CMV infection in HIV infected patient. Nia Kurniati Cipto Mangunkusumo Hospital Jakarta, Indonesia

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "CMV infection in HIV infected patient. Nia Kurniati Cipto Mangunkusumo Hospital Jakarta, Indonesia"

Transcription

1 CMV infection in HIV infected patient Nia Kurniati Cipto Mangunkusumo Hospital Jakarta, Indonesia

2 Background CMV infection are commonly found as HIV co-infection Vertical transmission is the important source of infection in infant In pre HAART era this co-infection has low survival Gabriel et al. Med Sci Monit 2007;13:177-81

3 Epidemiology Seropositivity among pregnant women in this region is high (India 35 90%, ) Chakravarti A, et al. Indian J Med Microbiol 2009;27:3-11 Symptomatic CMV infections was 23.1% among HIV-1 infected newborns and 6.7% among HIV-1 uninfected neonates. (French cohort) Guibert G, et al. Clin Infect Dis 2009; 48: % of HIV-infected children were co-infected with CMV. Khamduang W, et al. J Acquir Immune Defic Syndr 2011; 58(2):

4 Clinical Manifestation CMV Retinitis Esophagitis Colitis Hepatitis Pneumonitis

5 Diagnosis of Infection ( disease) Birth 2 wks month Congenital CMV infection: virus isolation in human fibroblast, CMV specific T-cell Acquired CMV infection: virus isolation/pcr Infection: antibody assay Shoby CT, et al. Indian Pediatr 2002;39:561-4 Ritter M, et al. Eur J Immunol 2012, Dec 26 (epub)

6 Problems Problem in diagnosis: When to decide whether it is infection or disease Problem in treatment: When to start When to stop When to restart

7 DIAGNOSIS OF CMV INFECTION

8 Case#1 A 7 month old girl was hospitalized for severe pneumonia. She had history of chronic diarrhea Her mother recently diagnosed with pulmonary TB Body weight 3.95 kg (< P 3 WHO chart) Microcephaly, hepatosplenomegaly

9 Within a week we have confirmation of HIV: PCR HIV was positive, CD4 5% Respons to therapy was slow, liver enlargement was prominent AST/ALT 120/135 IU/L We planned to check for certain OI (hepatitis B, C, TORCH)

10 Q1 HBsAg and anti HCV were negative IgM CMV 50 AU/L and IgG 130 IU/L Do you think we can diagnose CMV infection with antibody assay? Yes OR No

11 Diagnosis of CMV Sensitivity Specificity Positive Predictive Value Negative Predictive Value Antigen detection: 89.18% Antigen detection: 100% Antigen detection: 100% Antigen detection: 93.54% PCR: 100% PCR:72,41% PCR: 69.81% PCR: 100% IgM CMV: 72,97% IgM CMV: 62,06 IgM CMV: 55.1% IgM CMV: 78.26% Bhatia J, Chah BV, Mehta AP, Deshmukh M, Sirsat RA, Rodrigues C. Comparing serology, antigenemia assay and polymerase chain reaction for the diagnosis of cytomegalovirus infection in renal transplant patients.

12 Q2 A. Diagnosis of CMV disease can be established B. We need positive PCR CMV to deliver IV Ganciclovir C. Therapy of IV Ganciclovir can be started without confirmation of CMV isolation in this case

13 Answer A. Positive antibody assay in infant < 12 years old reflects maternal CMV infection B. True. We should detect CMV antigen accompanied by end-organ manifestation before starting treatment C. There is no guideline to give therapy based on clinical and antibody assay only

14 Follow up More evaluation showed no sign of retinitis. We decided to give IV ganciclovir. The patient gradually got better on the 3rd week of treatment, and ARV was started. She is now almost 2 years old, clinically well without ganciclovir maintenance and the last CD4 is > 15%

15 Case #2 A 7 month baby girl diagnosed with HIV infection During the process of diagnostic, her abdomen were getting bigger and she had constant low grade fever. On examination she looked like a healthy baby at her age, normocephaly, except for liver enlargement. Laboratory study revealed normal CBC, increase ALT/AST (560/947), positive IgG and IgM to CMV

16 CD4 was 30% (1483 cells/ml) Urine CMV PCR was positive BERA and eye examination revealed normal Birth weight 3900 g birth length 46 cm

17 Question Do you think that this is a CMV disease? Yes or No In term of prognostic, should we define congenital or acquired infection?

18 Congenital CMV Infection Small for gestational age (50%) Petechiae (76%) Jaundice (67%) Hepatosplenomegaly (60%) Chorioretinitis (20%) Microcephaly (53%) Intracranial calcifications (55%) Hearing impairment ( 65%)

19 Management We diagnosed CMV disease in this patient and started IV ganciclovir for 3 weeks, without valganciclovir maintenance. ARV was started by the end of week 3 On follow up her ALT/AST were decreased to normal level and her liver enlargement was also decreased. Urine PCR was also negative.

20 SECONDARY PREVENTION

21 Case #3, N, 14 months old girl Lymphadenitis BCG Excision biopsy PCR BCG CMV Retinitis IgM 50 AU/ml, IgG g/dl Funduscopy HIV Positive antibody assay PCR RNA 5.2 log 10 copies/ml CD4: 14.6% (328 cell/ml)

22 Other findings Hepatosplenomegaly (ALT 205 IU/L, AST 192 IU/L) HBs-Ag negative, anti HCV negative Anti Toxoplasma negative

23 Management Anti TB drugs ( Rifampicin, Isoniazide, Pyrazinamide) for 9 months Co-trimoxazole IV Ganciclovir (which we changed to Oral valganciclovir for 6 month) ARV (AZT + 3TC + NVP)

24 Question #3 At 18 month post starting therapy (age 4 y.o), patient had hematemesis and melena. Ultrasound showed cirrhotic liver and spleen enlargement. IgM CMV persists at 50 AU/mL. Other liver infection panel was negative Do we need to restart Valganciclovir treatment? Yes or No

