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A Guide to the Clinical Care of Women with HIV/AIDS, 2005 edition |
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Introduction
Editor
TOP
JEAN R. ANDERSON, MD
Associate Professor
Departments of Gynecology, Obstetrics, and Medicine
The Johns Hopkins University School of Medicine
Departments of Population and Family Health Sciences
The Johns Hopkins University School of Public Health
Recommendations change rapidly in HIV care, so the care provider is cautioned that this edition is dated 2005. For the most current and continually updated HIV/AIDS treatment guidelines, contact AIDSinfo at:
http://www.aidsinfo.nih.gov
This Guide contains information relating to general principles of medical care which should not be construed as specific instructions for individual patients. Some of the information may cite the use of a particular drug in a dosage, for an indication, or in a manner other than recommended. Therefore, the manufacturer’s package inserts should be consulted for complete prescribing information.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
HEALTH RESOURCES AND SERVICES ADMINISTRATION
HIV/AIDS BUREAU
PARKLAWN BUILDING, ROOM 7-13
5600 FISHERS LANE
ROCKVILLE MD 20857
http://www.hab.hrsa.gov
Publication date 2005
Forward TOP
A Guide to the Clinical Care of Women with HIV is a comprehensive clinical manual that addresses the primary care needs unique to women with HIV infection. The target audience is clinicians who provide primary care to women as well as those seeking a more in-depth understanding of how to care for women with HIV/AIDS. This 2005 edition of the guide, first published in 2001, has been updated and chapters have been added on international issues and nutrition.
A manual devoted specifically to the care of women with HIV is important. Because women are often challenged by social isolation, poverty, discrimination and lack of access to quality health care, they tend to be diagnosed later and to have poorer health status than men. They must contend with vulnerability related to reproductive and gender issues and domestic violence. Finally, women living with HIV are usually relied upon to meet the care needs of children and other family members, many of whom are also HIV-positive.
Dedication TOP
We want to acknowledge the women with HIV/AIDS who have been the inspiration for this Guide. Their strength is celebrated and their struggle is not forgotten. We offer this Guide as a tribute to them, and to the providers who have taken on this struggle and made it their own.
Acknowledgements TOP
A number of people made this Guide possible. Joan Holloway provided the framework for the Guide’s inception and development. Magda Barini-García, MD, MPH was the Project Officer who shepherded and oversaw the project. Helen Schietinger, the project manager, coordinated the production process and brought it to fruition. Laura Spofford designed the cover. For the 2005 edition, Patrice Lincoln was the typographer and designer and Bill Todd was the copyeditor and indexer.
For the 2005 Edition, the chapters were reviewed by the following experts:
- Dawn Averitt
- Founder and CEO, The Well Project
- Kirsten B. Balano, PharmD
- University of California, San Francisco
- John G. Bartlett, MD
- The Johns Hopkins University School of Medicine
- Gail V. Berkenblit, MD, PhD
- The Johns Hopkins University School of Medicine
- Jonathan Ellen, MD
- The Johns Hopkins University School of Medicine
- Thurma McCann Goldman, MD
- HIV/AIDS Bureau, HRSA
- Laura A. Guay MD
- The Johns Hopkins University School of Medicine
- Lisa Ruth Hirschhorn, MD
- Harvard University Medical School
- Gregory M. Lucas, MD, PhD
- The Johns Hopkins University School of Medicine
- Mary E. McCaul, PhD
- The Johns Hopkins University School of Medicine
- Howard L. Minkoff, MD
- State University of New York at Stonybrook School of Medicine
- Helen Miramontes, RN, MSN, FAAN
- School of Nursing, University of California, San Francisco (Emeritus)
- Ila Mulasi, MD
- University of Maryland School of Medicine
- Eula W. Pines, PhD, APRN, BC
- University of the Incarnate Word
- Timothy R. Sterling, MD
- Vanderbilt University School of Medicine
- Glenn J. Treisman, MD, PhD
- The Johns Hopkins University School of Medicine
- Ruth Ellen Tuomala, MD
- Harvard University Medical School
- Jonathan Zenilman, MD
- The Johns Hopkins University School of Medicine
Contributing Authors TOP
- Silvia M. Abularach, MD, MPH
- Assistant Professor
Department of Gynecology and Obstetrics
The Johns Hopkins University School of Medicine
Baltimore, MD, U.S.
- Carla S. Alexander, MD
- Assistant Professor of Medicine
University of Maryland School of Medicine
Baltimore, MD, U.S.
- Jean R. Anderson, MD
- Associate Professor
Departments of Gynecology, Obstetrics, and Medicine
The Johns Hopkins University School of Medicine
Departments of Population and Family Health Sciences
The Johns Hopkins University School of Public Health
Baltimore, MD, U.S.
