* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Human Herpesvirus-8
Survey
Document related concepts
Brucellosis wikipedia , lookup
Sexually transmitted infection wikipedia , lookup
Meningococcal disease wikipedia , lookup
Oesophagostomum wikipedia , lookup
Onchocerciasis wikipedia , lookup
Eradication of infectious diseases wikipedia , lookup
Chagas disease wikipedia , lookup
Coccidioidomycosis wikipedia , lookup
Schistosomiasis wikipedia , lookup
Leptospirosis wikipedia , lookup
Leishmaniasis wikipedia , lookup
Visceral leishmaniasis wikipedia , lookup
Transcript
Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents Human Herpesvirus-8 Slide Set Prepared by the AETC National Coordinating Resource Center based on recommendations from the CDC, National Institutes of Health, and HIV Medicine Association/Infectious Diseases Society of America About This Presentation These slides were developed using recommendations published in July 2013. The intended audience is clinicians involved in the care of patients with HIV. Certain sections have been updated to reflect changes in the published guidelines. Users are cautioned that, because of the rapidly changing field of HIV care, this information could become out of date quickly. Finally, it is intended that these slides be used as prepared, without changes in either content or attribution. Users are asked to honor this intent. – AETC National Coordinating Resource Center http://www.aidsetc.org www.aidsetc.org July 2013 2 Human Herpesvirus-8 Disease Epidemiology Clinical Manifestations Diagnosis Prevention Treatment Monitoring Preventing Recurrence Considerations in Pregnancy www.aidsetc.org July 2013 3 HHV-8 Disease: Epidemiology Associated with Kaposi sarcoma (KS) (all forms) and certain neoplastic and lymphoproliferative disorders (primary effusion lymphoma [PEL]), multicentric Castleman disease) HHV-8 seroprevalence in United States: 1-5% Higher in MSM regardless of HIV serostatus (20-77%) Higher in some Mediterranean countries (10-20%) and parts of sub-Saharan Africa (30-80%) www.aidsetc.org July 2013 4 HHV-8 Disease: Epidemiology (2) Pathogenesis of HHV-8 disease is unclear KS and PEL usually seen in advanced immunosuppression (CD4 count <200 cells/µL), but can occur at any CD4 count KS incidence up to 30% among AIDS patients in United States before use of effective ART Dramatically lower incidence in recent years ART prevents and may regress KS lesions Ganciclovir, foscarnet, and cidofovir given for CMV treatment may prevent or suppress KS Castleman disease and PEL remain rare www.aidsetc.org July 2013 5 HHV-8 Disease: Clinical Manifestations Most with chronic HHV-8 infection are asymptomatic Acute infection may cause fever, rash, lymphadenopathy, bone marrow failure, occasional rapid progression to KS Castleman disease: generalized adenopathy, fever; may progress to multiorgan failure PEL: pleural, pericardial, or abdominal effusions; mass lesions are less common www.aidsetc.org July 2013 6 HHV-8 Disease: Clinical Manifestations (2) KS presentation varies widely Most have nontender, purplish, indurated skin lesions Intraoral lesions are common Visceral dissemination may occur Credit: P. Volberding, MD; UCSF Center for HIV Information Image Library www.aidsetc.org July 2013 7 HHV-8 Disease: Diagnosis Routine screening for HHV-8 is not indicated Quantitation of HHV-8 by PCR has no established role in diagnosis KS: biopsy Consult with specialist for diagnosis of other suspected HHV-8 disease www.aidsetc.org July 2013 8 HHV-8 Disease: Prevention Preventing Exposure HHV-8 shedding in saliva and genital secretions may transmit HHV-8 to uninfected partners Interventions to prevent exposure to HHV-8 not likely to be highly effective, have not been validated; are not recommended Preventing Disease Toxicity of anti-HHV-8 therapy outweighs potential benefits Early initiation of ART likely to be most effective prevention measure www.aidsetc.org July 2013 9 HHV-8 Disease: Treatment ART for all: initiate or optimize Limited studies of HHV-8-specific agents KS: Ganciclovir, foscarnet may regress lesions; cidofovir ineffective in 1 study Chemotherapy if visceral KS; consider if widely disseminated cutaneous KS Castleman disease: Preferred: valganciclovir 900 mg PO BID for 3 weeks or ganciclovir 5 mg/kg IV Q12H for 3 weeks or valganciclovir 900 mg PO BID + zidovudine 600 mg PO Q6H for 7-12 days Alternative: rituximab for 4-8 weeks (effective as alternative or adjunctive therapy; associated with subsequent exacerbation or emergence of KS) PEL: Chemotherapy IV ganciclovir or PO valganciclovir may be useful adjunct Consult with specialist www.aidsetc.org July 2013 10 HHV-8 Disease: Starting ART Early ART initiation is likely to prevent KS and PEL ART should be given to all with KS, muticentric Castleman disease, or PEL Insufficient evidence to support specific ARV regimens www.aidsetc.org July 2013 11 HHV-8 Disease: Monitoring and Adverse Events IRIS reported in HHV-8-infected patients who initiate ART KS: new onset KS or exacerbations of previously stable disease Castleman disease: clinical decompensation PEL: no data ART is key component of therapy and should not be delayed www.aidsetc.org July 2013 12 HHV-8 Disease: Preventing Recurrence ART recommended for all with HHV-8 disease May prevent KS progression or recurrence www.aidsetc.org July 2013 13 HHV-8 Disease: Considerations in Pregnancy HHV-8 seropositivity does not appear to affect pregnancy outcome; screening for HHV-8 not indicated Antiviral therapy for HHV-8 infection during pregnancy is not recommended Diagnosis as in nonpregnant women For treatment, consult with specialist Perinatal transmission occurs infrequently, higher risk with higher maternal antibody titer; may be associated with increased infant mortality www.aidsetc.org July 2013 14 Websites to Access the Guidelines http://www.aidsetc.org http://aidsinfo.nih.gov www.aidsetc.org July 2013 15 About This Slide Set This presentation was prepared by Susa Coffey, MD, for the AETC National Resource Center in July 2013. See the AETC NRC website for the most current version of this presentation: http://www.aidsetc.org www.aidsetc.org July 2013 16