Monitoring
Tuberculosis (TB)
Patients are preferably monitored during their treatment. Directly observed therapy is recommended for all patients with HIV-related TB.
Monthly patient 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 patients.
For patients 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.[199]
Disseminated Mycobacterium avium complex
For patients 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
Patients should be monitored for adverse events and clinical and radiological improvement.[1]
Cryptococcal meningitis
Patients 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)
Patients should have regular ophthalmological follow-up because the retinitis can relapse even after immune recovery at CD4 counts as high as 1250 cells/microlitre.[256] Indirect ophthalmoscopy through a dilated pupil should be performed at the time of diagnosis of CMV retinitis, after completion of the induction therapy, 1 month after the initiation of therapy, and monthly thereafter while the patient is on anti-CMV treatment. The ophthalmological follow-up can be decreased to every 3 months for patients who have experienced immune recovery.[257]
FBC, renal function, and serum electrolytes should be monitored twice weekly during induction therapy and once weekly thereafter in patients receiving ganciclovir or foscarnet.[1]
Coccidioidomycosis
Lifelong follow-up may be required. In patients discontinuing treatment, follow-up to detect relapsed infection is important.
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