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TREATING HIV/AIDSA Quick Reference Guide

DOI: 10.1176/appi.books.9780890423370.108513
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Based on Practice Guideline for the Treatment of Patients With HIV/AIDS, originally published in November 2000. A guideline watch, summarizing significant developments in the scientific literature since publication of this guideline, may be available.

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Table Reference Number

Type of Manifestation

Condition

Acute HIV-1 infection

  • Viral meningitis

  • Encephalitis

  • Ascending polyneuropathy

Opportunistic infections (late HIV-1 infection)

  • Toxoplasma cerebritis

  • Cryptococcal meningitis

  • Progressive multifocal leukoencephalopathy

  • Neurosyphilis

  • Mycobacterium tuberculosis meningitis

  • Cytomegalovirus encephalitis

  • Herpes simplex encephalitis

Neoplastic disease (late HIV-1 infection)

  • CNS lymphoma

  • Kaposi's sarcoma

Other manifestations

  • HIV-associated cognitive dysfunctions (see section D.1.a in this guide)

Table Reference Number

Source. Adapted from Grant I, Atkinson JH Jr: "Neuropsychiatric Aspects of HIV Infection and AIDS," in Kaplan and Sadock's Comprehensive Textbook of Psychiatry. Edited by Sadock BJ, Sadock VA. Philadelphia, PA, Lippincott Williams & Wilkins, 1999, pp. 308–336.

Drug

Target Illness

Side Effects

Acyclovir

Herpes encephalitis

Visual hallucinations, depersonalization, tearfulness, confusion, hyperesthesia, hyperacusis, thought insertion, insomnia

Amphotericin B

Cryptococcosis

Delirium, peripheral neuropathy, diplopia

Atazanavir

HIV

Depression, headache

-Lactam antibiotics

Infections

Confusion, paranoia, hallucinations, mania, coma

Co-trimoxazole

Pneumocystis carinii pneumonia

Depression, loss of appetite, insomnia, apathy

Cycloserine

Tuberculosis

Psychosis, somnolence, depression, confusion, tremor, vertigo, paresis, seizures, dysarthria

Delavirdine

HIV

Anxiety, depression, insomnia, headache

Didanosine

HIV

Nervousness, anxiety, confusion, seizures, insomnia, peripheral neuropathy

Efavirenz

HIV

Nightmares, depression, confusion

Fosamprenavir

HIV

Headache, oral paresthesia, depression or other mood disorders

Foscarnet

Cytomegalovirus

Paresthesias, seizures, headache, irritability, hallucinations, confusion

Interferon-

Kaposi's sarcoma

Depression, weakness, headache, myalgias, confusion

Isoniazid

Tuberculosis

Depression, agitation, hallucinations, paranoia, impaired memory, anxiety

Lamivudine

HIV

Insomnia, mania

Methotrexate

Lymphoma

Encephalopathy (at high dose)

Pentamidine

Pneumocystis carinii pneumonia

Confusion, anxiety, lability, hallucinations

Procarbazine

Lymphoma

Mania, loss of appetite, insomnia, nightmares, confusion, malaise

Quinolones

Infection

Psychosis, delirium, seizures, anxiety, insomnia, depression

Stavudine

HIV

Headache, asthenia, malaise, confusion, depression, seizures, excitability, anxiety, mania, early morning awakening, insomnia

Sulfonamides

Infection

Psychosis, delirium, confusion, depression, hallucinations

Thiabendazole

Strongyloidiasis

Hallucinations, olfactory disturbance

Vinblastine

Kaposi's sarcoma

Depression, loss of appetite, headache

Vincristine

Kaposi's sarcoma

Hallucinations, headache, ataxia, sensory loss

Zalcitabine

HIV

Headache, confusion, impaired concentration, somnolence, asthenia, depression, seizures, peripheral neuropathy

Zidovudine

HIV

Headache, malaise, asthenia, insomnia, unusually vivid dreams, restlessness, severe agitation, mania, auditory hallucinations, confusion

Table Reference Number

Intracranial

Extracranial

  • Seizures

  • Infections

  • Cryptococcal meningitis

  • Encephalitis due to HIV, herpes, cytomegalovirus

  • Progressive multifocal leukoencephalopathy

  • Mass lesions

  • Lymphoma

  • Toxoplasmosis

  • Medications and other drugs (not exhaustive)

    • Amphotericin B

    • Acyclovir

    • Ganciclovir

    • Ethambutol

    • Trimethoprim/sulfamethoxazole

    • Pentamidine

    • Foscarnet

    • Ketoconazole

    • Sedative-hypnotics

    • Cycloserine

    • Opiate analgesics

    • Isoniazid

    • Rifampin

    • Zidovudine or didanosine

    • Vincristine

    • Dapsone

  • Drug or alcohol withdrawal

  • Infection/sepsis

  • Endocrine dysfunction/metabolic abnormality

    • Hypoglycemia due to pentamidine, protease inhibitors

    • Hypoxia due to pneumonia

  • Nonendocrine organ dysfunction

    • Renal failure due to HIV nephropathy or medication toxicity

    • Liver failure due to comorbid hepatitis and medication toxicity

  • Nutritional deficiencies

    • Wasting syndrome

    • Failure to replace trace elements or vitamins in total parenteral nutrition

Table Reference Number

aRelative rank ordering of CYP3A4 inhibition for protease inhibitors is ritonavir >> indinavir, nelfinavir, amprenavir, atazanavir, fosamprenavir, tipranavir > saquinavir.

bNo clinically significant effect.

cAbacavir-lamivudine-zidovudine, abacavir-lamivudine, lamivudine-zidovudine, lopinavir-ritonavir, and tenofovir-emtricitabine are available as combination preparations.

dIn combination with ritonavir.

Predominant Effects on CYP450 Enzymes

Class/Drug Name

Inhibition

Induction

Protease inhibitorsa

Amprenavir

3A4

b

Atazanavir

3A4

b

Fosamprenavir

3A4

b

Indinavir

3A4

b

Lopinavirc

3A4

b

Nelfinavir

3A4, 2C19, 2D6

b

Ritonavirc

3A4, 2C9, 2D6

b

Saquinavir

3A4

b

Tipranavir

3A4d

3A4d

Nonnucleoside reverse transcriptase inhibitors

Delavirdine

3A4

b

Efavirenz

3A4

3A4, 2B6

Nevirapine

b

3A4, 2B6

Nucleoside analogue reverse transcriptase inhibitors

Abacavir

b

b

Didanosine (formerly dideoxyinosine [ddI])

b

b

Emtricitabine

b

b

Lamivudine (formerly 3TC)c

b

b

Stavudine (formerly d4T)

b

b

Tenofovir

b

b

Zalcitabine (formerly 2'3'-dideoxycytidine [ddC])

b

b

Zidovudine (formerly azidothymidine [AZT])c

b

b

Entry and fusion inhibitors

Enfuvirtide

b

b

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