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

PS01Qiens

Histoplasmosis
Prevention: People with CD4+ cell counts of 100 or less
should consider itraconazole as prevention therapy. However, itraconazole has not been conclusively shown to be
effective in preventing some other fungal infections and
the potential for drug interactions should be considered.
People may reduce the risk of developing histoplasmosis
by avoiding cleaning chicken coops, disturbing soil beneath bird-roosting sites and exploring caves.
Maintenance: For maintenance therapy, lifelong treatment
with itraconazole is recommended.
Prevention in Children: There are no recommendations
for preventing histoplasmosis in children, however lifelong maintenance therapy with itraconazole is recommended for those who have had the disease.
Prevention During Pregnancy: There are no specific
guidelines for prevention during pregnancy.
Candidiasis
Prevention: Routine preventative therapy against candida
is not recommended because of the potential to develop
drug-resistant fungal infections.
Maintenance: There is considerable debate over the benefit of long-term maintenance therapy for candidiasis. Some
researchers believe that long-term maintenance therapy
will result in drug-resistant organisms while others believe that if candidiasis recurs frequently, then fluconazole
can be used either intermittently or as long-term maintenance therapy. It is unclear whether resistance develops
more quickly as a result of long-term maintenance therapy
or frequently recurring intermittent therapy. Itraconazole
and ketoconazole can also be considered alternatives to
fluconazole.
Cryptosporidiosis
Avoiding Infection: To reduce the risk of cryptosporidial
infection, people should wash their hands after contact
with human feces, after handling pets and after gardening. Additionally, people should avoid oral-anal intercourse and should not drink water directly from lakes
and rivers. Furthermore, newborn babies and very young
pets may pose a small risk for cryptosporidial infection.
Since tap water in some cities has been found to contain
cryptosporidia, water filters capable of removing particles
1 pm (a thousandth of a millimeter) in diameter and larger,
those that meet the NSF (National Sanitation Foundation) standard number 53 for "cyst removal," and those
that use reverse osmosis technology should be considered. This information is typically advertised on the package when buying a water filter. Many bottled waters are
also not free of cryptosporidia and only those that are
distilled or filtered by reverse osmosis can be certain to
be free of the organism. It is important to consider that
ice from restaurants and bars may be made with water
contaminated with cryptosporidia.
Prevention and Maintenance: There are as yet no
proven preventative medications for cryptosporidiosis.

Varicella-Zoster Virus
Prevention: Adults and children who have not had chicken
pox or zoster (shingles) in the past, or who have no detectable antibodies to zoster are at risk for zoster and should
avoid exposure to someone who has zoster or chicken pox.
However if they have come in close contact with someone
who has zoster or chicken pox they should be given zoster
immune globulin within 96 hours of the exposure.
Maintenance: No therapy has proven effective to prevent
the recurrence of zoster.
Prevention in Children: There are no specific guidelines
for prevention in children.
Prevention During Pregnancy: Pregnant women who
are at risk for zoster should receive zoster immune globulin after exposure.
Tuberculosis
Prevention: People should receive a tuberculin skin test
after diagnosis of HIV infection. People who receive a
positive skin test result (a reddening of the skin greater
than 5 mm around) should undergo chest radiography
and clinical evaluation for active tuberculosis. People who
are skin-test positive, but do not have active infection and
have not been treated for or received preventative medications, should receive isoniazid + pyridoxine for 12
months. People who are skin-test negative but are at risk
for tuberculosis (healthcare workers, people who work or
volunteer in correctional facilities and homeless shelters,
etc.) should consider isoniazid + pyridoxine for preventative therapy. Additionally, people who are skin-test negative should consider annual testing for tuberculosis.
Prevention in Children: Children who are born to HIVinfected mothers should receive a tuberculin skin test at
9-12 months of age. Children who are exposed to people
with active tuberculosis should start isoniazid preventative therapy once it has been determined that the child
does not have active infection.
Prevention During Pregnancy: Tuberculosis prevention therapy is recommended for pregnant women who
have a positive skin test or if they have been exposed to
people with active tuberculosis. Preferred therapies are
isoniazid + pyridoxine, however many researchers believe
that these medications should only be started after the
first trimester of pregnancy to avoid potential harm to the
developing fetus.
For more specific information on issues to
consider for prevention, treatment or maintenance Of any of these HJV-related infections,
call the Project Inform hotline at
800-822-7422.
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PI PERSPECTIVE NUIVBER 23 NOVEIVBER 1 997