Hướng dẫn lâm sàng cho Nhân viên y tế

203 Pages·2014·1.65 MB·Vietnamese

Hướng dẫn lâm sàng cho Nhân viên y tế

Phiên bản 1
2014
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 o f Medicine
Harvard Med ical School
Boston, M A, USA

This manual was supported by the Cooperative Agree ment 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.
EDITORIAL NOTE
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
CONTRIBUTING EDITORS
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
HO CHI MINH CITY, VIETNAM
SURESH RANGARAJAN, MD
ACTING DIRECTOR AND TECHNICAL ADVISOR
HIV/AIDS CLINICAL CARE AND TREATMENT, FAMILY HEALTH INTERNA-
TIONAL (FHI360)
HO CHI MINH CITY, VIETNAM
RACHEL BURDON, MD
SENIOR TECHNICAL OFFICER (2005-2013)
HIV CLINICAL CARE AND TREATMENT, FAMILY HEALTH INTERNATIONAL
(FHI360)
HANOI, VIETNAM
CONTRIBUTING EDITORS
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
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)
HO CHI MINH CITY, VIETNAM
DONG THI HOAI TAM, MD, PHD
ASSOCIATE PROFESSOR OF MEDICINE
HO CHI MINH UNIVERSITY OF MEDICINE AND PHARMACY
HO CHI MINH CITY, VIETNAM
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
HO CHI MINH CITY, VIETNAM
CONTRIBUTING EDITORS
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
BOSTON, MASSACHUSETTS, USA
LE THI ANH THU, MD, PHD
ASSOCIATE PROFESSOR OF MEDICINE
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
HO CHI MINH CITY, VIETNAM
LE THI ANH THU, MD, PHD
ASSOCIATE PROFESSOR OF MEDICINE
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
HO CHI MINH CITY, VIETNAM
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, MASSACHUSETTS, USA
CONTRIBUTING EDITORS
DOANH LU, MD
INSTRUCTOR OF MEDICINE
VIETNAM NATIONAL UNIVERSITY
HO CHI MINH CITY, VIETNAM
NGUYEN HUU CHI, MD
INSTRUCTOR OF MEDICINE, INFECTIOUS DISEASES
HO CHI MINH UNIVERSITY OF MEDICINE AND PHARMACY
HO CHI MINH CITY, VIETNAM
NGUYEN DINH DUY, MD, SPECIALIST LEVEL II
VICE DIRECTOR
PHAM NGOC THACH HOSPITAL
HO CHI MINH CITY, VIETNAM
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
BOSTON, MASSACHUSETTS, USA
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)
HO CHI MINH CITY, VIETNAM
TODD POLLACK, MD
INSTRUCTOR OF MEDICINE, GENERAL MEDICINE AND PRIMARY CARE
HARVARD MEDICAL SCHOOL (HMS) / BETH ISRAEL DEACONESS MEDICAL
CENTER
BOSTON, MASSACHUSETTS, USA
COUNTRY MEDICAL DIRECTOR, HMS AIDS INITIATIVE IN VIETNAM
(HAIVN)
HANOI, VIETNAM
BICH-THUY (TWEE) SIM, MD
INSTRUCTOR OF MEDICINE, GENERAL MEDICINE AND PRIMARY CARE
HARVARD MEDICAL SCHOOL (HMS) / BETH ISRAEL DEACONESS MEDICAL
CENTER
BOSTON, MASSACHUSETTS, USA
SENIOR TECHNICAL ADVISOR, HMS AIDS INITIATIVE IN VIETNAM (HAIVN)
HO CHI MINH CITY, VIETNAM
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
ABBREVIATIONS
Antiretroviral Medication Terms
ABC Abacavir HBV Hepatitis B Virus
ARV Antiretroviral HCV Hepatitis C Virus
ART Antiretroviral therapy HDL High-density lipoprotein
ATV Atazanavir HIV Human immunodeficiency virus
AZT/ZDV Zidovudine HSV Herpes Simplex Virus
DDI Didanosine IDU Injection Drug User
D4T Stavudine kg Kilogram
DRV Darunavir LDL Low-density lipoprotein
EFV Efavirenz MAI (MAC) Mycobacterium avium-
FTC Emtricitabine Intracellulare / complex
3TC Lamivudine MARP Most at-risk group
LPV/r lopinavir-ritonavir mg Milligram
NVP Nevirapine MOH Ministry of Health
RTV Ritonavir MSM Men who have sex with men
TDF Tenofovir NNRTI Non-Nucleoside reverse
transcriptaseinhibitor
Others NRTI Nucleos(t)ide reverse
AIDS Acquired immunodeficiency transcriptase inhibitor
syndrome OI Opportunistic infection
CBC Complete blood count PI Protease inhibitor
CD4 T-lymphocyte CD4 cells PLHIV Persons living with HIV/AIDS
CMV Cytomegalovirus PML Progressive multifocal
CTX Cotrimoxazole leukoencephalopathy
FSW Female sex worker PMTCT Prevention of Mother-To-Child
gm Gram Transmission
Hb Hemoglobin STI Sexuallytransmitted infection
TB Tuberculosis
TLC Total lymphocyte count
VZV Varicella-Zoster Virus
TABLES AND FIGURE S
Tables
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)