25 Follow up Liver biopsy was declined by her father Diagnosis of active CMV hepatitis was made, and decided to restart Valganciclovir. Treatment lasted for 12 month which resulted in clinical improvement Annual funduscopy ensure no relaps of retinitis CD4 maintain on 20 25%

26 Treatment Infant: Start therapy in confirmation of CMV disease Evaluate at 6 weeks, decide to stop or continue (HIV) CMV retinitis: IV Ganciclovir (duration not stated for infant and children) Valganciclovir for 3 6 months reduction of morbidity and mortality ARV needs 3 to 6 months to control HIV replication and to stimulate the immune system to control CMV infection. Kaplan JE, et al. Guidelines for prevention and treatment of opportunistic infections in HIVinfected adults and adolescents Mofenson LM, et al. Guidelines for prevention and treatment of opportunistic infections among HIV exposed and HIV Infected Children. 2009

27 Stop and start secondary prophylaxis Secondary prophylaxis should be reinstituted in children aged 1--5 years when the CD4 count decreases to <500 cells/mm3 or CD4 percentage to <15%, and for children aged 6 years when the CD4 count decreases to <100 cells/mm3 or CD4 percentage to <15% (BIII). Mofenson LM, et al. Guidelines for prevention and treatment of opportunistic infections among HIV exposed and HIV Infected Children. 2009

28 Prophylaxis Secondary prophylaxis (Chronic Maintenance Therapy) is recommended for CMV retinitis in older children and adult (AII), combine with other modalities. There is no clear guideline in younger children Discontinuing prophylaxis may be considered for children aged 1--5 years who are receiving HAART and have a sustained (e.g., >6 months) increase in CD4 count to >500 cells/mm3 or CD4 percentage to >15% For children aged 6 years, an increase in CD4 count to >100 cells/mm3 as for adults (CIII)

29 Issues to be resolved Diagnosis in infant Treatment indication in relatively stable children with disease manifestation Duration of treatment Prophylaxis

30 THANK YOU

Cytomegalovirus in Pregnancy

Cytomegalovirus in Pregnancy Cytomegalovirus in Pregnancy This guideline was updated in June 2016 by Dr Margaret Harpham with input from members of the New Zealand Maternal Fetal Medicine Network. Background Cytomegalovirus (CMV)

More information

Antiretroviral therapy for HIV infection in infants and children: Towards universal access

Antiretroviral therapy for HIV infection in infants and children: Towards universal access Antiretroviral therapy for HIV infection in infants and children: Towards universal access Executive summary of recommendations Preliminary version for program planning 2010 Executive summary Tremendous

More information

Chapter 10 Human Immuno Deficiency Virus Infection

Chapter 10 Human Immuno Deficiency Virus Infection 143 Chapter 10 Human Immuno Deficiency Virus Infection Chapter 10 Human Immuno Deficiency Virus Infection...143 HIV infection...144 Clinical Features...146 Clinical Staging of HIV infection recommended

More information

Executive summary of recommendations

Executive summary of recommendations MOH CLINICAL PRACTICE GUIDELINES 2/2011 Chronic Hepatitis B Infection College of Family Physicians, Singapore Academy of Medicine, Singapore Singapore Medical Association Executive summary of recommendations

More information

Cytomegalovirus (HHV5/CMV) Roseolovirus (HHV6 & 7)

Cytomegalovirus (HHV5/CMV) Roseolovirus (HHV6 & 7) Betaherpesvirinae Cytomegalovirus (HHV5/CMV) Roseolovirus (HHV6 & 7) CYTOMEGALOVIRUS CMV is thought to be amongst the oldest type of herpesvirus in evolutionary terms. CMV is the prototype of beta-herpesviruses

More information

VIH/SIDA en Pediatría: Epidemiología Mundial, Transmisión Perinatal, Manejo Integral.

VIH/SIDA en Pediatría: Epidemiología Mundial, Transmisión Perinatal, Manejo Integral. VIH/SIDA en Pediatría: Epidemiología Mundial, Transmisión Perinatal, Manejo Integral. Juan Carlos Salazar, M.D. Universidad de Connecticut, EE.UU. End-1998 global estimates Children (

More information

Molecular Diagnosis of Hepatitis B and Hepatitis D infections

Molecular Diagnosis of Hepatitis B and Hepatitis D infections Molecular Diagnosis of Hepatitis B and Hepatitis D infections Acute infection Detection of HBsAg in serum is a fundamental diagnostic marker of HBV infection HBsAg shows a strong correlation with HBV replication

More information

CMV: Your questions answered

CMV: Your questions answered The basics about the virus CMV: Your questions answered What is CMV? CMV, or Cytomegalovirus, is a common virus that can infect people of all ages. Once CMV is in a person s body, it stays there for life.

More information

HBV screening and management in HIV-infected children and adolescents

HBV screening and management in HIV-infected children and adolescents HBV screening and management in HIV-infected children and adolescents Linda Aurpibul M.D. Research Institute for Health Sciences, Chiang Mai University 8% HIV and Hepatitis B Co-infection Among Perinatally

More information

Case Finding for Hepatitis B and Hepatitis C

Case Finding for Hepatitis B and Hepatitis C Case Finding for Hepatitis B and Hepatitis C John W. Ward, M.D. Division of Viral Hepatitis Centers for Disease Control and Prevention Atlanta, Georgia, USA Division of Viral Hepatitis National Center

More information

In Tanzania, ARVs were introduced free-of-charge by the government in 2004 and, by July 2008, almost 170,000 people were receiving the drugs.

