Product Selection for Opportunistic Infections

Affordable healthcare Product Selection for Opportunistic Infections IDA HIV/AIDS Group, Nienke Gruppelaar “HIV does not kill, opportunistic infections do!” Frequency of OI (US) Male(%) Female(%) Pneumocystis carinii pneumonia Kaposi sarcoma Esophageal candidiasis Wasting syndrome Mycobacterium avium complex Pulmonary tuberculosis Extrapulmonary cryptococcosis HIV encephalopathy Cytomegalovirus retinitis Cytomegalovirus disease Toxoplasmosis of brain Chronic cryptosporidiosis Recurrent pneumonia Extrapulmonary tuberculosis Chronic herpes simplex 35.7 12.5 11.9 7.8 6.4 4.8 4.3 4.2 3.8 3.4 2.9 2.9 2.3 2.0 2.0 33.7 1.3 19.9 9.0 6.8 6.6 3.1 3.2 3.4 2.1 3.8 1.5 7.1 3.0 4.1 -2- 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 -3- 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* -4- 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 -5- Fungal Infections Candidiasis (oral trush), Cryptococcal Menigitis, Cryptosporidiosis Medicines: • Clotrimazole (cream, vaginal tabs) • Miconazole (oral tabs) • AmphotericineB (injection) * • Fluconazole (caps) -6- 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) -7- 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 -8- Malignancies Kaposi's sarcoma, CNS lymphoma, Non Hodgkin's lymphoma, Cervical cancer Medicines: • Vincristine, Vinblastine • Etoposide • Doxorubicine All injections, Specialised care is needed -9- Other infections • Diarrhoea: ORS • Worm infections: Albendazole • Malaria: Quinine, Artmether, Artesunate - 10 - 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. - 11 - 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 - 12 -