Hypoadrenalism

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Cytomegalovirus can cause necrotizing adrenalitis. This is difficult to distinguish from TB of the adrenal glands or pseudoadrenal crisis (rifampicin).Treatment is with steroid supplements.

Soft-tissue infections, e.g. pyomyositis, and sinusitis

These are common in HIV-positive patients. They are diagnosed and treated in the usual way.

I2*UM PREVENTION OF HIV-RELATED OPPORTUNISTIC INFECTIONS

12.11.1 General measures

There are some general measures that may help in reducing exposure to selected pathogens in HIV-positive patients.

Pathogen

Suggested intervention

Pneumocystis cariniii

Avoid close contact with patients who have known Pneumocystis carinii pneumonia

Toxoplasma gondii

Avoid eating undercooked red meat Avoid exposure to cats

Cryptosporidium

Avoid drinking ground water (difficult for rural communities)

Avoid young household pets

Histoplasma capsulatum

In endemic areas avoid caves (bats) or cleaning chicken coops

12.11.2 Immunizations

Killed or inactivated vaccines pose no danger to immunosuppressed individuals.

Adults

In general, adult HIV-positive patients should not receive live bacteria or live virus vaccines (e.g. oral poliovirus, measles, varicella, mumps and yellow fever vaccines). It is often recommended that pneumococcal, hepatitis B and influenza vaccines be given to HIV-positive persons. However, this is rarely done in resource-poor countries within the public health sector because of cost.Also, a study in Uganda showed no benefit to using a 23-valent pneumococccal polysaccharide vaccine in HIV-1 infected adults.

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