Ebook HIV tại Việt Nam hướng dẫn lâm sàng cho nhân viên y tế - Phiên bản 1 năm 2014

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Phiên bản 1 2014

Hướng dẫn lâm sàng cho Nhân viên y tế

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HIV in Vietnam: A Clinical Guide for the Medical Practitioner

First Edition, 2014

Bich-Thuy Sim, MD

Senior Technical Advisor Harvard Medical School AIDS Initiative in Vietnam

Ho Chi Minh City, Vietnam Instructor of Medicine Division of General Medicine and Primary Care

Beth Israel Deaconess Medical Center / Harvard Medical School

Boston, MA, USA

Howard Libman, MD

Director, HIV Program Healthcare Associates Education Section Chief Division of General Medicine and Primary Care

Beth Israel Deaconess Medical Center Professor of Medicine Harvard Medical School Boston, MA, USA

This manual was supported by the Cooperative Agreement Number 5U2GPS001177-05 with the United States Center for Disease Control and Prevention (CDC) The contents of the manual are the sole responsibility of the authors and do not necessarily represent the official views of the CDC or the US Government

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Since the first HIV infection reported in 1990 to now, there have been an estimated 250,000 persons living with HIV (PLHIV) in Vietnam with the vast majority (>80%) in the 20-39 year-old population Vietnam is experiencing a highly concentrated HIV epidemic, with infections primarily focused among most

at risk persons (MARPs) including injection drug users (IDUs), female sex workers (FSWs), and men who have sex with men (MSM) Recent trends show a significant decrease in IDUs living with HIV in contrast to an increase in MSM living with HIV In addition, there has been a steady increase since 2002 in the percentage of women infected with HIV to its currently estimated 31% of newly reported infections, speculated to be transmitted via heterosexual contact

As of December 2011, there were reported HIV cases in 77% of the communes, 98% of the districts, and in all 63 provinces

With donor support from international organizations, the Vietnam Ministry of Health (MOH) and provincial health services provide antiretroviral therapy (ART)

to approximately 54% of all adults and children who are eligible for treatment There remains much work to be undertaken in the areas of prevention, testing and counseling, treatment and care of HIV patients in Vietnam As part of the continued need for expert advice and recommendations for addressing the epidemic in Vietnam and in striving for improved quality of care and life for these individuals, we hope to provide a quick reference manual for health care workers, particularly clinicians, directly involved in the care of these patients This manual

is based on the Vietnam MOH guidelines and meant to be relevant specifically to the situation in Vietnam

This clinical manual represents a collaborative effort over the past five years among leaders and experts involved in the care of HIV patients in Vietnam and is designed to be a dynamic one with continued annual updates and future editions

As such, we want to acknowledge the incredible efforts of all those involved, directly and indirectly, in the compilation of this first edition In addition to the editors and authors listed in the book, we want to acknowledge the significant assistance and contributions of Dr Nguyen Tran Chinh, Dr Dang Bich Thao, Dr Phi Huynh-Do, and countless other physicians, nurses, pharmacists, and other healthcare professionals

Most importantly, we would like to thank and dedicate this manual to the individu-als living with HIV who allow us the privilege of taking care of them during this vulnerable time in their lives

Bich-Thuy (TWEE) Sim, M.D and Howard Libman, M.D

Editors-in-Chief

EDITORIAL NOTE

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DONN COLBY, MD, MPH

SENIOR CLINICAL RESEARCH PHYSICIAN, SEARCH, THAI RED CROSS AIDS RESEARCH CENTER

BANGKOK, THAILAND

SENIOR TECHNICAL ADVISOR, CENTER FOR APPLIED RESEARCH ON MEN AND HEALTH (CARMAH)

COUNTRY MEDICAL DIRECTOR (2004-2013), HARVARD MEDICAL SCHOOL (HMS) AIDS INITIATIVE IN VIETNAM (HAIVN)

HO CHI MINH CITY, VIETNAM

MARCELO FERNANDEZ, MD

COUNTRY MEDICAL DIRECTOR (2007-2012), HMS AIDS INITIATIVE IN VIETNAM (HAIVN)

HANOI, VIETNAM

MEDICAL COORDINATOR, MEDECINS SANS FRONTIERES (MSF) / DOCTORS WITHOUT BORDERS

YANGON, MYANMAR

NGUYEN QUOC THAI, MD

DEPUTY MEDICAL DIRECTOR (2012-2013), HMS AIDS INITIATIVE IN VIETNAM (HAIVN)