In Tanzania, ARVs were introduced free-of-charge by the government in 2004 and, by July 2008, almost 170,000 people were receiving the drugs. ANTIRETROVIRAL TREATMENT What is ART and ARV? ART is a short form for Antiretroviral Therapy (or Treatment). Antiretroviral therapy is a treatment consisting of a combination of drugs which work against

More information

William Atkinson, MD, MPH Hepatitis B Vaccine Issues June 16, 2016

William Atkinson, MD, MPH Hepatitis B Vaccine Issues June 16, 2016 William Atkinson, MD, MPH Hepatitis B Vaccine Issues June 16, 2016 Advisory Committee on Immunization Practices (ACIP) The recommendations to be discussed are primarily those of the ACIP composed of 15

More information

Zika Virus. Fred A. Lopez, MD, MACP Richard Vial Professor Department of Medicine Section of Infectious Diseases

Zika Virus. Fred A. Lopez, MD, MACP Richard Vial Professor Department of Medicine Section of Infectious Diseases Zika Virus Fred A. Lopez, MD, MACP Richard Vial Professor Department of Medicine Section of Infectious Diseases What is the incubation period for Zika virus infection? Unknown but likely to be several

More information

HIV and Hepatitis Co-infection. Martin Fisher Brighton and Sussex University Hospitals, UK

HIV and Hepatitis Co-infection. Martin Fisher Brighton and Sussex University Hospitals, UK HIV and Hepatitis Co-infection Martin Fisher Brighton and Sussex University Hospitals, UK Useful References British HIV Association 2010 http://www.bhiva.org/documents/guidelines/hepbc/2010/ hiv_781.pdf

More information

Viral Hepatitis Case Report

Viral Hepatitis Case Report Page 1 of 9 Viral Hepatitis Case Report Perinatal Hepatitis B Virus Infection Michigan Department of Community Health Communicable Disease Division Investigation Information Investigation ID Onset Date

More information

CMV UPDATES. Spring 1998 Vol. 4 No. 1. My Baby has Congenital CMV Disease: The Newborn

CMV UPDATES. Spring 1998 Vol. 4 No. 1. My Baby has Congenital CMV Disease: The Newborn Vol. 6, No. 1 CMV UPDATES Spring 1998 Vol. 4 No. 1 1 My Baby has Congenital CMV Disease: The Newborn Editor's note. This article is part of a series of articles to provide practical information for parents,

More information

What is HIV? What is AIDS? The HIV pandemic HIV transmission Window period Stages of HIV infection

What is HIV? What is AIDS? The HIV pandemic HIV transmission Window period Stages of HIV infection Module 1 Overview of HIV Infection Purpose Pre-requisite Modules Learning Objectives To provide you with the basic terms and concepts related to HIV infection. None At the end of this module, you will

More information

Varicella and Varicella Vaccine

Varicella and Varicella Vaccine Varicella and Epidemiology and Prevention of Vaccine- Preventable Diseases Note to presenters: Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at http://www.vaccineinformation.org/photos/index.asp

More information

2015 Outpatient Chronic Hepatitis B Management

2015 Outpatient Chronic Hepatitis B Management 2015 Outpatient Chronic Hepatitis B Management Hepatitis B Hepatitis B Info 70% of acute infections are subclinical More severe symptoms when in addition to other liver disease Fulminant Hepatitis

More information

SOGC recommendation on ZIKA virus exposure for clinicians caring for pregnant women and those who intend to get pregnant

SOGC recommendation on ZIKA virus exposure for clinicians caring for pregnant women and those who intend to get pregnant SOGC recommendation on ZIKA virus exposure for clinicians caring for pregnant women and those who intend to get pregnant Foreword The rapid emergence of Zika virus as a potential causative agent for fetal

More information

12/2/2015 HEPATITIS B AND HEPATITIS C BLOOD EXPOSURE OBJECTIVES VIRAL HEPATITIS

12/2/2015 HEPATITIS B AND HEPATITIS C BLOOD EXPOSURE OBJECTIVES VIRAL HEPATITIS HEPATITIS B AND HEPATITIS C BLOOD EXPOSURE DISEASE 101 ONLINE CONFERENCE SARAH WENINGER, MPH VIRAL HEPATITIS.STD.HIV PREVENTION COORDINATOR DECEMBER 3, 2015 OBJECTIVES Describe the populations that should

More information

Routine HIV Monitoring

Routine HIV Monitoring Routine HIV Monitoring Guideline of the HIV/AIDS Division at San Francisco General Hospital Statement of Guideline: Patients will be routinely evaluated and monitored for HIV parameters, antiretroviral

More information

PERINATAL AND CHILDHOOD HEPATITIS.. WHAT ABOUT THE CHILDREN?

PERINATAL AND CHILDHOOD HEPATITIS.. WHAT ABOUT THE CHILDREN? PERINATAL AND CHILDHOOD HEPATITIS.. WHAT ABOUT THE CHILDREN? John T. Stutts, MD, MPH University of Louisville School of Medicine Department of Pediatrics Division of Pediatric Gastroenterology, Hepatology

More information

Transmission of HCV in the United States (CDC estimate)

Transmission of HCV in the United States (CDC estimate) Transmission of HCV in the United States (CDC estimate) Past and Future US Incidence and Prevalence of HCV Infection Decline among IDUs Overall incidence Overall prevalence Infected 20+ years Armstrong

More information

Dr David Chadwick. James Cook University Hospital, Middlesbrough. 19 th Annual Conference of the British HIV Association (BHIVA)

Dr David Chadwick. James Cook University Hospital, Middlesbrough. 19 th Annual Conference of the British HIV Association (BHIVA) 19 th Annual Conference of the British HIV Association (BHIVA) Dr David Chadwick James Cook University Hospital, Middlesbrough 16-19 April 2013, Manchester Central Convention Complex Occult hepatitis B/HIV

More information

GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG HIV INFECTED INDIVIDUALS IN SOUTH AFRICA

GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG HIV INFECTED INDIVIDUALS IN SOUTH AFRICA GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG HIV INFECTED INDIVIDUALS IN SOUTH AFRICA 2010 1 TB prophylaxis GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG HIV INFECTED INDIVIDUALS Background

More information

What Everyone Should Know About CMV

What Everyone Should Know About CMV What Everyone Should Know About CMV What Everyone Should Know about CMV is an outreach program of the National Congenital CMV Disease Registry. The CMV Registry is directed by Dr. Gail J. Demmler, Associate

