Term
| When to start primary prophylaxis: Pneumocystis jiroveci pneumonia (PCP) |
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Definition
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Term
| When to start primary prophylaxis: Toxoplasma gondii (toxo) |
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Definition
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Term
| When to start primary prophylaxis: Mycobacterium Avium complex (MAC) |
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Definition
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Term
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Definition
| any HIV adult, adolescent, pregnant pt with CD4 < 200, fever > 100, or thrush |
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Term
| PCP Prophylaxis: Preferred: |
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Definition
| SMX-TMP: 1 D (or SS) tablet daily) |
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Term
| PCP Prophylaxis: SMX-TMP Intolerances: |
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Definition
| Rash (up to 50%), GI- N/v, liver transaminases, Hematologic: RBC, WBC, platelets; life threatening: exfoliative dermatitis, anaphylaxis, hypotension |
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Term
| PCP Prophylaxis- Alternatives: |
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Definition
| SMX/TMP 1 DS Tab po 3x a week; Dapsone 100 mg po daily; Aerosolized pentamidine 300 mg vial via Respirgard II nebulizer |
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Term
| PCP- Immune Reconstitution Primary Prophylaxis- stop when: |
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Definition
| CD4 > 200 for > 3 months with ART response |
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Term
| PCP- Immune Reconstitution Secondary prophylaxis stop when: |
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Definition
| CD4 increase from < 200 to > 200 for > 3 months in response to ART; If PCP occurred CD4 > 200, continue for life |
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Term
| PCP- Immune Reconstitution Restarting: |
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Definition
| Primary: CD4 < 200; Secondary: CD4 < 200 |
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Term
| PCP- Immune Reconstitution Additional Protection |
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Definition
| SMX/TMP: bacteria, toxoplasmosis; Atovaquone: toxoplasmosis; trimetrexate: antineoplastic, fungi (including toxo) |
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Term
| PCP- Children- HIV + mothers: |
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Definition
| SMX/TMP prophylaxis- start 4-6 weeks old; continue through 1st year, reassess need after 1 year, Dapsone or aerosolized pentamidine |
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Term
| Toxoplasmosis Preferred Prophylaxis |
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Definition
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Term
| Toxoplasmosis Alternatives Prophylaxis |
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Definition
| SMX/TMP 1 SS po daily; SMX?TMP 1 DS tab po 3x per week; Dapsone 100 mg po daily; Atovaquone 1500 mg po daily; Dapsone + pyrimethamine + leucovorin po; Atovaquone + pyrimethamine + leucovorin po |
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Term
| Toxoplasmosis- Immune Reconstitution: Primary prophylaxis stop when: |
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Definition
| CD4 > 200 for > 3 months on ART |
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Term
| Toxoplasmosis- Immune Reconstitution: Secondary prophylaxis stop when: |
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Definition
| CD4 > 200 for sustained period of time (>6 months on ART) plus complete treatment courses for toxo (6 wks) and remain asymptomatic; consider CNS imaging for resolution |
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Term
| Toxoplasmosis- Immune Reconstitution: Restarting prophylaxis |
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Definition
| primary: CD4 < 100-200 (200 for PCP med); Toxo: CD4 < 200 |
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Term
| MAC Prophylaxis: Preferred |
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Definition
| Clarithromycin (Biaxin) 500 mg po BID or Azithromycin (Zithromax) 1200 mg po once a week (2 600 mg tabs) or 600 mg po twice weekly |
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Term
| MAC Prophylaxis: ALternative |
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Definition
| rifabutin 300 mg po daily |
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Term
| MAC Prophylaxis Considerations |
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Definition
| azithro and clarithro decrease respiratory infections; azithro has less drug interactions than clarithromycin; GI side effects; Azithro-- food/mepty stomach, clari- food; Watch drug interactions with rifabutin, rule out active TB first |
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Term
| MAC Immune Reconstitution Primary Prophylaxis stop when: |
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Definition
| CD4> 100 for > 3 months with sustained suppression on ART |
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Term
| MAC Immune Reconstitution Secondary Prophylaxis stop when: |
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Definition
| Completed > 12 months of therapy plus asymptomatic plus CD4 > 100 for > 6 months on ART |
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Term
| MAC- Immune Reconstitution Restarting: |
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Definition
| Primary: CD4 < 50; Secondary: CD4 < 100 |
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Term
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Definition
| No vaccine, short-term passive immunity (CMV IG IV; watch live vaccine drug interaction); consider ganciclovir CD4 < 50 - lack of survival advantage may induce resistance, high cost; Best prevention: recognition of early manifestations |
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Term
| CMV- Immune Reconstitution: Primary Prophylaxis |
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Definition
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Term
| CMV- Immune Reconstitution: Secondary prophylaxis- stop when: |
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Definition
| CD4 <100 for 3-6 months with ART, non-sight-threatening, good vision in contralateral eye, regular ophthalmic exam |
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Term
| CMV- Immune Reconstitution: Restarting: |
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Definition
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