- Barbara Aranda-Naranjo, PhD, RN, FAAN
- Scanlon Endowed Chair in Values Based Health Care
Nursing and Health Studies
Georgetown University
Washington, DC, U.S.
- Jared M. Baeten, MD, PhD
- Department of Medicine
Massachusetts General Hospital
Boston, MA, U.S.
- Patricia Barditch-Crovo, MD
- Assistant Professor
Division of Infectious Diseases
The Johns Hopkins University School of Medicine
Baltimore, MD, U.S.
- Magda Barini-García, MD, MPH
- Senior Medical Advisor
HRSA Center for Quality
HIV/AIDS Bureau, Health Resources and Services Administration
Rockville, MD, U.S.
- Victoria A. Cargill, MD, MSCE
- Director of Minority Research, Director of Clinical Studies
Office of AIDS Research
National Institutes of Health
Bethesda, MD, U.S.
- Connie Celum, MD, MPH
- Professor of Medicine and Adjunct Professor of Epidemiology
University of Washington
Seattle, WA, U.S.
- Laura Cheever, MD, ScM
- Deputy Associate Administrator
Chief Medical Officer
HIV/AIDS Bureau, Health Resources and Services Administration
Rockville, MD, U.S.
- Rachel Davis, RN, ACRN
- Field Nurse Case Manager
Concentra Integrated Services, Inc.
Pleasanton, TX, U.S.
- Judith Y. Ellis, MS
- Division of Training and Technical Assistance
HRSA Center for Quality
HIV/AIDS Bureau, Health Resources and Services Administration
Rockville, MD, U.S.
- Judith Feinberg, MD
- Professor of Medicine
University of Cincinnati College of Medicine
Cincinnati, OH, U.S.
- Henry Francis, MD
- Director, Center on AIDS and Other Medical Consequences of Drug Abuse (CAMCODA)
National Institute on Drug Abuse, National Institutes of Health
Bethesda, MD, U.S.
- Donna Futterman, MD
- Professor of Clinical Pediatrics, Albert Einstein College of Medicine
Director, Adolescent AIDS Program, Montefiore Medical Center
Bronx, NY, U.S.
- Monica Gandhi, MD, MPH
- Assistant ProfessorDivision of Infectious Diseases
University of California, San Francisco
San Francisco, CA, U.S.
- Ruth M. Greenblatt, MD
- Professor of Medicine, Epidemiology and Biostatistics
University of California at San Francisco
San Francisco, CA, U.S.
- Nancy A. Hessol, MSPH
- Assistant Professor Department of Medicine
University of California, San Francisco
San Francisco, CA, U.S.
- Dorothy Kasonde, MBCHB, MMed
- Antiretroviral Consultant
JHPIEGO/Zambia
Lusaka, Zambia
- Joyce Seiko Kobayashi, MD
- Associate Professor
University of Colorado Health Sciences Center
Denver, CO, U.S.
- Rani Lewis, MD
- Division Director for Maternal Fetal Medicine
Meharry School of Medicine
Nashville, TN, U.S.
- Janine Maenza, MD
- Clinical Assistant Professor
Division of Allergy and Infectious Diseases, Department of Medicine
University of Washington
Seattle, WA, U.S.
- Paul Pham, PharmD
- Research Associate
Division of Infectious Diseases
The Johns Hopkins University School of Medicine
Baltimore, MD, U.S.
- Moses Pounds, PhD
- Deputy Chief
Service Evaluation and Research Branch
Office of Science & Epidemiology
HIV/AIDS Bureau, Health Resources and Services Administration
Rockville, MD, U.S.
- Helen Schietinger, MA, ACRN
- HIV Policy Analyst
Washington, DC, U.S.
- Suniti Solomon, MD
- Founding Director
Y.R.Gaitonde (YRG) Centre for AIDS Research and Education
Chennai, India
- Valdiléa Gonçalves Veloso Dos Santos, MD, MSc
- Associate Researcher
Evandro Chagas Clinical Research Institute
Oswaldo Cruz Foundation
Rio Di Janiero, Brazil
- Chia C. Wang, MD, MS
- Assistant Professor Department of Medicine
Division of Infectious Diseases University of Washington
Seattle, WA, U.S.