More information

Virology. Varicella - Zoster Virus (VZV) Lec (18) Dr. Areej A. Hussein

Virology. Varicella - Zoster Virus (VZV) Lec (18) Dr. Areej A. Hussein Lec (18) Dr. Areej A. Hussein Virology Varicella - Zoster Virus (VZV) Varicella (chicken pox) is a highly contagious disease of childhood, more than 90% of people in the United States have antibody by

More information

HIV 201: What I Wish I Knew as a NEW RN

HIV 201: What I Wish I Knew as a NEW RN NORTHWEST AIDS EDUCATION AND TRAINING CENTER HIV 201: What I Wish I Knew as a NEW RN Andrea Carriedo, RN The New Hope Clinic NO CONFLICTS OF INEREST OR RELATIONSHIPS TO DISCLOSE Objectives Describe the

More information

Parvovirus B19 Infection in Pregnancy

Parvovirus B19 Infection in Pregnancy Parvovirus B19 Infection in Pregnancy Information Pack Parvovirus B19 Infection in Pregnancy Information Booklet CONTENTS: THE VIRUS page 3 CLINICAL MANIFESTATIONS page 6 DIAGNOSIS page 8 PATIENT MANAGEMENT

More information

CME Article Hiv Disease Surveillance

CME Article Hiv Disease Surveillance CME Article Hiv Disease Surveillance hiv disease surveillance cme Collaboration between Medicine and Public Health Sindy M. Paul, md, mph; Helene Cross, phd; Linda Dimasi, mpa; Abdel R. Ibrahim, phd; and

More information

NHS FORTH VALLEY Guidelines for Hepatitis B Vaccination in High Risk Groups

NHS FORTH VALLEY Guidelines for Hepatitis B Vaccination in High Risk Groups NHS FORTH VALLEY Guidelines for Hepatitis B Vaccination in High Risk Groups Approved 01/04/2012 Version 1.0 Date of First Issue 01/04/2012 Review Date 01/02/2014 Date of Issue 01/04/2012 EQIA Yes Author

More information

Prior Authorization Conditions for Approval of Hepatitis C Agents

Prior Authorization Conditions for Approval of Hepatitis C Agents Prior Authorization Conditions for Approval of Hepatitis C Agents All requests for Hepatitis C Agents require a prior authorization and will be screened for medical necessity and appropriateness using

More information

EPIDEMIOLOGY OF HEPATITIS B IN IRELAND

EPIDEMIOLOGY OF HEPATITIS B IN IRELAND EPIDEMIOLOGY OF HEPATITIS B IN IRELAND Table of Contents Acknowledgements 3 Summary 4 Introduction 5 Case Definitions 6 Materials and Methods 7 Results 8 Discussion 11 References 12 Epidemiology of Hepatitis

More information

Combination Anti-Retroviral Therapy (CART) - Rationale and Recommendation. M Dinaker. Fig.1: Effect of CART on CD4 and viral load

Combination Anti-Retroviral Therapy (CART) - Rationale and Recommendation. M Dinaker. Fig.1: Effect of CART on CD4 and viral load Combination Anti-Retroviral Therapy (CART) - Rationale and Recommendation M Dinaker INTRODUCTION The wide availability of effective, safe and mostly well tolerated combined anti-retroviral therapy (CART)

More information

HEPATITIS WEB STUDY Acute Hepatitis C Virus Infection: Epidemiology, Clinical Features, and Diagnosis

HEPATITIS WEB STUDY Acute Hepatitis C Virus Infection: Epidemiology, Clinical Features, and Diagnosis HEPATITIS WEB STUDY Acute C Virus Infection: Epidemiology, Clinical Features, and Diagnosis H. Nina Kim, MD Assistant Professor of Medicine Division of Infectious Diseases University of Washington School

More information

Appendix E-- The CDC s Current and Proposed Classification System for HIV Infection

Appendix E-- The CDC s Current and Proposed Classification System for HIV Infection Appendix E-- The CDC s Current and Proposed Classification System for HIV Infection The Centers for Disease Control (CDC) has developed a classification system for human immunodeficiency virus (HIV) infection

More information

Chapter 21. What Are HIV and AIDS?

Chapter 21. What Are HIV and AIDS? Section 1 HIV and AIDS Today What Are HIV and AIDS? Human immunodeficiency virus (HIV) is the virus that primarily affects cells of the immune system and that causes AIDS. Acquired immune deficiency syndrome

More information

An Overview of NYS Hepatitis C Testing Law. Statewide Stakeholder Meetings

An Overview of NYS Hepatitis C Testing Law. Statewide Stakeholder Meetings An Overview of NYS Hepatitis C Testing Law Statewide Stakeholder Meetings Agenda Overview of Hepatitis C virus (HCV) CDC HCV screening recommendations Review of HCV screening and diagnostic tests CDC HCV

More information

HIV and Hepatitis B CoInfection

HIV and Hepatitis B CoInfection HIV and Hepatitis B CoInfection Douglas G. Fish, MD June 3, 2014 44 yo male with AIDS who had fallen out of care and returned in October 2013 Last seen in November 2012 CD4 at that time 340 cells/cmm HIV

More information

Diagnosis of Acute HCV Infection

Diagnosis of Acute HCV Infection Hepatitis C Online PDF created August 23, 2016, 2:28 pm Diagnosis of Acute HCV Infection Module 1: Lesson 5: Contents: Screening and Diagnosis of Hepatitis C Infection Diagnosis of Acute HCV Infection

More information

MANAGEMENT OF INFANTS BORN TO HIV POSITIVE MOTHERS

MANAGEMENT OF INFANTS BORN TO HIV POSITIVE MOTHERS MANAGEMENT OF INFANTS BORN TO HIV POSITIVE MOTHERS Introduction Perinatal management of infants born to HIV-infected mothers requires a coordinated multidisciplinary team approach. The consultant leads

More information

Issues in Perinatally HIV Infected Adolescents. Gloria P Heresi, MD Professor of Pediatrics UTHealth, Houston

Issues in Perinatally HIV Infected Adolescents. Gloria P Heresi, MD Professor of Pediatrics UTHealth, Houston Issues in Perinatally HIV Infected Adolescents Gloria P Heresi, MD Professor of Pediatrics UTHealth, Houston Perinatally HIV Infected Adolescents Who are they? How many? Issues of special impact MTCT Race

More information

Indicate whether the case had jaundice. If not known or unavailable then select the Unknown option.

