Monitoring
Tuberculosis (TB)
Individuals are preferably monitored during their treatment. Directly observed therapy is recommended for all people with HIV-related TB.
Monthly follow-up including clinical, bacteriological, and periodic laboratory and radiographic evaluations are essential to ensure treatment success.
Liver function tests (LFTs) (aminotransferases, bilirubin, and alkaline phosphatase) and renal function (serum creatinine), full blood count (FBC) with differential, and CD4 count are recommended for all individuals.
For individuals with pulmonary TB, at least one sputum specimen for acid-fast bacilli smear and mycobacterial culture should be obtained monthly until 2 consecutive specimens are culture negative. Sputum specimens should also be obtained after 8 weeks of treatment to guide the duration of the continuation phase of therapy.[216]
Disseminated Mycobacterium avium complex
For individuals who fail to have a clinical response to their initial treatment regimen, repeat blood culture should be obtained 4-8 weeks after initiation of treatment.[1]
Pneumocystis jirovecii pneumonia
Careful monitoring during treatment is important to evaluate response to treatment and to detect early toxicity as soon as possible.
Follow-up after therapy is recommended, especially when therapy has been with an agent other than trimethoprim/sulfamethoxazole or has been shortened for toxicity.[1]
Toxoplasmosis
Individuals should be monitored for adverse events and clinical and radiological improvement.[1]
Cryptococcal meningitis
Individuals should be closely monitored during their treatment.
Any neurological signs of increased intracranial pressure (ICP) such as confusion, blurred vision, papilloedema, or lower extremity clonus should be managed using measures to decrease ICP with lumbar punctures. After 2 weeks of treatment, a repeat lumbar puncture should be performed to confirm clearance of the organism from the cerebrospinal fluid.
Monitor LFTs (fluconazole), renal function, and electrolytes (amphotericin) throughout treatment.[1]
Cytomegalovirus (CMV)
Individuals should have regular ophthalmological follow-up because the retinitis can relapse even after immune recovery at CD4 counts as high as 1250 cells/microlitre.[283] Indirect ophthalmoscopy of both ideas through dilated pupils should be performed at the time of diagnosis of CMV retinitis, after completion of the induction therapy, 2 weeks after the initiation of therapy, and monthly thereafter while the individual is on anti-CMV treatment.[1] The ophthalmological follow-up can be decreased to every 3 months for individuals who have experienced immune recovery.[1][284]
In people receiving ganciclovir, FBC and renal function should be monitored twice weekly during induction therapy and once weekly during maintenance therapy, or more frequently if indicated. In people receiving foscarnet, FBC, renal function and serum electrolytes (including potassium, magnesium, calcium and phosphorus) should be monitored closely in the inpatient setting and at least weekly during maintenance therapy as an outpatient, if stable.[1]
Coccidioidomycosis
Lifelong follow-up may be required. In individuals discontinuing treatment, follow-up to detect relapsed infection is important.
Monthly monitoring of Histoplasma capsulatum antigen levels in urine and serum is essential during therapy and for at least 12 months after completing treatment to detect relapse. Persistent low-level antigenuria may not require extended treatment in asymptomatic individuals who have completed an appropriate therapeutic course.
Therapeutic drug monitoring of itraconazole levels is recommended to ensure adequate drug exposure during maintenance therapy.
Individuals should be evaluated for clinical improvement, and laboratory markers of infection should be tracked, particularly in individuals with persistent immunosuppression or incomplete immune recovery on ART.
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