Clinical Guidelines for the Treatment and Prevention of Opportunistic Infections in HIV-infected Koreans

doi:10.3947/ic.2012.44.3.93

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The Korean Society for AIDS: Clinical Guidelines for the Treatment and Prevention of Opportunistic Infections in HIV-infected Koreans

Special Article

Infect Chemother 2012;44(3):93-139.

Published online: 30 June 2012

DOI: https://doi.org/10.3947/ic.2012.44.3.93

Clinical Guidelines for the Treatment and Prevention of Opportunistic Infections in HIV-infected Koreans

The Korean Society for AIDS

Correspondence to The Committee for Clinical Guidelines for the Treatment and Prevention of Opportunistic Infections in HIV-infected Koreans of The Korean Society for AIDS. The Korean Society for AIDS, Asterium #1203, Maezllan 21, Samseong-dong 158-10, Kangnam-gu, Seoul 135-880, Korea Tel: +82-2-557-1755, Fax: +82-2-6499-1755, E-mail: kosa@kosaids.or.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Clinical guidelines for treatment and prevention of opportunistic infections in HIV-infected patients have been developed in other countries. However, due to different epidemiological and clinical situations in Korea, the implementation of such guidelines may be not assured. Therefore, the Committee for Clinical Guidelines for the Treatment and Prevention of Opportunistic Infections in HIV-infection Koreans of The Korean Society for AIDS was founded in 2011 for development of optimal guidelines that can be directly applied in Korea. These guidelines aim to provide comprehensive information regarding treatment and prevention of opportunistic infections in Korea. The recommendations contain important information for physicians working with HIV/AIDS in actual clinical fields. Regular revision of the guidelines will be performed according to changes in clinical situations for opportunistic infections in HIV-infected Koreans.

Keywords: HIV/AIDS, Opportunistic infections, Treatment, Prevention, Guideline

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Table 1.

Strength of Recommendation and Quality of Evidence for Recommendation

Strength of Recommendation	Quality of Evidence for Recommendation
A; should always be offered	I: one or more properly designed randomized, controlled trials
B: should generally be offered	II: one or more welldesigned, nonrandomized trials
C: optional	III: expert opinion, descriptive studies
D: should generally not be offered
E: should never be offered

Table 2.

Drug Interactions Between Anti-mycobacterial Drugs and Antiretroviral Drugs [56]

Anti-mycobacterial drugs	Antiretroviral drugs	Dosing Recommendations and Clinical Comments
Protease inhibitors (PIs)
Clarithromycin	ATV±RTV	May cause QTc prolongation.
	ATV±RTV	Reduce clarithromycin dose by 50%. Consider alternative therapy.
	DRV/r	Monitor for clarithromycin-related toxicities.
	IDV +/ RTV	Reduce clarithromycin dose by 50% in patients with CrCl 30-60 mL/min.
	LPV/r	Reduce clarithromycin dose by 75% in patients with CrCl <30 mL/min.
Rifabutin	RTVboosted Pis
	ATV +/ RTV	Rifabutin 150 mg every other day or 3x/week.
	DRV/r	Acquired rifamycin resistance has been reported in patients with inadequate rifabutin levels while on 150 mg twice weekly and RTV-boosted PIs.
	IDV/r
	LPV/r	Rifabutin 150 mg three times weekly in combination with LPV/r has resulted in inadequate rifabutin levels and has led to acquired rifamycin resistance in patients with HIV-associated tuberculosis.
	PIs without RTV
	IDV	Rifabutin 150 mg daily or 300 mg 3x/week + IDV 1,000 mg q 8h or consider RTV boosting.
	NFV	Rifabutin 150 mg daily or 300 mg 3x/week
Rifampin	All PIs	Do not coadminister rifampin and PIs
Non-neucleoside reverse transcriptase inhibitors (NNRTIs)
Clarithromycin	EFV	Consider alternative agent, such as azithromycin, for MAC prophylaxis and treatment.
	ETR
	NVP
Rifabutin	EFV	Dose: rifabutin 450-600 mg once daily or 600 mg 3x/week if EFV is not coadministered with a PI.
	ETR	Dose: rifabutin 300 mg once daily if ETR is not coadministered with a RTV-boosted PI.
	ETR	If ETR is coadministered with a RTV-boosted PI, rifabutin should not be coadministered.
Rifampin	NVP	No dosage adjustment necessary. Use with caution.
	EFV	Maintain EFV dose at 600 mg once daily and monitor for virologic response.
	ETR	Do not coadminister.
	NVP

ATV, atazanavir; ATV/r, atazanavir+ritonavir; DRV/r, darunavir+ritonavir; IDV, indinavir; IDV/r, indinavir+ritonavir; LPV/r, lopinavir+ritonavir; NFV, nelfinavir; RTV, ritonavir; EFV, efavirenz; ETR, etravirine; NVP, nevirapine; MAC, Mycobacterium avium complex

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