HIV-INFECTION - RECOMMENDATIONS FOR THE M ANAGEMENT OF ASYMPTOMATIC ADULTS AND SELECTED CLINICAL SYNDROMES

This paper presents recommendations on the care of HIV infected adults based upon the authors' personal experience with close to 700 patient s in a multiprofessional pilot center. This medical care has 5 main ob jectives: 1) Promotion of good health (through standard recommendation of hygiene, health habits and regular checkups); 2) prevention of inf ectious complications (through detection of latent pathogens, chemopro phylaxis, vaccination and avoidance of risky exposures); 3) Treatment of complications (mainly infectious, through early diagnosis and prope r treatment); 4) Delay of HIV disease progression (through timely and properly chosen antiretroviral therapy); 5) Reduction of HIV infection spread from index case to others (through promotion of responsible be havior and avoidance of pregnancy and HIV exposure to others). Studies for evaluating global health and immunologic status and carriage of p otential pathogens are discussed as well as the criteria and timing fo r chemoprophylaxis for tuberculosis and P carinii pneumonia (PCP). Alg orithms for the management of major clinical syndromes are presented: Diarrhea (afebrile, mostly parasitic, versus febrile, frequency bacter ial); Pneumonia (lobar mostly bacterial versus interstitial, frequentl y PCP especially if lymphogenic and not receiving PCP prophylaxis); Br ain mass lesion (most commonly toxoplasmosis). Finally, the evaluation and diagnostic possibilities of febrile patients is presented, based upon the immunologic status and associated symptoms.