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They are intended to complement more comprehensive textbooks, journals, and other relevant informational materials They will require periodic updates based on local data and clinical experiences
2. Objectives and Targets 2.1. Objectives • To provide standardized simplified preventive (prophylaxis) and management approaches to opportunistic infections common in Ethiopia • To promote evidence-based, safe and rational use of OI drugs • To demonstrate management of OI in the context of ART • To prepare a reference manual for health service providers, program managers, and people living with HIV 2.2. Targets • Health care workers caring for people infected with HIV • HIV/AIDS program managers, health planners, and researchers • Institutions involved in OI drug procurement and supply chain management
3. Management of Common Opportunistic Infections Opportunistic infections are the predominant causes of morbidity and mortality among HIV-infected patients. Main areas affected are the nervous, gastro-intestinal and respiratory systems, and the skin. The level of immunity determines the occurrence and type of opportunistic infections. In general milder infections, such as herpes zoster and other skin infections, occur early whereas serious life- threatening infections such as CNS toxoplasmosis and cryptococcal meningitis occur later with severe immunity. Some lifethreatening infections, such as pneumonia and TB, may occur early as well as later. When TB occurs later it is atypical, more disseminated and more extra pulmonary. Although these guidelines are organised by systems, patients must be assessed and managed holistically since HIV disease is a multi-systemic condition. Concurrent infectious and non-infectious conditions, such as diabetes, hypertension and bronchial asthma, sometimes occur with OIs, and require appropriate management. Nonopportunistic pathogens such as M. Tuberculosis, Entamoeba histolytica or Strongyloids stercoralis, etc are frequent, severe and recurrent among patients with HIV disease. All patients with OI must be followed up after initiation of treatment; if there is no improvement, patients may be referred for better care or more thorough investigation if facilities permit. All patients must be enrolled in chronic HIV care services, including ART, after standard clinical and immunological assessments of eligibility are conducted. Treatment of OIs entails administration of different drugs, therefore drug interactions, toxicities, and overlap toxicities should always be addressed, especially in patients already on ART and/or TB DOTS.
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