HANOI, VIETNAM

NGUYEN HUU CHI, MD

INSTRUCTOR OF MEDICINE, INFECTIOUS DISEASES

HO CHI MINH UNIVERSITY OF MEDICINE AND PHARMACY

SURESH RANGARAJAN, MD

ACTING DIRECTOR AND TECHNICAL ADVISOR

HIV/AIDS CLINICAL CARE AND TREATMENT, FAMILY HEALTH INTERNA-TIONAL (FHI360)

RACHEL BURDON, MD

SENIOR TECHNICAL OFFICER (2005-2013)

HIV CLINICAL CARE AND TREATMENT, FAMILY HEALTH INTERNATIONAL (FHI360)

HANOI, VIETNAM

CONTRIBUTING EDITORS

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DONN COLBY, MD, MPH

SENIOR CLINICAL RESEARCH PHYSICIAN, SEARCH, THAI RED CROSS AIDS RESEARCH CENTER

BANGKOK, THAILAND

SENIOR TECHNICAL ADVISOR, CENTER FOR APPLIED RESEARCH ON MEN AND HEALTH (CARMAH)

COUNTRY MEDICAL DIRECTOR (2004-2013), HARVARD MEDICAL SCHOOL (HMS) AIDS INITIATIVE IN VIETNAM (HAIVN)

LISA COSIMI, MD

ASSOCIATE PHYSICIAN, INFECTIOUS DISEASES, BRIGHAM AND

WOMEN’S HOSPITAL

INSTRUCTOR OF MEDICINE, HARVARD MEDICAL SCHOOL (HMS)

DIRECTOR, HMS AIDS INITIATIVE IN VIETNAM (HAIVN)

BOSTON, MASSACHUSETTS, USA

DANG THI NHAT VINH, MD

SENIOR PROGRAM COORDINATOR, HMS AIDS INITIATIVE IN VIET-NAM (HAIVN)

DONG THI HOAI TAM, MD, PHD

ASSOCIATE PROFESSOR OF MEDICINE

DUONG THI HUONG, MD, PHD

FACULTY OF MEDICINE

HAI PHONG MEDICAL UNIVERSITY (HPMU)

HAI PHONG, VIETNAM

ALYSA KRAIN, MD, MSC

CLINICAL FELLOW, DIVISION OF GERIATRIC MEDICINE

UNIVERSITY OF PENNSYLVANIA

PHILADELPHIA, PENNSYLVANIA, USA

NGO THI KIM CUC, MD, MS

HOSPITAL FOR TROPICAL DISEASES

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ERIC KRAKAUER, MD, PHD

DIRECTOR, INTERNATIONAL PROGRAMS, CENTER FOR PALLIATIVE CARE

ASSISTANT PROFESSOR OF MEDICINE AND GLOBAL HEALTH AND SOCIAL MEDICINE, HARVARD MEDICAL SCHOOL

ATTENDING PHYSICIAN, PALLIATIVE CARE UNIT, MASSACHUSETTS GENERAL HOSPITAL

SENIOR HEALTH AND POLICY ADVISOR FOR PALLIATIVE CARE, PART-NERS IN HEALTH

LE THI ANH THU, MD, PHD

PRESIDENT OF HO CHI MINH CITY INFECTION CONTROL SOCIETY, VIETNAM

CHIEF OF INFECTION CONTROL DEPARTMENT, CHO RAY HOSPITAL, HCMC

CHIEF OF INFECTION CONTROL DEPARTMENT AND HOSPITAL EPIDEMI-OLOGY, MEDICINE UNIVERSITY OF PHAM NGOC THACH

LE THI ANH THU, MD, PHD

PRESIDENT OF HO CHI MINH CITY INFECTION CONTROL SOCIETY, VIETNAM

CHIEF OF INFECTION CONTROL DEPARTMENT, CHO RAY HOSPITAL, HCMC

CHIEF OF INFECTION CONTROL DEPARTMENT AND HOSPITAL EPIDEMI-OLOGY, MEDICINE UNIVERSITY OF PHAM NGOC THACH

HOWARD LIBMAN, MD

DIRECTOR, HIV PROGRAM, HEALTHCARE ASSOCIATES

EDUCATION SECTION CHIEF, DIVISION OF GENERAL MEDICINE AND PRIMARY CARE

BETH ISRAEL DEACONESS MEDICAL CENTER

PROFESSOR OF MEDICINE

HARVARD MEDICAL SCHOOL

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DOANH LU, MD

INSTRUCTOR OF MEDICINE

VIETNAM NATIONAL UNIVERSITY

NGUYEN HUU CHI, MD

INSTRUCTOR OF MEDICINE, INFECTIOUS DISEASES

NGUYEN DINH DUY, MD, SPECIALIST LEVEL II

VICE DIRECTOR

PHAM NGOC THACH HOSPITAL

PHAM ANH DUC, MD

PEDIATRIC PROGRAM MANAGER, HMS AIDS INITIATIVE IN VIETNAM (HAIVN)

