Term
| What is the difference between primary and secondary prophylaxis? |
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Definition
- Primary - Initiated when at risk for an opportunistic infection at certain CD4 counts
- Secondary/suppression - Patient has the disease, preventing relapse or recurrence. |
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Term
| What is esophageal candidiasis? |
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Definition
Seen in CD4 < 200, caused by candida albicans. Pain on swallowing is key
**Tx: Oropharyngeal - fluconazole 100 QD x10-14 days. Esophageal - Fluconazole 200-400 IV/PO QD x14-21 days |
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Term
| How is prophylaxis done for esophageal candidiasis? |
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Definition
| Not done due to resistance and low morbidity/mortality |
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Term
| What is the most common OI in HIV patients? |
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Definition
| Pneumocystic pneumonia - in CD4 < 200/15% |
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Term
| What are the symptoms of pneumocystic pneumonia? |
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Definition
- Subacute dyspnea on exertion
- Low grade fever
- Nonproductive cough
- Chest pain
- Sx worsen over days to weeks |
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Term
| What markers are used to indicate pneumocystic pneumonia? |
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Definition
- Lactic Dehydrogenase > 500
- Hypoxemia: PaO2 < 70, A-a gradient > 35
- Radiology: CXR is diffuse, patchy
**Cannot be cultured, requires a silver stain that will still show after empiric therapy |
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Term
| What is the drug of choice for treatment of Pneumocystic pneumonia? |
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Definition
- sulfasoxazole/trimethoprim - 15-20 mg/kg/day of TMP IV/PO divided into q6-8h FOR 21 DAYS
**Causes HYPERKALEMIA, bone marrow suppression, renal dysfunction. |
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Term
| What is the prednisone taper for treatment of Pneumocystic pneumonia? |
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Definition
When PaO2 < 70 or A-a > 35:
Prednisone (days1-5): 40 mg BID
Prednisone (days6-10): 40 mg QD
Prednisone (days11-21): 20 mg QD |
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Term
| What are 2nd line treatments for PCP? |
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Definition
- Clindamycin + primaquine
- Atovaquone
- Dapsone + Trimethoprim
- Pentamidine |
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Term
| What is prophylaxis for pneumocystic pneumonia? |
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Definition
SMX/TMP DS: 1 tab QD - also works for Toxoplasmosis gondii. Can also use SMX/TMP SS, but SS does not work for toxoplasmosis.
**Initiate at CD4 < 200 or a history of AIDS defining illness |
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Term
| What is Toxoplasmosis gondii? |
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Definition
A protozoa that can cause encephalitis - seen when CD4 < 50
Complaints of altered mental status, fever, seizures.
**Diagnosis: IgG for Toxoplasmosis, ring lesions in the brain |
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Term
| What is the treatment for Toxoplasmosis gondii? |
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Definition
- SulfaDIAzine + Pyrimethamine + Leucovorin for 6 weeks to life. Pyrimethamine causes bone marrow suppression, which is reversed by leucovorin
- May replace sulfa with clindamycin in case of sulfa allergy
**May add dexamethasone if rings seen in the brain. |
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Term
| What is prophylaxis for toxoplasmosis gondii? |
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Definition
When CD4 < 100 and IgG(+): Bactrim DS 1 tab QD. Intolerant: Dapson + pyrimethamine + leucovorin
**Secondary is lifelong unless CD4 > 200 for 6+ months. Secondary prophylaxis is same as Tx: sulfadiazine + Pyri + leucovorin |
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Term
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Definition
Mycobacterium-Avium-Complex. Can be inhaled or ingested, seen in CD4 < 50
- Anemia, incr AlkPhos, enlarged liver, spleen, and lymph nodes
- Diagnosis: signs and symptoms + isolation in culture/bone marrow/lungs |
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Term
| What is the preferred regimen for MAC treatment? |
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Definition
| - Clarithromycin + Ethambutol - can be continued for life |
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Term
| What is prophylaxis for MAC? |
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Definition
| When CD4 < 50, rule out active infection, then use Azithromycin 1200 mg QW (preferred) or Clarithromycin 500 mg BID |
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Term
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Definition
| Cytomegalovirus infection of the eye in CD4 < 50 - can lead to permanent blindness. |
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Term
| What is the treatment for CMV retinitis? |
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Definition
Valganciclovir 900 mg BID for 14-21 days, then QD. Can used ganciclovir implant when sight is threatened.
**Ganciclovir has no oral bioavailability. Valcyte does. |
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Term
| What is used for prophylaxis of CMV retinitis? |
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Definition
| ONLY secondary suppression - Valcyte 900 mg QD with or without a Ganciclovir implant replaced every 6-8 months if CD4 < 100 |
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