Global HIV/AIDS Medicine

805 Pages·2007·16.48 MB·English

by  Paul A. Volberding MD

This book is dedicated to the visionary leaders of the
Academic Alliance for AIDS Care in Africa, a model for
care-based professional training and research as an
indispensable means of ending the AIDS pandemic.
FM-X2882.indd ii 7/20/2007 2:33:42 PM
An imprint of Elsevier Inc
© 2008, Elsevier Inc. All rights reserved.
Chapter 69 © Tony Barnett.
The material in Chapter 63 is in the public domain and may be used and
reprinted without special permission; citation of the source, however, is
appreciated.
First published 2008
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ISBN 978-1-4160-2882-6
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Notice
Medical knowledge is constantly changing. Standard safety precautions must be
followed, but as new research and clinical experience broaden our knowledge,
changes in treatment and drug therapy may become necessary or appropriate.
Readers are advised to check the most current product information provided by
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dose, the method and duration of administration, and contraindications. It is the
responsibility of the practitioner, relying on experience and knowledge of the
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The Editors acknowledge the generous and unrestricted gift from Pfi zer Global Health.
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Preface
The fi rst edition of this book’s predecessor, The off-patent production along with pharmaceutical
Medical Management of AIDS, appeared in 1988, at a subsidies and governmental distribution are allow-
time when care for even the most economically priv- ing millions of patients access to potent treatment.
ileged sought to ameliorate but not reverse what was Although huge challenges remain, hope is now pos-
then an invariably fatal disease. The epidemic in less sible for those areas most in need in confronting the
advantaged areas such as Africa was barely men- scourge of HIV along with tuberculosis, malaria, and
tioned, and antiretroviral therapy, primarily zidovu- the crushing poverty and gender inequalities that
dine monotherapy, had only modest benefi t. serve as the stage on which the epidemic often
The next six editions of The Medical Management of unfolds.
AIDS saw great changes. By 1999, when the sixth The editors of the prior volume hope that this
edition appeared, multi-drug antiretroviral regi- book’s re-birth as Global HIV/AIDS Medicine addresses
mens had begun to reverse AIDS mortality trends in both the hope of newer treatment and the challenges
the US and other resource-rich countries, and had that remain to be addressed for this hope to be real-
been shown to dramatically decrease transmission ized globally. Additional editors have brought new
from infected women to their infants. The incidence expertise to the book’s leadership, and many new
of formerly common opportunistic infections and authors and topics make this the fi rst textbook aimed
malignancies had decreased, and HIV infection was at a comprehensive approach to the management of
increasingly seen as a chronic, albeit still serious, what is truly a global problem. The editors hope that
disease. Still, in 1999, almost no one dared hope that this effort can play a valuable role in extending the
similar benefi ts could be achieved in Africa, Asia, or incredible advances of HIV/AIDS therapy to the
other resource-constrained regions. many millions still in desperate need.