Abbreviations
TOP
Nos A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Nos
SECTION TOP
3TC |
Lamivudine |
5-FU |
5-fluorouracil |
A
SECTION TOP
A-aDO2 |
Alveolar to arterial oxygen difference |
ABC |
Abacavir |
ACOG |
American College of Obstetricians and Gynecologists |
ADC |
AIDS dementia complex |
ADR |
Adverse drug reaction |
AFB |
Acid-fast bacilli |
AFI |
Amniotic fluid index |
AFP |
Alfa fetoprotein |
AGC |
Atypical glandular cells |
ALT |
Alanine aminotransferase |
Anti-HBc |
Hepatitis B core antibody |
Anti-HBs |
Hepatitis B surface antibody |
AP |
Antepartum |
APAP |
Acetaminophen |
APV |
Amprenavir |
ARV |
Antiretroviral |
ASA |
Aspirin (acetylsalicylic acid) |
ASC-H |
Anal squamous intraepithelial lesions—cannot exclude HSIL |
ASCUS |
Anal squamous intraepithelial lesions—undetermined significance |
ASIL |
Anal squamous intraepithelial lesions |
ATV |
Atazanavir |
AUC |
Area under the concentration-time curve |
AZT |
Zidovudine |
B
SECTION TOP
bDNA |
Branched DNA |
bid |
2 times daily |
biw |
2 times weekly |
BMI |
Body mass index |
BV |
Bacterial vaginosis |
bx |
Biopsy |
C
SECTION TOP
CASI |
Computer assisted self-interviewing |
CBC |
Complete blood count |
CBV |
Combivir |
CDC |
Centers for Disease Control and Prevention |
CEA |
Carcinoembryonic antigen |
CES-D |
Center for Epidemiological Studies Depression scale |
CI |
Confidence interval |
CIN1, -2, -3 |
Cervical intraepithelial neoplasia, grade 1 (2, 3) |
CLIA |
Clinical Laboratory Improvements Amendments |
Cmax |
Peak serum concentration |
Cmin |
Trough serum concentration |
CMV |
Cytomegalovirus |
CNS |
Central nervous system |
CPK |
Creatinine phosphokinase |
CrCl |
Creatinine clearance |
CSF |
Cerebrospinal fluid |
CST |
Contraction stress test |
CT |
Computed tomography |
CVD |
Cardiovascular disease |
CXR |
Chest x-ray |
D
SECTION TOP
d |
Day |
d/c |
Discontinue |
d4T |
Stavudine |
ddC |
Zalcitibine |
ddI |
Didanosine |
DEXA |
Dual-energy X-ray absorptiometry |
DFA |
Direct fluorescent antibody |
DLV |
Delavirdine |
DMPA |
Depo-medroxyprogesterone acetate |
DOT |
Directly observed therapy |
DRESS |
Drug rash, eosinophilia, systemic symptoms |
DS |
Double strength |
dT |
Diphtheria/tetanus toxoid |
DVT |
Deep venous thrombosis |
E
SECTION TOP
EBV |
Epstein-Barr virus |
EC |
Enteric coated |
EFV |
Efavirenz |
ELISA |
Enzyme-linked immunosorbent assay |
EM |
Electron microscopy |
EMG |
Electromyelogram |
ERCP |
Endoscopic retrograde cholangiopancreatography |
ESR |
Erythrocyte sedimentation rate |
ETOH |
Ethyl alcohol |
F
SECTION TOP
FA |
Fluorescent antibody |
FDA |
Food and Drug Administration |
FSH |
Follicle stimulating hormone |
FTA |
Fluorescent treponemal antibody |
FTC |
Emtracitabine |
FUO |
Fever of unknown origin |
G
SECTION TOP
G6PD |
Glucose-6-phosphate dehydrogenase |
GBS |
Group B Streptococci |
GBV-C |
GB virus type C |
GC |
Gonorrhea culture |
G-CSF |
Granulocyte-colony stimulating factor |
GI |
Gastrointestinal |
GTT |
Glucose tolerance test |
H
SECTION TOP
H&E |
Hematoxylin and eosin |
HAART |
Highly active antiretroviral therapy |
HAD |
HIV-associated dementia |
HAV |
Hepatitis A virus |
HBIG |
Hepatitis B immunoglobulin |
HbsAg |
Hepatitis B surface antigen |
HBV |
Hepatitis B virus |
HCG |
Human chorionic gonadotropin |
HCSUS |
HIV Cost and Services Utilization Study |
HCV |
Hepatitis C virus |
HDL |
High-density lipoprotein |
HERS |
HIV Epidemiology Research Study |
hgc |
Hard gel capsule |
HLA |
Human leukocyte antigen |
HPV |
Human papillomavirus |
hr |
Hour |
HRT |
Hormone replacement therapy |
HSIL |
High-grade squamous intraepithelial lesion |
HSV |
Herpes simplex virus |
HTLV |
Human T-cell lymphotropic virus |
I
SECTION TOP
IDSA |
Infectious Disease Society of America |
IDU |
Injection drug use/user |
IDV |
Indinavir |
IgA |
Immunoglobulin A (E, G, M, etc.) |
