

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