The urological management of the patient with acquired immunodeficiency syndrome

Heyns C.F.
Fisher M.
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In people infected with the human immunodeficiency virus (HIV) both the CD4 T-cell count and the viral load are used to monitor disease progression to acquired immunodeficiency syndrome (AIDS). CD4 counts of &lt
500/mm3 are associated with opportunistic infections and certain malignancies, so-called 'AIDS-defining' conditions. Highly active antiretroviral therapy, using combinations of reverse transcriptase inhibitors and/or protease inhibitors, can improve considerably the prognosis of people who are HIV-positive, but such therapy is not yet widely available in many developing countries. People with AIDS are predisposed to urinary tract infection (UTI) by uncommon bacteria and pathogens, e.g. fungi, parasites and viruses, which may affect any urogenital organ
treatment should be culture-specific and long-term, because there is a tendency to recurrence, infection with multiple organisms and resistant isolates. Voiding dysfunction in patients with AIDS is usually a result of neurological complications caused by opportunistic infections, and has a poor prognosis. Of patients with AIDS, 30-50% develop a cancer, especially Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL). KS may involve any urogenital organ, but is usually part of systemic disease. Small lesions on the external genitalia can be treated with laser, cryotherapy or surgical excision, larger lesions with radiotherapy, and disseminated or visceral KS with multidrug chemotherapy. NHL may involve the kidneys, testes and retroperitoneal lymph nodes, thus obstructing the ureters, which may require ureteric stenting or percutaneous nephrostomy. NHL can be treated with radiotherapy and combination chemotherapy. Urolithiasis in patients with AIDS may be caused by indinavir, a protease inhibitor, but the more common types of stones may also occur. Fluid-electrolyte and acid-base disturbances are common in patients with advanced AIDS, secondary to vomiting, diarrhoea, malnutrition or septicaemia. HIV-associated nephropathy occurs in 10-30% of patients, and often leads to renal failure. Testicular atrophy is common, leading to infertility, erectile dysfunction (ED) and decreased libido. Treatment for ED must include counselling about strategies to reduce the transmission of HIV. The risk of HIV transmission after parenteral exposure to blood from an HIV-positive patient is relatively low (0.2-0.4%)
the urologist can reduce the risk of transmission during surgery by adopting certain precautions. After occupational exposure to HIV, chemoprophylaxis with antiretroviral medication can significantly reduce the probability of HIV transmission. © 2005 BJU INTERNATIONAL.
abacavir, aciclovir, alpha interferon, aminoglycoside antibiotic agent, amphotericin B, amprenavir, analgesic agent, antifungal agent, antivirus agent, azithromycin, bleomycin, cefixime, cholinergic receptor blocking agent, cidofovir, ciprofloxacin, clotrimazole, contrast medium, cotrimoxazole, dapsone, delavirdine, didanosine, doxorubicin, doxycycline, efavirenz, ethambutol, famciclovir, fluconazole, fluorouracil, foscarnet, ganciclovir, imiquimod, indinavir, interferon, isoniazid, lamivudine, miconazole, nelfinavir, nevirapine, norfloxacin, ofloxacin, pentamidine, podophyllotoxin, prostaglandin, proteinase inhibitor, pyrazinamide, quinolone derivative, retinoic acid, retinoid, rifampicin, ritonavir, RNA directed DNA polymerase inhibitor, saquinavir, sildenafil, stavudine, sulfadiazine, testosterone, tioconazole, trichloroacetic acid, vincristine, zalcitabine, zidovudine, antibiotic agent, antiretrovirus agent, phenazopyridine, unindexed drug, acquired immune deficiency syndrome, candidiasis, condyloma acuminatum, cryotherapy, cystostomy, disease classification, disease course, electrolyte disturbance, epididymitis, erectile dysfunction, genital ulcer, germ cell tumor, hematuria, highly active antiretroviral therapy, human, Human immunodeficiency virus infection, infection prevention, Kaposi sarcoma, kidney carcinoma, kidney failure, kidney infection, laser surgery, libido disorder, lymphocyte count, male infertility, micturition disorder, molluscum contagiosum, nephrolithiasis, nonhodgkin lymphoma, opportunistic infection, pathogenesis, patient counseling, penis cancer, percutaneous nephrostomy, priority journal, prostate cancer, prostatitis, rectovaginal fistula, review, single drug dose, testis atrophy, ureter obstruction, ureter stent, urethritis, urinary tract infection, urolithiasis, virus load, virus transmission, abnormally high substrate concentration in blood, abscess, agitation, anemia, aphthous ulcer, bloating, cancer combination chemotherapy, chemoprophylaxis, diarrhea, disease predisposition, dizziness, fatigue, fistula, headache, hyperbilirubinemia, infertility, kidney disease, lactic acidosis, myopathy, nausea, neutropenia, pancreatitis, paresthesia, peripheral neuropathy, prognosis, prostate abscess, rash, side effect, Acquired Immunodeficiency Syndrome, Female, Humans, Male, Urologic Diseases
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