Much has changed by this edition’s publication
in 2007. Antiretroviral regimens have become Paul A. Volberding, Merle A. Sande
more convenient, less toxic, and, in resource-limited Warner C. Greene, Joep M. A. Lange, Joel E. Gallant
settings, often much less expensive. Generic and
xi
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List of Contributors
Donald I. Abrams MD Tony Barnett BA (Hons), MA Sahai Burrowes MALD
Director of Clinical Programs (Econ), PhD International Projects Manager
Osher Center for Integrative ESRC Professorial Research Center for HIV Information
Medicine Fellow University of California San
Professor of Clinical Medicine LSE Health Francisco
University of California San London School of Economics San Francisco, CA
Francisco London USA
San Francisco, CA UK
USA Oluma Y. Bushen MD
John G. Bartlett MD Associate Director
Frederick L. Altice MD
Professor of Medicine Tulane University Technical
Associate Professor of Medicine
Division of Infectious Diseases Assistance Program
Yale University AIDS Program
The John Hopkins University Addis Ababa
Yale University
School of Medicine Ethiopia
New Haven, CT
Baltimore, MD
USA
USA Jayne Byakika-Tusiime
Andrew Angelino MD BPharm, MSc
Assistant Professor Paul R. Bohjanen MD, PhD PhD Candidate and
Department of Psychiatry and Associate Professor of Epidemiologist
Behavioural Sciences Microbiology and Medicine University of California Berkeley
The Johns Hopkins University Department of Microbiology Berkeley, CA
School of Medicine, University of Minnesota USA
Baltimore, MD Minneapolis, MN
USA USA Denise M. Cardo MD
Director
Cristian Apetrei MD, PhD Charles Boucher MD, PhD Division of Healthcare Quality
Associate Professor Department of Virology Promotion
Department of Microbiology Eijkman-Winkler Institute Centers for Disease Control and
Tulane National Primate University Medical Center Prevention
Research Center Utrecht Atlanta, GA
Covington, LA Utrecht , The Netherlands USA
USA
David R. Boulware MD, MPH, David J. Cennimo MD
David Bangsberg MD, MPH
DTMH Chief Medical Resident
Associate Professor of Medicine
Assistant Professor of Medicine Department of Medicine
Department of Medicine
Department of Medicine New Jersey Medical School
University of California San
Division of Infectious Diseases Newark, NJ
Francisco
and International Medicine USA
San Francisco, CA
University of Minnesota
USA
Minneapolis, MN Richard E. Chaisson MD
Jason D. Barbour PhD, MHS USA Professor of Medicine,
Assistant Professor of Medicine Epidemiology and International
Positive Health Program R. Douglas Bruce MD, MA Health
San Francisco General Hospital Clinical Instructor of Medicine Johns Hopkins University
University of California San Yale University AIDS Program Baltimore, MD
Francisco Yale School of Medicine USA
San Francisco, CA New Haven, CT
USA USA
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List of Contributors
Marie Charles MD, MIA J. Lucian Davis MD W. Lawrence Drew MD, PhD
Chair & CEO, International Clinical Instructor Director, Clinical Virology
Center for Equal Healthcare Division of Pulmonary and Laboratory
Access Critical Care Medicine and HIV/ Professor, Laboratory Medicine
Henry Crown Fellow AIDS Division and Medicine
The Aspen Institute San Francisco General Hospital Medical Center at Mount Zion
Adjunct Professor, Columbia University of California San University of California San
University, School of Francisco Francisco
International and Public Affairs San Francisco, CA San Francisco, CA
New York, NY USA USA
USA
Kevin M. DeCock MD, FRCP, Ernest Drucker PhD
David B. Clifford MD DTM&H Professor of Epidemiology and
Melba and Forest Seay Professor Director, HIV/AIDS Program Social Medicine
of Clinical Neuropharmacology World Health Organization Montefi ore Medical Center
Department of Neurology Geneva Albert Einstein College of
Washington University School of Switzerland Medicine
Medicine New York, NY
St Louis, MO Steven G. Deeks MD USA
USA Associate Professor of Medicine
Positive Health Program James P. Dunn MD
David A. Cooper MD, DSc San Francisco General Hospital Associate Professor of
