Drug Treatment of AIDS Complications

Tuberculosis (TB)

viagra The treatment for tuberculosis depends on whether the infection is latent or active.

Latent tuberculosis is treated with isoniazid (which is usually taken with pyridoxine to help prevent peripheral neuropathy) or the combination of rifampin and pyrazinamide. Active tuberculosis is usually treated with a combination of four drugs: isoniazid, rifampin, pyrazinamide and ethambutol. Pyridoxine is also taken to prevent peripheral neuropathy.

Herpes Simplex Virus (HSV)

Herpes cannot be cured but it can be treated. There are three treatments available: acyclovir, valacyclovir and famciclovir. In some cases herpes does not respond to these drugs, probably due to the emergence of resistant strains. The most common treatment for acyclovir-resistant herpes is foscarnet.

Candidiasis

There are three types of candidiasis: oral, vaginal and esophageal candidiasis. Oral candidiasis is treated with liquids or lozenges containing clotrimazole, nystatin or amphotericin B. If these drugs are unsuccessful, more potent drugs such as ketoconazole, itraconazole or fluconazole can be taken.

Vaginal candidiasis is treated with a cream or vaginal suppository containing clotrimazole, miconazole, terconazole, tioconazole or butoconazole. If these drugs are unsuccessful, more potent drugs such as ketoconazole, itraconazole or fluconazole can be taken.

Esophageal candidiasis is considered to be more severe and harder to treat than either oral thrush or vaginal yeast infections. The drugs used are itraconazole (often taken with flucytosine to increase effectiveness), fluconazole or ketoconazole. Drug-resistant candidiasis is treated with IV amphotericin B.

Non-Hodgkin’s Lymphoma (NHL)

The standard treatments for lymphoma include surgery, radiation or chemotherapy. Chemotherapy for Non-Hodgkin’s Lymphoma almost always involves a combination of three or more compounds and there are three generally recommended regimens:

• mBACOD -- a combination of methotrexate, bleomycin, Adriamycin, cyclophosphamide, Oncovin, and dexamethasone
• CHOP -- a combination of cyclophosphamide, hydroxydaunomycin (doxorubicin), Oncovin, and prednisone
• CDE -- a combination of cyclophosphamide, doxorubicin, and etoposide.

Chemotherapy can cause CD4 cells and other white blood cells to decrease. This can increase the risk of developing infections like Pneumocystis carinii pneumonia (PCP). It is recommended that all HIV-infected patients undergoing lymphoma chemotherapy receive prophylaxis to prevent PCP (e.g. TMP/SMX). Chemotherapy can have a serious effect on white blood cell counts (WBCs) and red blood cell counts (RBCs). There are treatments available to help manage these two serious side effects during chemotherapy. For decreased WBCs, Neupogen and Leukine are usually started within days after chemotherapy is initiated. RBCs can be decreased during chemotherapy, which can cause anemia and fatigue. Blood transfusions are sometimes recommended, along with the drugs leucovorin calcium (Leukovorin) and/or epoetin-alfa (Procrit).

Salmonellosis

Salmonellosis is treated with antibiotics such as ciprofloxacin, ampicillin, chloramphenicol and sulfamethoxazole/trimethoprim.

Bacillary Angiomatosis

Bacillary angiomatosis is treated with antibiotics.

Viral Hepatitis

The usual treatment of interferon alfa 2b is not approved for HIV patients. The antiretroviral drug lamivudine (3TC) is sometimes effective in treating chronic hepatitis.

Human Papillomavirus (HPV)

The only treatments available are procedures to remove or destroy irregular cells such as those that make up genital warts or cervical cancer. Treatment depends on the location and the severity of the disease and can include cryotherapy, laser treatment, LEEP (loop electrical excision procedure), surgery/cold-knife cone biopsy or radical surgery/radiation/chemotherapy.

Topical medications such as podofilox, podophyllum, trichloroacetic acid, and imiquimod are used only for the treatment of genital warts.

Cryptosporidiosis

There are a number of drugs under investigation, including nitazoxanide (NTZ), letrazuril, paromomycin, diclazuril and octreotide. The antibiotics azithromycin, clarithromycin, and roxithromycin are used occasionally.

Pneumocystis Carinii Pneumonia (PCP)

The most effective treatment for PCP is a combination of the drugs trimethoprim and sulfamethoxazole (TMP-SMX). Unfortunately, many people are allergic to the sulfur in sulfamethoxazole. Alternative treatments for PCP include pentamidine, clindamycin-primaquine, trimethoprim (TMP)-dapsone, Trimetrexate-leucovorin, aerosolized pentamidine (NebuPent) and prednisone, which can be taken to control the symptoms of PCP.

Kaposi’s Sarcoma (KS)

KS cutaneous lesions of the skin do not necessarily need to be treated.

There are localized therapies available such as alitretinoin (Panretin Gel) or locally injected vinblastine, which treat the lesions, but are generally not effective in prevention. Systemic therapy can treat and prevent the lesions but has serious side effects. KS lesions in the digestive tract and in the lungs require systemic therapy such as antiretroviral therapy (HAART), Interferon alfa (Roferon-A, Intron A), liposomal chemotherapy (Doxil or DaunoXome) or standard chemotherapy (doxorubicin, vincristine, bleomycin, etoposide, paclitaxel).

Cryptococcal Meningitis

Drugs used in the treatment of Cryptococcal meningitis include amphotericin B, flucytosine and fluconazole.

Toxoplasmosis

Toxoplasmosis is treated with pyrimethamine and sulfadiazine.

Progressive Multifocal Leukoencephalopathy (PML)

Unfortunately, there are no treatments that have proven to be effective for PML.

Mycobacterium Avium Complex (MAC)

MAC is treated with the following drugs: clarithromycin, azithromycin, ethambutol, rifampin, rifabutin, ciprofloxacin, and amikacin.

Cytomegalovirus (CMV)

CMV is treated using powerful antiviral drugs. In most cases CMV treatment consists of two phases: induction therapy (to treat the disease) and maintenance therapy (to prevent the virus causing disease again in the future). Intravenous foscarnet and ganciclovir (IV induction and oral maintenance) can be used to treat CMV retinitis and all other forms of CMV disease. IV cidofovir (probenecid must also be taken to prevent kidney damage) has been studied only for CMV retinitis but may also be effective for other forms of the disease.

Valganciclovir is the first oral treatment for CMV. Ganciclovir implants are used only for the treatment of CMV retinitis and do not prevent CMV disease occurring in other parts of the body, including the other eye. Fomivirsen is approved for injection into the eye when any of the previous therapies have failed.

Wasting Syndrome

There are a number of treatments available to control symptoms of reduced appetite. Drugs commonly used include antiemetics to control nausea and vomiting, antidiarrheals for diarrhea, and appetite stimulants. Treatments such as Marinol (gel-caps containing THC, the active ingredient in marijuana) and megestrol acetate have also been shown to help boost appetite.