HAIVN Clinical Manual_VIE

Hướng dẫn lâm sàng cho Nhân viên y tế Phiên 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 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 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 individuals 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 INTERNATIONAL (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, PARTNERS 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 EPIDEMIOLOGY, 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 EPIDEMIOLOGY, 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 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 CBC CD4 CMV CTX FSW gm Hb Acquired immunodeficiency syndrome Complete blood count T-lymphocyte CD4 cells Cytomegalovirus Cotrimoxazole Female sex worker Gram Hemoglobin HBV HCV HDL HIV HSV IDU kg LDL MAI (MAC) MARP mg MOH MSM NNRTI NRTI OI PI PLHIV PML PMTCT STI TB TLC VZV Hepatitis B Virus Hepatitis C Virus High-density lipoprotein Human immunodeficiency virus Herpes Simplex Virus Injection Drug User Kilogram Low-density lipoprotein Mycobacterium aviumIntracellulare / complex Most at-risk group Milligram Ministry of Health Men who have sex with men Non-Nucleoside reverse transcriptase inhibitor Nucleos(t)ide reverse transcriptase inhibitor Opportunistic infection Protease inhibitor Persons living with HIV/AIDS Progressive multifocal leukoencephalopathy Prevention of Mother-To-Child Transmission Sexually transmitted infection Tuberculosis Total lymphocyte count Varicella-Zoster Virus TABLES AND FIGURES 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) ... (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,... TECHNICAL ADVISOR HIV/AIDS CLINICAL CARE AND TREATMENT, FAMILY HEALTH INTERNATIONAL (FHI360) HO CHI MINH CITY, VIETNAM RACHEL BURDON, MD SENIOR TECHNICAL OFFICER (2005-2013) HIV CLINICAL CARE AND TREATMENT,... 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