Professor of Medicine University of California San Ophthalmology
National Centre in HIV Francisco The Wilmer Eye Institute
Epidemiology and Clinical San Francisco, CA John Hopkins School of Medicine
Research USA Baltimore, MD
University of New South Wales USA
Darlinghurst, NSW Inge Derdelinckx MD, PhD
Australia Associate Professor Jerrold J. Ellner MD
Department of Virology Professor and Chair
Paul Coplan MSc, DSc, MBA Eijkman Winkler Institute Department of Medicine
Senior Director, Risk University Medical Center New Jersey Medical School
Management Utrecht Newark, NJ
Global Safety Surveillance, The Netherlands USA
Epidemiology and Labeling
Wyeth Pharmaceuticals Emma Devitt MB BCh Kim S. Erlich MD
Worldwide Special Lecturer in Medicine Assistant Clinical Professor of
Collegeville, PA Medical Professorial Unit Medicine
USA University College Dublin/Mater University of California San
Hospital Francisco
Ernest Darkoh-Ampem MD, Dublin San Francisco, CA
MPH, MBA Ireland USA
Chairman and Founding Partner
BroadReach Healthcare Douglas Dieterich MD Oren K. Fix MD, MSc
Washington, DC Professor of Medicine Assistant Professor of Medicine
USA Department of Medicine Division of Gastroenterology
Mount Sinai School of Medicine University of Washington
New York, NY Medical School
USA Seattle, WA
USA
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List of Contributors
Charles W. Flexner MD Clive M. Gray MSc, PhD Richard L. Guerrant MD
Professor of Medicine, Chief Specialist Scientist Thomas H. Hunter Professor of
Pharmacology and Molecular Head of HIV Immunology International Medicine
Sciences, and International HIV Immunology AIDS Research Division of Infectious Diseases
Health Unit and International Health
Division of Clinical National Institute for Director, Center for Global
Pharmacology Communicable Diseases Health,
Johns Hopkins University Johannesburg University of Virginia
Baltimore, MD South Africa Charlottesville, VA
USA USA
Warner C. Greene MD, PhD
Gerald Friedland MD Director, Gladstone Institute of Catherine Hankins MD, MSc,
Professor of Medicine and Virology and Immunology FRCP(C)
Epidemiology and Public Health Nick and Sue Hellman Endowed Chief Scientifi c Adviser and
Director, AIDS Program Professor of Translational Biology Associate Director
Yale New Haven Hospital Professor of Medicine, Policy, Evidence and Partnerships
Yale School of Medicine Microbiology and Immunology UNAIDS
New Haven, CT University of California San Geneva
USA Francisco Switzerland
San Francisco, CA
Helene D. Gayle MD, MPH USA P. Richard Harrigan PhD
President and Chief Executive Director
Offi cer Deborah Greenspan BDS, DSc, Research Labs
CARE USA FDSRCS British Columbia Centre for
Atlanta, GA Leland and Gladys Barber Excellence in
USA Distinguished Professor and HIV/AIDS
Interim Chair Vancouver, BC
Sibyl Geelen MD, PhD Department of Orofacial Sciences Canada
Senior Consultant School of Dentistry
Pediatric Infectious Disease University of California San Marianne Harris MD
Specialist Francisco Clinical Research Advisor
Center for Poverty-related San Francisco, CA AIDS Research Programme
Communicable Diseases- USA St Paul’s Hospital
PharmAccess Foundation Vancouver, BC
Amsterdam John S. Greenspan BSc, BDS, Canada
Department of Pediatric PhD, FRC Path, ScD(hc),
Infectious Diseases FDSRCS (Eng) Robert Heimer PhD
University Medical Center Professor and Dean for Research Professor of Epidemiology and
Utrecht School of Dentistry Public Health
The Netherlands Director Department of Epidemiology and
AIDS Research Institute Public Health
Trevor E. Gerntholtz MD School of Medicine Yale University School of
Dumisani Mzamane African University of California San Medicine
Institute of Kidney Disease Francisco New Haven, CT
Chris Hani Baragwanath San Francisco, CA USA
Hospital USA
Soweto Hans V. Hogerzeil MD, PhD,
South Africa Carl Grunfeld MD, PhD DSc, FRCP(Edin)
Professor of Medicine Director
Metabolism and Endocrine Medicines Policy and Standards
Sections World Health Organization
University of California San Geneva
Francisco Switzerland