HANOI, VIETNAM

PHAM THI HANH, MD, PHD

PROFESSOR, INFECTIOUS DISEASES

UNIVERSITY OF AUSTRALIA

AUSTRALIA

TODD POLLACK, MD

INSTRUCTOR OF MEDICINE, GENERAL MEDICINE AND PRIMARY CARE HARVARD MEDICAL SCHOOL (HMS) / BETH ISRAEL DEACONESS MEDICAL CENTER

COUNTRY MEDICAL DIRECTOR, HMS AIDS INITIATIVE IN VIETNAM (HAIVN)

HANOI, VIETNAM

SURESH RANGARAJAN, MD

ACTING DIRECTOR AND TECHNICAL ADVISOR

CLINICAL CARE AND TREATMENT, FAMILY HEALTH INTERNATIONAL (FHI360)

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TODD POLLACK, MD

COUNTRY MEDICAL DIRECTOR, HMS AIDS INITIATIVE IN VIETNAM (HAIVN)

HANOI, VIETNAM

BICH-THUY (TWEE) SIM, MD

SENIOR TECHNICAL ADVISOR, HMS AIDS INITIATIVE IN VIETNAM (HAIVN)

ANNETTE H SOHN, MD

DIRECTOR

THERAPEUTICS RESEARCH, EDUCATION, AND AIDS TRAINING IN ASIA (TREAT ASIA/AMFAR)

THE FOUNDATION FOR AIDS RESEARCH

BANGKOK, THAILAND

ANN BARTLEY WILLIAMS, RN, EDD

PROFESSOR AND ASSOCIATE DEAN FOR RESEARCH

UNIVERSITY OF CALIFORNIA AT LOS ANGELES (UCLA) SCHOOL OF NURSING

LOS ANGELES, CALIFORNIA, USA

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ABBREVIATIONS

Antiretroviral Medication Terms

ABC Abacavir

ARV Antiretroviral

ART Antiretroviral therapy

ATV Atazanavir

AZT/ZDV Zidovudine

DDI Didanosine

D4T Stavudine

DRV Darunavir

EFV Efavirenz

FTC Emtricitabine

3TC Lamivudine

LPV/r lopinavir-ritonavir

NVP Nevirapine

RTV Ritonavir

TDF Tenofovir

Others

AIDS Acquired immunodeficiency

syndrome CBC Complete blood count

CD4 T-lymphocyte CD4 cells

CMV Cytomegalovirus

CTX Cotrimoxazole

FSW Female sex worker

Hb Hemoglobin

HBV Hepatitis B Virus HCV Hepatitis C Virus HDL High-density lipoprotein HIV Human immunodeficiency virus HSV Herpes Simplex Virus IDU Injection Drug User

LDL Low-density lipoprotein MAI (MAC) Mycobacterium

avium-Intracellulare / complex MARP Most at-risk group

mg Milligram MOH Ministry of Health MSM Men who have sex with men NNRTI Non-Nucleoside reverse

transcriptase inhibitor NRTI Nucleos(t)ide reverse

transcriptase inhibitor

OI Opportunistic infection

PI Protease inhibitor PLHIV Persons living with HIV/AIDS PML Progressive multifocal

leukoencephalopathy PMTCT Prevention of Mother-To-Child

Transmission STI Sexually transmitted infection

TB Tuberculosis TLC Total lymphocyte count VZV Varicella-Zoster Virus

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2-1: Vietnam MOH Clinical Staging of HIV/ AIDS in adults

2-2: Functional Status Assessment

2-3: Initial and routine clinical monitoring

2-4: Initial and routine laboratory / other monitoring

2-5: Eligibility for Cotrimoxazole prophylaxis for adults infected with HIV 2-6: MOH eligibility criteria for initiation of ART in Adult patients

2-7: When to schedule follow-up visit?

