4424 Treatment • First line treatment for CMV colitis is intr Treatment. • First line treatment for CMV colitis is intravenous ganciclovir (5 mg/kg Alectinib twice daily) for 14–28 days (category Ib recommendation). CMV colitis has traditionally been treated with ganciclovir 5 mg/kg bd iv for 14–28 days

[62]. Caution should be used in initiating treatment with the oral medication valganciclovir as there is a theoretical concern of decreased absorption, but HIV and non-HIV-related cases of CMV colitis have been successfully treated [63]. Intravenous foscarnet (90 mg/kg twice daily) for 14–28 days is used as an alternative [64,65]. Therapeutic drug monitoring may be required to ensure adequate HAART absorption (category IV recommendation). Chronic maintenance therapy is not routinely recommended in gastrointestinal disease unless patients relapse after induction therapy ceases [64]. All individuals with CMV involving the gastrointestinal tract should have prompt ophthalmological evaluation to exclude concomitant CMV retinitis and if this is present treatment and secondary prophylaxis should be initiated as recommended (see section 5.1 CMV retinitis). Impact of HAART. Continuous use of effective HAART is required to prevent relapse. Background and epidemiology. Cryptosporidium, a protozoan

parasite, was the most common pathogen in HIV-antibody-positive individuals with chronic diarrhoea in the pre-HAART era. Those at greatest risk Veliparib cost of infection are individuals with a CD4 count <100 cells/μL [66]. It predominantly infects the small bowel mucosa, Etofibrate but in

the immunocompromised patient, the large bowel and extraintestinal sites may be involved. The most common species infecting humans in the UK are C. hominis and the zoonotic species C. parvum and C. meleagridis [67]. In areas with a low rate of environmental contamination and where HAART is widely available, cryptosporidiosis has an incidence of<1 per 100 person-years among HIV-seropositive individuals. Ingestion of cryptosporidium oocysts leads to transmission of the parasite. Faeces from infected animals, including humans, can contaminate the water supply with viable oocysts, which are highly resistant to chlorination. Transmission may also occur during sex, particularly via the faecal–oral route [68]. Presentation. Cryptosporidiosis should be considered in any individual with an acute or subacute history of profuse, non-bloody watery diarrhoea. In immunocompetent individuals, cryptosporidiosis presents as an acute, self-limiting diarrhoeal illness, which may be accompanied by nausea, abdominal cramps and low-grade pyrexia, lasting up to 14 days. In HIV-seropositive individuals with a CD4 count <50 cells/μL there is a worsening of these symptoms, and stool volumes of up to 24 litres per day have been described, although more commonly, 2–3 litres per day are passed [69]. Malabsorption may be present.

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