San Francisco, CA
USA
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List of Contributors
Laurence Huang MD Lawrence D. Kaplan MD Jeanne C. Keruly MS, CRNP
Associate Professor of Medicine Professor of Medicine Assistant Professor of Medicine
Chief, AIDS Chest Clinic University of California San Department of Medicine
HIV/AIDS Division and Division Francisco Johns Hopkins University School
of Pulmonary and Critical Care San Francisco, CA of Medicine
Medicine USA Baltimore, MD
Department of Medicine USA
San Francisco General Hospital Elly Katabira MD
University of California San Deputy Dean for Research Paul E. Klotman MD
Francisco Faculty of Medicine Professor and Chair
San Francisco, CA Makerere University Medical Division of Nephrology
USA School Mount Sinai School of Medicine
Kampala New York, NY
Jula K. Inrig MD Uganda USA
Instructor in Medicine
Division of Nephrology Salim Abdool Karim MBChB, Jane E. Koehler MA, MD
Department of Medicine PhD Professor of Medicine
Duke University Medical Center Director Division of Infectious Diseases
Durham, NC Centre for the AIDS Programme University of California San
USA of Research Francisco
South Africa San Francisco, CA
Mark A. Jacobson MD Professor in Clinical USA
Professor of Medicine in Epidemiology
Residence Columbia University Richard A. Koup MD
Positive Health Program Adjunct Professor in Medicine Chief, Immunology Laboratory
University of California San Cornell University Vaccine Research Center
Francisco New York, NY National Institute of Allergy and
San Francisco, CA USA Infectious Diseases
USA Bethesda, MD
Anthony D. Kelleher PhD, MB USA
Malcolm John MD, MPH BS, MD
Assistant Clinical Professor Associate Professor of Medicine Oliver Laeyendecker MS, MBA
Director, 360: The Positive Care National Centre in HIV Research Assistant
Center at USCF Epidemiology and Division of Infectious Diseases
Division of Infectious Diseases- Clinical Research Department of Medicine
Department of Medicine University of New South Wales Johns Hopkins School of
University of California San Darlinghurst, NSW Medicine
Francisco Australia Baltimore, MD
San Francisco, CA USA
USA Stephen J. Kerr BPharm, MIPH,
PhD Joep M. A. Lange MD, PhD
Edward C. Jones-López MD, MS Biostatistician Center for Poverty-Related
Assistant Professor of Medicine HIV Netherlands Australia Communicable Diseases
Division of Infectious Diseases Thailand Resarch collaboration International AIDS Therapy
and Center for Emerging (HIV-NAT) Evaluation Center
Pathogens Bangkok University of Amsterdam
New Jersey Medical School Thailand Amsterdam, The Netherlands
Newark, NJ Senior Lecturer
USA National Centre in HIV
Epidemiology and Clinical
Research
University of New South Wales
Sydney
Australia
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List of Contributors
Joan C. Lo MD John R. Mascola MD Julio S. G. Montaner MD
Assistant Professor of Medicine Deputy Director Professor of Medicine & Chair of
Division of Endocrinology Vaccine Research Center AIDS Research
San Francisco General Hospital National Institute of Allergy and University of British Columbia
University of California San Infectious Diseases AIDS Research Program
Francisco Bethesda, MD St Paul’s Hospital
San Francisco, CA USA Vancouver, BC
USA Canada
Toby Maurer MD
Jessica L. Long MD Associate Professor Jose G. Montoya MD
Johns Hopkins School of Department of Dermatology Associate Professor of Medicine,
Medicine, MS IV University of California San Division of Infectious Diseases
JH Bloomberg School of Public Francisco and Geographical Medicine
Health, MPH Candidate San Francisco, CA Stanford University School of
Baltimore, MD USA Medicine
USA Stanford, CA
Concepta Merry MB, PhD, MSc, USA
Primo Madra MD, PhD MRCPI
National Program Offi cer Clinical Researcher Richard D. Moore MD
UNFPA – Uganda Country Offi ce University of Makerere Professor of Medicine
Kampala Kampala Department of Medicine
Uganda Uganda John Hopkins University School
of Medicine
Kasia Malinowska-Sempruch Mark Mitchnick MD Baltimore, MD
MSW Chief Scientifi c Consultant USA
Program Director International Partnership for