3-1: Laboratory Tests to Monitor HIV Infection

5-1: NRTIs, NNRTIs, and PIs currently available in Vietnam

5-2: First-line drug regimens approved by the Vietnam MOH

5-3: Adult ARV dosage, formulation, requirements and use in specific situations 5-4: Drug Interactions with NNRTIs, NRTIs, and PIs and drugs commonly used

in Vietnam

5-5: Lead in dosing of NVP based on ARV and TB treatment history

5-6: Side effects of ARVs by organ system

5-7: Management of Adverse ARV Side Effect

5-8: Vietnam MOH Definition of Treatment Failure

5-9: MOH Integrated Guide Switching to Second Line ART

5-10 Current MOH Recommendations for Second Line ART

6-1: Results of pain intensity assessment

6-2: Non-opioid analgesics

6-3: Weak opioids

6-4: Strong opioids

6-5: Adjuvant Analgesic Drugs for Pain

6-6 Management of Common symptoms in Palliative Care in Pediatric Patients 7-1 Common Opportunistic Infections Stratified by CD4 Cell Count

7-2 MOH Diagnosis and Treatment Guidelines for Opportunistic Infections 7-3: Timing of ART initiation in setting of active OIs

8-1 Differences between Latent and Reactivation TB

8-2 Clinical Presentation of TB in Patients with and without HIV Infection 8-3 Clinical Presentation of TB in Early vs Advanced HIV Infection

8-4 Summarized table for diagnosis of common extra pulmonary TB in people with HIV infection

8-5 Dosages of Anti-TB Drugs

8-6 When Should Antiretroviral Therapy be Initiated in HIV-infected Patients Being Treated for TB?

8-7 Adverse Effects of Anti-TB Drugs

8-8 Prevalence of Drug Resistance in Patients with Pulmonary TB in HCMC (2001)

TABLES AND FIGURES

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9-1 Interpretation of Serologic Results in HBV diagnosis

9-2 Hepatotoxicity Grades

12-1 Rates of HIV Transmission from Mother-to-Child by Period of Exposure 12-2 Nine-step Initial Evaluation for the HIV-Exposed or HIV-Infected Child 12-3 Child Development by Age Groups and WARNING SINGS of Develop-mental Delay due to Active HIV

12-4 Eligibility for Cotrimoxazole prophylaxis for HIV exposed and infected children

12-5 Cotrimoxazole (CTX) Dosing based on Weight or Body Surface Area 12-6 MOH Approved Vaccine Schedule for Children with HIV

12-7 Clinical Staging of Children with HIV/AIDS

12-8 HIV/AIDS Immunological Staging for Children with Confirmed Infection 12-9 Diagnosis of Severe Immunodeficiency in Children by Total Lymphocyte Count (TLC)

12-10 When to Start and Treat with ART in Pediatric Patients

12-11 What ART regimen to start in Pediatric Patients

12-12 Management of issues related to administration of ARVs in pediatric patients

12-13 Current MOH Recommendations for Second Line ART in pediatric patients

12-14 Baseline and routine clinical and laboratory monitoring for HIV-infected pediatric patients

13-1 Percutaneous HIV, HBV, HCV Transmission Risk Rates

13-2 HIV Transmission and Type of Exposure

13-3 Factors Associated with Percutaneous HIV Transmission

13-4 Recommended Healthcare Worker Testing after Exposure

Figures

2-1 Sample Protocol for HIV-infected Persons at Care and Treatment Facilities 2-2 Sample Protocol of Pre-ART Preparation for Adults

2-3 Sample Protocol of Follow-up Visits for Adults on ART

4-1 Management of Prolonged Fever

4-2 Management of Respiratory symptoms

4-3 Management of Neurologic deficits

4-4 Management of Odynophagia

4-5 Management of Chronic diarrhea

4-6 Management of Lymphadenopathy

4-7 Management of Anemia

4-8 Management of Mucocutaneous lesions

4-9 Management of Wasting

4-10 Management of Failure to Thrive in Pediatric Patients

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6-1: WHO 3-step pain treatment ladder

8-1 Diagnosis procedure of pulmonary TB in HIV-infected patients

8-2 Diagnosis procedure of pulmonary TB in severe HIV-infected patients 9-1 Serology of Chronic HBV Infection

11-1 Procedures for provision of care and treatment services for Prevention of Mother-to-Child Transmission of HIV for women during pregnancy

11-2 Management of HIV infected pregnant women

11-3 Prevention-of-Mother-to-Child-Transmission of HIV for women of unknown HIV status during labor

12-1 MOH algorithm for testing infants <9 months of age

12-2 MOH algorithm for testing infants 9-18 month of age

12-3 Growth / developmental charts for boys and girls

13-1 CDC recommendations for PEP in percutaneous injuries

13-2 CDC recommendations for PEP in mucous membrane and nonintact skin injuries

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