Management

Opportunistic infection - treatment of specific infection (see page 494). With known HIV + ve patients, invasive procedures such as biopsy are often avoided and trials of therapy are administered, e.g. cerebral toxoplasmosis - trial of pyrimethamine and sulphadiazine, monitored with CT scanning. If lesions do not resolve -ยป biopsy (? lymphoma).

Cerebral toxoplasmosis

Once AIDS is established, fatal infection or malignancy is inevitable. For this reason, treatments which boost the immune system or influence virus replication are considered.

- Zidovudine (AZT), by interfering with nucleic acid synthesis, blocks HIV DNA formation and reduces virus replication. AZT is used at present in ARC and AIDS and prolongs survival. When given with Probenecid the dosage is reduced without loss of effectiveness. AZT also reduces rate of transmission from infected mother to baby.

Immune modulators, e.g. Interferon and Interleukin 2, stimulate the immune system and may be of value.

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