Indicate whether the case had jaundice. If not known or unavailable then select the Unknown option. HBC-1 HEPATITIS B, C, NOS Disease name Disease Indicate whether the case is hepatitis B, C or NOS (Not Otherwise Specified). Select hepatitis NOS for cases of hepatitis D, hepatitis E or if the type of

More information

HBV DNA < monitoring interferon Rx

HBV DNA < monitoring interferon Rx Hepatitis B Virus Suspected acute hepatitis >>Order: Acute Unknown hepatitis screen Suspected chronic hepatitis >>Order: Chronic unknown hepatitis screen Acute HBV or Delayed Anti HBs response after acute

More information

AIR FORCE REPORTABLE EVENTS GUIDELINES & CASE DEFINITIONS

AIR FORCE REPORTABLE EVENTS GUIDELINES & CASE DEFINITIONS AIR FORCE REPORTABLE EVENTS GUIDELINES & CASE DEFINITIONS An Air Force addendum to the TRI-SERVICE REPORTABLE EVENTS GUIDELINES & CASE DEFINITIONS Prepared by: Air Force Institute for Operational Health

More information

Cryptococcal Screening Program Case Studies

Cryptococcal Screening Program Case Studies Slide 1 Cryptococcal Screening Program Case Studies Image courtesy of World Health Organization National Center for Emerging and Zoonotic Infectious Diseases Mycotic Diseases Branch Slide 2 Note to trainers

More information

Infection Prevention and Control Team (IPCT) GUIDELINES FOR STAFF WHO COME INTO CONTACT WITH VARICELLA ZOSTER VIRUS (CHICKENPOX OR SHINGLES)

Infection Prevention and Control Team (IPCT) GUIDELINES FOR STAFF WHO COME INTO CONTACT WITH VARICELLA ZOSTER VIRUS (CHICKENPOX OR SHINGLES) Infection Prevention and Control Team (IPCT) GUIDELINES FOR STAFF WHO COME INTO CONTACT WITH VARICELLA ZOSTER VIRUS (CHICKENPOX OR SHINGLES) WARNING This document is uncontrolled when printed. Check local

More information

FURTHER EXPERIENCE WITH SUBCUTANEOUS IMMUNOGLOBULIN THERAPY IN CHILDREN WITH PRIMARY IMMUNE DEFICIENCIES

FURTHER EXPERIENCE WITH SUBCUTANEOUS IMMUNOGLOBULIN THERAPY IN CHILDREN WITH PRIMARY IMMUNE DEFICIENCIES FURTHER EXPERIENCE WITH SUBCUTANEOUS IMMUNOGLOBULIN THERAPY IN CHILDREN WITH PRIMARY IMMUNE DEFICIENCIES Dr Alison Jones Great Ormond Street Hospital for Children NHS Trust London WC1N 3JH United Kingdom

More information

Tuberculosis and HIV/AIDS Co-Infection: Epidemiology and Public Health Challenges

Tuberculosis and HIV/AIDS Co-Infection: Epidemiology and Public Health Challenges Tuberculosis and HIV/AIDS Co-Infection: Epidemiology and Public Health Challenges John B. Kaneene, DVM, MPH, PhD University Distinguished Professor of Epidemiology Director, Center for Comparative Epidemiology

More information

HBC-1. If the case had jaundice, tick the Yes box. If not, tick the No box. If not known or unavailable then tick the Unknown box.

HBC-1. If the case had jaundice, tick the Yes box. If not, tick the No box. If not known or unavailable then tick the Unknown box. HBC-1 HEPATITIS B, C, NOS Disease Name Disease Indicate whether the case is hepatitis B, C or NOS (Not Otherwise Specified). Use NOS for cases of hepatitis D or E or if the type of hepatitis has not been

More information

Appendix B: Provincial Case Definitions for Reportable Diseases

Appendix B: Provincial Case Definitions for Reportable Diseases Infectious Diseases Protocol Appendix B: Provincial Case Definitions for Reportable Diseases Disease: Lassa Fever Revised December 2014 Lassa Fever 1.0 Provincial Reporting Confirmed and probable cases

More information

Appendix B: Provincial Case Definitions for Reportable Diseases

Appendix B: Provincial Case Definitions for Reportable Diseases Infectious Diseases Protocol Appendix B: Provincial Case Definitions for Reportable Diseases Disease: Hepatitis B Revised Hepatitis B 1.0 Provincial Reporting Confirmed, chronic and probable cases of disease

More information

CIBMTR Infection Data and the New Infection Inserts.

CIBMTR Infection Data and the New Infection Inserts. CIBMTR Infection Data and the New Infection Inserts. Marcie Tomblyn, MD, MS Scientific Director, CIBMTR Infection and Immune Reconstitution Working Committee Overview Indication for expanded data collection

More information

HIV/AIDS Care: The Diagnosis Code Series 2. Prepared By: Stacey L. Murphy, MPA, RHIA, CPC AHIMA Approved ICD-10-CM/ICD-10-CM Trainer

HIV/AIDS Care: The Diagnosis Code Series 2. Prepared By: Stacey L. Murphy, MPA, RHIA, CPC AHIMA Approved ICD-10-CM/ICD-10-CM Trainer HIV/AIDS Care: The Diagnosis Code Series 2 Prepared By: Stacey L. Murphy, MPA, RHIA, CPC AHIMA Approved ICD-10-CM/ICD-10-CM Trainer Learning Outcomes Identify and explain the difference between ICD-9-CM

More information

Disease or Condition-Specific Information (Please complete if appropriate)