International Harm Reduction Microbicides Philippa Musoke MB, ChB
Development Program (IHRD) East Hampton, NY Consultant Paediatrician
Open Society Institute USA Paediatrics Department
New York, NY Mulago Hospital
USA Mesfi n Teshome Mitike MD Kampala
Assistant Professor Uganda
Simon Mallal MB BS, FRACP, Department of Internal Medicine
FRCPA Faculty of Medicine Meg D. Newman MD
Professor of Clinical Immunology Addis Ababa University Associate Professor of Clinical
and Infectious Diseases Addis Ababa Medicine
Centre for Clinical Immunology Ethiopia Positive Health Program at San
and Biomedical Statistics Francisco General Hospital
Royal Perth Hospital Jean-Paul Moatti PhD University of California San
Perth, WA Professor of Health Economics Francisco
Australia University of Mediterranean & San Francisco, CA
INSERM USA
Preston Marx PhD Marseilles
Chair, Division of Microbiology France David Nolan MB BS, FRACP
and Professor of Tropical Centre for Clinical Immunology
Medicine Lynne M. Mofenson MD and Biomedical Statistics
Tulane National Primate Chief, Pediatric, Adolescent and Royal Perth Hospital and
Research Center Maternal AIDS Branch Murdoch University
Covington, LA National Institute of Child Health Perth, WA
USA and Human Development Australia
Rockville, MD
USA
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List of Contributors
Catherine Orrell MBChB, B. Matija Peterlin MD Peter Reiss MD, PhD
MMed Professor of Medicine, Professor of Medicine
Clinical Trials Manager Microbiology and Immunology Department of Infectious
Infectious Diseases Unit Rosalind Russell Medical Diseases, Tropical Medicine and
UCT Lung Institute Research Center AIDS
University of Cape Town University of California San Academic Medical Center
Cape Town Francisco Amsterdam
South Africa San Francisco, CA The Netherlands
USA
Julie Overbaugh PhD Jack S. Remington MD
Member, Division of Human Marion Peters MD Professor Emeritus
Biology Chief of Hepatology Research Department of Medicine
Fred Hutchinson Cancer Professor of Medicine Division of Infectious Diseases
Research Center Division of Gastroenterology and Geographic Medicine
Seattle, WA University of California San Stanford University School of
USA Francisco Medicine
San Francisco, CA Marcus A. Krupp Research Chair
Kathleen R. Page MD USA and Chairman
Instructor of Medicine Department of Immunology and
Division of Infectious Diseases Marco Petrella Infectious Diseases Research
Johns Hopkins University School Neurochem Inc. Institute
of Medicine Québec Palo Alto Medical Foundation
Baltimore, MD Canada Palo Alto, CA
USA USA
William G. Powderly MD,
Adelisa L. Panlilio MD, MPH FRCPI Tobias F. Rinke de Wit PhD
Medical Epidemiologist Professor of Medicine Professor of Sustainable
Department of Healthcare Head, School of Medicine Diagnostics
Quality Promotion University College Dublin School PharmAccess Foundation
Centers for Disease Control and of Medicine Center for Poverty-related
Prevention Dublin Communicable Diseases
Atlanta, GA Ireland Academic Medical Center –
USA University of Amsterdam
Thomas C. Quinn MD, MSc Amsterdam
Andrew T. Pavia MD Director The Netherlands
Professor of Pediatrics and Johns Hopkins Center for Global
Medicine Health Allan Ronald OC, FRSC, MD,
Chief, Division of Pediatric Professor of Medicine, FRCPC, MACP
Infectious Diseases International Health, Distinguished Professor Emeritus
University of Utah Health Epidemiology, and Molecular Department of Internal Medicine
Sciences Center Microbiology and Immunology University of Manitoba
Salt Lake City, UT Johns Hopkins Medical Winnipeg, MB
USA Institutions Canada
Associate Director for
Laurence Peiperl MD International Research Zeda F. Rosenberg ScD
Associate Professor of Clinical Division of Intramural Research Chief Executive Offi cer
Medicine National Institute of Allergy and International Partnership for
University of California San Infectious Diseases Microbicides
Francisco National Institutes of Health Silver Spring, MD
San Francisco, CA Bethesda, MD USA
USA USA
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