Affordable healthcare

Product Selection for Opportunistic InfectionsIDA HIV/AIDS Group, Nienke Gruppelaar

“HIV does not kill, opportunistic infections do!”

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Frequency of OI (US)

Male(%)Female(%)Pneumocystis carinii pneumonia 35.7 33.7Kaposi sarcoma 12.5 1.3Esophageal candidiasis 11.9 19.9Wasting syndrome 7.8 9.0Mycobacterium avium complex 6.4 6.8Pulmonary tuberculosis 4.8 6.6Extrapulmonary cryptococcosis 4.3 3.1HIV encephalopathy 4.2 3.2Cytomegalovirus retinitis 3.8 3.4Cytomegalovirus disease 3.4 2.1Toxoplasmosis of brain 2.9 3.8Chronic cryptosporidiosis 2.9 1.5Recurrent pneumonia 2.3 7.1Extrapulmonary tuberculosis 2.0 3.0Chronic herpes simplex 2.0 4.1

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Pneumocystis Carinii Pneumonia (PCP)

• Very common among HIV-infected people

• PCP almost always occurs when CD4 < 200

• First choice Co-Trimoxazole oral tablets (960 mg or higher dosage), 3 times a day

• If CD4<200, Profylaxis Co-Trimoxazole 960 mg once a day

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Bacterial infections and Protozoal Infections

TB, PCP (pneumonia),Toxoplasmosis, gastro-intestinal infections

Medicines:• Azithromycine * (tabs), Clarithromycine * (tabs)• Ceftriaxone (tabs, injection)• Cefixime (tabs)• Ciprofloxacin (tabs), Ofloxacin (tabs), Levofloxacin• Co-trimoxazole, (CTX) prophylaxis daily (tabs, injection)• Clindamycine (caps)• Tinidazole (caps), Metronidazole• Pyrimethamine, Sulfadiazine*

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Effect of TB on HIV disease

• TB is the most frequent ‘opportunistic’ infection in HIV+ people

• TB is the leading cause of death in HIV+ people

• TB may occur at any moment in HIV disease but the risk increases as the disease progresses

• TB treatment: Attention to overlapping drug toxicities & drug-drug interactions

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Fungal Infections

Candidiasis (oral trush), Cryptococcal Menigitis, Cryptosporidiosis

Medicines:• Clotrimazole (cream, vaginal tabs) • Miconazole (oral tabs)• AmphotericineB (injection) *• Fluconazole (caps)

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Miconazole for treatment of Oral candidiasis

• IDA supplies a convenient once daily dosage form of Miconazole

• Cost-effective treatment for oral candidiasis

• Convenient, long-acting topical drug which can be used at lowest level of care (home based care workers)

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Viral Infections

Cytomegalovirus (CMV), Herpes Zoster, Hepatitis, Herpes Simplex

Medicines:•Aciclovir (tabs, IV)•Ganciclovir (caps, IV) *•Valganciclovir (tabs) *

Ganciclovir & Valganciclovir are relative expensive, and require skilled healthcare workers in high-end resource setting

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Malignancies

Kaposi's sarcoma, CNS lymphoma, NonHodgkin's lymphoma, Cervical cancer

Medicines:• Vincristine, Vinblastine• Etoposide • Doxorubicine

All injections, Specialised care is needed

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Other infections

• Diarrhoea: ORS

• Worm infections: Albendazole

• Malaria: Quinine, Artmether, Artesunate

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Palliative Care

• Reliefing pain, improving quality of life

• Physical pain, Fevers, night sweats, poor sleep, weight loss– Paracetamol (tab 500mg), Codeine (tab), Ibuprofen

(tab) Diclofenac (tab), Multivitamins (tabs, syrup), Diazepam (tab 5mg, injection 10mg/2ml)

• Physical pain (severe)– Opioids: Morphine (tabs, oral solution,

injection)

• Psychological effects: anger, anxiety, depression, fatigue/lethargy, loss of appetite etc.

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Conclusion

• Treatment OIs essential part of HIV/AIDS programs

• Effective treatment for most frequent OIs is available– Not all medicines are currently

available from a generic source

• Total overview: Price Indicator IDA