Disease or Condition-Specific Information (Please complete if appropriate) Arkansas Department of Health 4815 West Markham Street, Communicable Disease Reporting Form Slot #32 Fax Reports to (501) 661-2428 Little Rock, AR 72205 Please Print Legibly Reporting facility: Address:

More information

Diagnosis of CMV infection UPDATE ECIL

Diagnosis of CMV infection UPDATE ECIL UPDATE ECIL-4 2011 Recommendations for CMV and HHV-6 management in patients with hematological diseases Per Ljungman, Rafael de la Camara, Hermann Einsele, Dan Engelhard, Pierre Reusser, Jan Styczynski,

More information

Clinical Criteria for Hepatitis C (HCV) Therapy

Clinical Criteria for Hepatitis C (HCV) Therapy Diagnosis Clinical Criteria for Hepatitis C (HCV) Therapy Must have chronic hepatitis C, genotype and sub-genotype specified to determine the length of therapy; Liver biopsy or other accepted test demonstrating

More information

Hepatitis B and C Co-infection. Mark Hull MHSc, FRCPC Clinical Assistant Professor Division of AIDS

Hepatitis B and C Co-infection. Mark Hull MHSc, FRCPC Clinical Assistant Professor Division of AIDS Hepatitis B and C Co-infection Mark Hull MHSc, FRCPC Clinical Assistant Professor Division of AIDS Objectives Review natural history of hepatitis coinfection Brief overview of treatment indications for

More information

2011 Update on the ECIL-3 guidelines for EBV management in patients with leukemia and other hematological disorders

2011 Update on the ECIL-3 guidelines for EBV management in patients with leukemia and other hematological disorders UPDATE ECIL-4 2011 2011 Update on the ECIL-3 guidelines for EBV management in patients with leukemia and other hematological disorders Jan Styczynski, Hermann Einsele, Rafael de la Camara, Catherine Cordonnier,

More information

Hepatitis C Treatment Criteria Commercial & Minnesota Health Care Programs

Hepatitis C Treatment Criteria Commercial & Minnesota Health Care Programs Last update: February 23, 2015 Hepatitis C Treatment Criteria Commercial & Minnesota Health Care Programs Please see healthpartners.com for Medicare coverage criteria. Table of Contents 1. Harvoni 2. Sovaldi

More information

Prevention of Mother to Child Transmission (MTCT) of HIV

Prevention of Mother to Child Transmission (MTCT) of HIV Prevention of Mother to Child Transmission (MTCT) of HIV Tim Farley Department of Reproductive Health and Research World Health Organization Geneva 17 September 2001 Postgraduate Course in Reproductive

More information

Goals of Therapy. Treatment Options for Hepatitis C. Patterns of Response. Progress in Hepatitis C Therapy

Goals of Therapy. Treatment Options for Hepatitis C. Patterns of Response. Progress in Hepatitis C Therapy Treatment Options for Hepatitis C Helen S. Te, M.D. Center for Liver Diseases University of Chicago Hospitals Chicago, Illinois Primary: To eliminate the virus Goals of Therapy Secondary: To decrease inflammation

More information

Beginner's guide to Hepatitis C testing and immunisation against hepatitis A+B in general practice

Beginner's guide to Hepatitis C testing and immunisation against hepatitis A+B in general practice Beginner's guide to Hepatitis C testing and immunisation against hepatitis A+B in general practice Dr Chris Ford GP & SMMGP Clinical Lead Kate Halliday Telford & Wrekin Shared Care Coordinator Aims Discuss:

More information

Congenital Toxoplasmosis Patient Scenario

Congenital Toxoplasmosis Patient Scenario Diagnosis and Management of Foodborne Illnesses A Primer for Physicians and Other Health Care Professionals Congenital Toxoplasmosis Patient Scenario Congenital Toxoplasmosis Patient Scenario American

More information

Human Immunodeficiency Virus Acquired Immunodeficiency syndrome first described in 1981 HIV-1 isolated in 1984, and HIV-2 in 1986 Belong to the lentiv

Human Immunodeficiency Virus Acquired Immunodeficiency syndrome first described in 1981 HIV-1 isolated in 1984, and HIV-2 in 1986 Belong to the lentiv Global HIV/AIDS Manju Gaglani, M. D. Pediatric Infectious Diseases Scott & White Clinic Human Immunodeficiency Virus Acquired Immunodeficiency syndrome first described in 1981 HIV-1 isolated in 1984, and

More information

Lyme Disease in Pregnancy. Dr Sarah Chissell Consultant Obstetrician William Harvey Hospital, Kent

Lyme Disease in Pregnancy. Dr Sarah Chissell Consultant Obstetrician William Harvey Hospital, Kent Lyme Disease in Pregnancy Dr Sarah Chissell Consultant Obstetrician William Harvey Hospital, Kent Conflict of interest My son has chronic Lyme disease Infections in pregnancy Transplacental infection Perinatal

More information

Guideline. Treatment of tuberculosis in pregnant women and newborn infants. Version 3.0

Guideline. Treatment of tuberculosis in pregnant women and newborn infants. Version 3.0 Guideline Treatment of tuberculosis in pregnant women and newborn infants Version 3.0 Key critical points The decision to treat tuberculosis (TB) in pregnancy must consider the potential risks to mother

More information

APPENDIX C: Viral Load Suppression Measures

APPENDIX C: Viral Load Suppression Measures Newark EMA HIV Health Services Planning Council Needs Assessment 2012 Update APPENDIX C: Viral Load Suppression Measures Page C-1 APPENDIX C: Viral Load Suppression Measures in+care Campaign Measures November

More information

CMV UPDATES. Advances in CMV Vaccine Research

CMV UPDATES. Advances in CMV Vaccine Research 1 Vol. 6, No. 1 CMV UPDATES Fall 1995 Vol. 1 No. 2 Advances in CMV Vaccine Research Cytomegalovirus is known to some text books as the "silent" virus because most people will catch the virus at some point