im |
Intramuscularly |
INH |
Isoniazid |
INR |
International normalization ratio |
IP |
Intrapartum |
IUD |
Intrauterine device |
iv |
Intravenously |
IVP |
Intravenous pyelogram |
J
SECTION TOP
JC virus |
(Initials of index case of PML) |
K
SECTION TOP
KOH |
Potassium hydroxide |
KS |
Kaposi sarcoma |
L
SECTION TOP
LAAM |
L-a-acetyl-methadol |
LCR |
Ligase chain reaction |
LDH |
Lactic dehydrogenase |
LDL |
Low-density lipoprotein |
LFT |
Liver function test |
LIP |
Lymphoid interstitial pneumonia |
LP |
Lumbar puncture |
LPV |
Lopinavir |
LTS |
Long-term survival |
M
SECTION TOP
MAC |
Mycobacterium avium complex |
MCMD |
Minor cognitive-motor disorder |
MDD |
Major depressive disorder |
MDMA |
Methylenedioxymethamphetamine (ecstasy) |
MMR |
Measles, mumps and rubella |
mo |
Month |
MPA |
Medroxyprogesterone acetate |
MRI |
Magnetic resonance imaging |
MSM |
Men who have sex with men |
MTCT |
Mother-to-child transmission |
MTPA |
Methoxy (trifluoromethyl) phenylacetic acid |
N
SECTION TOP
N/V/D |
Nausea/vomiting/diarrhea |
N-9 |
Nonoxynol-9 |
NASBA |
Nucleic acid sequence-based amplification |
NFV |
Nelfinavir |
NIDU |
Non-injection drug use |
NIH |
National Institutes of Health |
NIMH |
National Institute of Mental Health |
NNRTI |
Non-nucleoside reverse transcriptase inhibitor |
NOS |
Not otherwise specified |
NRTI |
Nucleoside reverse transcriptase inhibitor |
NSAID |
Nonsteroidal anti-inflammatory drug |
NST |
Non-stress test |
O
SECTION TOP
O&P |
Ova and parasites |
OC |
Oral contraceptive |
OI |
Opportunistic infection |
OR |
Odds ratio |
P
SECTION TOP
PACTG |
Pediatric AIDS Clinical Trials Group |
PACTS |
Perinatal AIDS Collaborative Transmission Study |
PaO2 |
Partial pressure of oxygen |
PCN |
Penicillin |
PCP |
Pneumocystis jiroveci (formerly carinii) pneumonia |
PCR |
Polymerase chain reaction |
PEP |
Postexposure prophylaxis |
PGL |
Persistent generalized lymphadenopathy |
PI |
Protease inhibitor |
PID |
Pelvic inflammatory disease |
PK |
Pharmacokinetic |
PLWHA |
People living with HIV/AIDS |
PML |
Progressive multifocal leukoencephalopathy |
PMTCT |
Prevention of mother-to-child transmission |
po |
By mouth |
PP |
Postpartum |
PPD |
Purified protein derivative |
PSN |
Predominantly sensory neuropathy |
PTSD |
Post-traumatic stress disorder |
PV |
Vaginally |
Q
SECTION TOP
qd |
1 time daily |
qm |
1 time monthly |
qod |
Every other day |
qw |
1 time weekly |
R
SECTION TOP
r/o |
Rule out |
RIBA |
Recombinant immunoblot assay |
RNA |
Ribonucleic acid |
RPR |
Rapid plasma reagin |
RT-PCR |
Reverse transcriptase polymerase chain reaction |
RTV |
Ritonavir |
S
SECTION TOP
sc |
Subcutaneously |
sgc |
Soft gel capsule |
SI |
Syncytium-inducing |
SIL |
Squamous intraepithelial lesions |
SIV |
Simian immunodeficiency virus |
SMX |
Sulfamethoxazole |
SOC |
States of Change behavior theory |
SP |
Sulfadioxone pyrimethamine |
sq |
Subcutaneous |
SQV |
Saquinavir |
SS |
Single strength |
SSRI |
Selective serotonin reuptake inhibitor |
STI |
Sexually transmitted infection |
sx |
Symptom |
T
SECTION TOP
TAM |
Thymidine-associated mutation |
TB |
Tuberculosis |
Td |
Tetanus/diphtheria |
TDM |
Therapeutic drug monitoring |
TE |
Toxoplasmic encephalitis |
TIBC |
Total iron binding capacity |
tid |
3 times daily |
tiw |
3 times weekly |
TMP |
Trimethoprim |
TSH |
Thyroid-stimulating hormone |
TSS |
Toxic shock syndrome |
TST |
Tuberculin skin test |
U
SECTION TOP
UNAIDS |
United Nations Program on AIDS |
USPHS |
United States Public Health Service |
V
SECTION TOP
VCT |
Voluntary counseling and testing |
VDRL |
Venereal Disease Research Laboratory slide test |
VZV |
Varicella zoster virus |
W
SECTION TOP
WBC |
White blood cell |
WHO |
World Health Organization |
WIHS |
Women’s Interagency HIV Study |
WITS |
Women and Infants Transmission Study |
Y
SECTION TOP
|