More information

El Paso - Ambulatory Clinic Policy and Procedure

El Paso - Ambulatory Clinic Policy and Procedure Regulation Reference: Title: HEALTHCARE WORKERS WITH COMMUNICABLE DISEASES Policy Number: EP 7.4 Effective Date: 5/2013 Policy Statement: It is the policy of Paul L. Foster School of Medicine to protect

More information

NOTIFIABLE. Infectious Disease Assessment for Migrants 2015 - 27 - RECOMMENDATIONS. Offer test (HBsAg and anti-hbc) to: Vaccinate:

NOTIFIABLE. Infectious Disease Assessment for Migrants 2015 - 27 - RECOMMENDATIONS. Offer test (HBsAg and anti-hbc) to: Vaccinate: 5.2 Hepatitis B NOTIFIABLE RECOMMENDATIONS Offer test (HBsAg and anti-hbc) to: = All new migrants originating from countries with a HBsAg prevalence of 2% = Household and sexual of identified acute or

More information

Outpatient/Ambulatory Health Services

Outpatient/Ambulatory Health Services Outpatient/Ambulatory Health Services Service Definition Outpatient/ambulatory medical care includes the provision of professional diagnostic and therapeutic services rendered by a physician, physician

More information

TB-HIV Co-Infection in Children. Reené Naidoo Paediatric HIV/TB Symposium August 2013

TB-HIV Co-Infection in Children. Reené Naidoo Paediatric HIV/TB Symposium August 2013 TB-HIV Co-Infection in Children Reené Naidoo Paediatric HIV/TB Symposium August 2013 Introduction TB & HIV are two of the leading causes of morbidity & mortality in children in South Africa HIV infection

More information

ROYAL HOSPITAL FOR WOMEN

ROYAL HOSPITAL FOR WOMEN HEPATITIS B POSITIVE MOTHERS AND THEIR BABIES This LOP is developed to guide clinical practice at the Royal Hospital for Women. Individual patient circumstances may mean that practice diverges from this

More information

New York City Department of Health Protocols for Latent TB Infection Treatment

New York City Department of Health Protocols for Latent TB Infection Treatment New York City Department of Health Protocols for Latent TB Infection Treatment CONTENT A. Medical evaluation for latent TB infection (LTBI) treatment 1. Medical history and physical examination 2. Chest

More information

Pregnancy and Tuberculosis. Information for clinicians

Pregnancy and Tuberculosis. Information for clinicians Pregnancy and Tuberculosis Information for clinicians When to suspect Tuberculosis (TB)? Who is at risk of TB during pregnancy? Recent research suggests that new mothers are at an increased risk of TB

More information

The following should be current within the past 6 months:

The following should be current within the past 6 months: EVALUATION Baseline Labs Obtain at time or prior to initial evaluation CBC with diff PT/INR CMP HCV Genotype (obtained PRIOR TO consult visit) HCV RNA (obtained PRIOR TO consult visit) Hep A IgG Hep BsAg,

More information

HCV/HIVCo-infection A case study by. Dominic Côté, Nurse Clinician B.Sc Chronic Viral Illness Services McGill University Health Centre

HCV/HIVCo-infection A case study by. Dominic Côté, Nurse Clinician B.Sc Chronic Viral Illness Services McGill University Health Centre HCV/HIVCo-infection A case study by Dominic Côté, Nurse Clinician B.Sc Chronic Viral Illness Services McGill University Health Centre Objectives By sharing a case study of a patient co-infected with HIV/HCV

More information

TB Prevention, Diagnosis and Treatment. Accelerating advocacy on TB/HIV 15th July, Vienna

TB Prevention, Diagnosis and Treatment. Accelerating advocacy on TB/HIV 15th July, Vienna TB Prevention, Diagnosis and Treatment Accelerating advocacy on TB/HIV 15th July, Vienna Diagnosis Microscopy of specially stained sputum is the main test for diagnosing TB (1 2 days) TB bacilli seen in

More information

Review: How to work up your patient with Hepatitis C

Review: How to work up your patient with Hepatitis C Review: How to work up your patient with Hepatitis C You screened your patient, and now the HCV antibody test is positive. What do you do next? The antibody test only means they have been exposed to HCV.

More information

Early infant diagnosis of HIV infection in South Africa: 2008 to 2010

Early infant diagnosis of HIV infection in South Africa: 2008 to 2010 Early infant diagnosis of HIV infection in South Africa: 28 to 21 Gayle Sherman a,b*, Rivka Lilian b a National Health Laboratory Service and Department of Molecular Medicine and Haematology, University

More information

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents Visit the AIDSinfo website to access the most up-to-date guideline. Register for e-mail notification of guideline

More information

New IDSA/AASLD Guidelines for Hepatitis C

New IDSA/AASLD Guidelines for Hepatitis C NORTHWEST AIDS EDUCATION AND TRAINING CENTER New IDSA/AASLD Guidelines for Hepatitis C John Scott, MD, MSc Associate Professor, UW SoM Asst Director, Liver Clinic, Harborview Medical Center Presentation

More information

PENNSYLVANIA DEPARTMENT OF HEALTH 2015 PAHAN 307 04-02-ADV Pertussis in Centre County

PENNSYLVANIA DEPARTMENT OF HEALTH 2015 PAHAN 307 04-02-ADV Pertussis in Centre County PENNSYLVANIA DEPARTMENT OF HEALTH 2015 PAHAN 307 04-02-ADV Pertussis in Centre County DATE: 04/02/2015 TO: Health Alert Network FROM: Karen M. Murphy, PhD, RN, Acting Secretary of Health SUBJECT: DISTRIBUTION:

More information

MANAGEMENT OF TUBERCULOSIS

MANAGEMENT OF TUBERCULOSIS MANAGEMENT OF TUBERCULOSIS Dean B. Ellithorpe, M.D. Clinical Professor of Medicine Section of Pulmonary Diseases, Critical Care and Environmental Medicine Tulane University School of Medicine INTRODUCTION

More information

Incidencia y Características Clínicas del Síndrome Inflamatorio de Reconstitución Inmune (IRIS) en el Contexto de la Coinfección VIH-TB

Incidencia y Características Clínicas del Síndrome Inflamatorio de Reconstitución Inmune (IRIS) en el Contexto de la Coinfección VIH-TB Incidencia y Características Clínicas del Síndrome Inflamatorio de Reconstitución Inmune (IRIS) en el Contexto de la Coinfección VIH-TB Dr. Christian Manzardo Hospital Clínic/IDIBAPS- Universidad de Barcelona

More information

Fact Sheet for Health Care Providers: Interpreting Results from the Aptima Zika Virus Assay. June 17, 2016

Fact Sheet for Health Care Providers: Interpreting Results from the Aptima Zika Virus Assay. June 17, 2016 Dear Health Care Provider: Fact Sheet for Health Care Providers: Interpreting Results from the Aptima Zika Virus Assay June 17, 2016 The U.S. Food and Drug Administration (FDA) has issued an Emergency

More information

Consolidated guidelines on the use of antiretroviral drugs for treating

Consolidated guidelines on the use of antiretroviral drugs for treating TB conference, 10-13 June 2014, Durban, South Africa Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection Dr Augustin Ntilivamunda Objectives of 2013 WHO

More information

! What Parents Should Know About Measles-Mumps-Rubella (MMR) Vaccine and Autism

! What Parents Should Know About Measles-Mumps-Rubella (MMR) Vaccine and Autism What Parents Should Know About Measles-Mumps-Rubella (MMR) Vaccine and Autism Autism Q. What is autism? Autism is a spectrum of chronic developmental disorders. The main characteristics of autism are difficulties

More information

GUIDELINES FOR VIRAL HEPATITIS SURVEILLANCE AND CASE MANAGEMENT

GUIDELINES FOR VIRAL HEPATITIS SURVEILLANCE AND CASE MANAGEMENT GUIDELINES FOR VIRAL HEPATITIS SURVEILLANCE AND CASE MANAGEMENT January 2005 Guidelines for Viral Hepatitis Surveillance and Case Management Ordering information To order a copy of this manual, write to:

More information

Perinatal Hepatitis B

Perinatal Hepatitis B Perinatal Hepatitis B MISTY HALL RN, BSN NURSE CONSULTANT AK IMMUNIZATION PROGRAM Perinatal Case Management Importance of Birth Dose to End Hepatitis B in Newborns was addressed yesterday Goals: Identify

More information

PRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT

PRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT PRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT HARVONI (90mg ledipasvir/400mg sofosbuvir): tablet (PREFERRED AGENT) SOVALDI (sofosbuvir ): 400mg tablets (PREFERRED AGENT ) OLYSIO (simeprivir) PEG-INTRON

More information

When an occupational exposure occurs, the source patient should be evaluated for both hepatitis B and hepatitis C. (AII)

When an occupational exposure occurs, the source patient should be evaluated for both hepatitis B and hepatitis C. (AII) XI. OCCUPATIONAL EXPOSURES TO HEPATITIS B AND C RECOMMENDATION: When an occupational exposure occurs, the source patient should be evaluated for both hepatitis B and hepatitis C. (AII) The risk of transmission

More information

Chapter 3 South African guidelines and introduction to clinical cases

Chapter 3 South African guidelines and introduction to clinical cases Chapter 3 South African guidelines and introduction to clinical cases 3.1. South African national antiretroviral guidelines When this book was published in 2012 the current national antiretroviral treatment

More information

Outline: STOP HIV/AIDS: Seek and Treat for Optimal Prevention of HIV/AIDS. STOP HIV/AIDS Provincial HIV/AIDS Collaborative

Outline: STOP HIV/AIDS: Seek and Treat for Optimal Prevention of HIV/AIDS. STOP HIV/AIDS Provincial HIV/AIDS Collaborative STOP HIV/AIDS Provincial HIV/AIDS Collaborative Rolando Barrios, MD, FRCPC Assistant Director BC Centre for Excellence in HIV/AIDS Assistant Medical Director HIV/AIDS Program Providence Health Care Adjunct

More information

Informed Consent: Valcyte (valganciclovir) Treatment for Chronic Fatigue Syndrome. From Richard Podell, M.D., MPH, August 3, 2014

Informed Consent: Valcyte (valganciclovir) Treatment for Chronic Fatigue Syndrome. From Richard Podell, M.D., MPH, August 3, 2014 Informed Consent: Valcyte (valganciclovir) Treatment for Chronic Fatigue Syndrome Background: From Richard Podell, M.D., MPH, August 3, 2014 Currently there are no proven effective treatments for chronic

More information

CARE AND TREATMENT FOR PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV

CARE AND TREATMENT FOR PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV MINISTRY OF HEALTH PROCEDURE OF CARE AND TREATMENT FOR PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV HA NOI, 2007 1 TABLE OF CONTENTS Decision on the Issuance of the Procedure of Care and Treatment

More information

TESTING AND MANAGEMENT. Dr Nicole Allard GP Cohealth, Joslin Clinic, West Footscray PhD student, Epidemiology Unit VIDRL

TESTING AND MANAGEMENT. Dr Nicole Allard GP Cohealth, Joslin Clinic, West Footscray PhD student, Epidemiology Unit VIDRL TESTING AND MANAGEMENT Dr Nicole Allard GP Cohealth, Joslin Clinic, West Footscray PhD student, Epidemiology Unit VIDRL Disclosure and acknowledgments No conflicts of interest Board Member of Hepatitis

More information

3/25/2014. April 3, 2014. Dennison MM, et al. Ann Intern Med. 2014;160:293 300.

3/25/2014. April 3, 2014. Dennison MM, et al. Ann Intern Med. 2014;160:293 300. April 3, 2014 3.6 million persons ever infected; 2.7 million chronic infections 1 Up to 75% unaware of status Transmitted through percutaneous exposure to infected blood Injection drug use (IDU) is the

More information