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PDAT6 ID > 35 - Intro to HIV + OIs > Flashcards

35 - Intro to HIV + OIs Flashcards

1
Q

Highest Risk for HIV Transmission

A
  • *BLOOD TRANSFUSION**
    92. 5%

Vertical Transmission
w/o tx = 25%

MSM

IVDU = NEedle Charing

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2
Q

Surrogate Markers

What do we monitor when a patient is on HIV treatment?

A

HIV VIRAL LOAD
Range:
40copies -> 1mil

  • *CD4 T-Lymphocyte Count**
  • *normal is ​600-1,100**
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3
Q

AIDS DEFINITION

A

HIV+** **Positive
rapid test / screening test + confirmatory test

AND

CD4 < 200** or **AIDS Defining Illness

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4
Q

AID DEFINING ILLNESSES

A

PJP = PCP

HIV Associated Wasting

Systemic Candidiasis
esophageal / bronchi / trachea / lungs

KS = Kapsosi Sarcoma

CMV / HSV / MAC / MTB

Toxoplasmosis / Histoplasmosis

Cryptococcal meningitis / Lymphoma

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5
Q

Correlation of OI & CD4

200-500

A

CD4 200-500
rare infections, get HIV tested

Bacterial pneumonia / pulmonary TB

VZV / KS

oral candida (thrush)

cryptosporidiosis

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6
Q

Correlation of OI & CD4

<200

A
  • *CD4 < 200**
  • *definitely get HIV test if one of these infectious complications**

PCP

disseminated histoplasmosis

coccidioidomycosis

extrapulmonary TB

PML

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7
Q

PJP = PCP
Pneumocystis Jiroveci Pneumonia

Clinical Presentation

A

S/Sx:
Subacute onset 1-4 weeks, Fever / DOE / dry cough

Labs:

  • *↓pO2** (hypoxic) / ↑LDH >500
  • *CD4 < 200**

CXR:
Diffuse bilateral Interstitial Infiltrates

Diagnosis:
Bronchoscopy - for confirmation

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8
Q

PJP

Outpatient Treatment

Preferred Tx + ADR

A

Bactrim DS - 2T TID
15mg/kg/day TMP

for
21 DAYS

ADR:
RASH / neutropenia / anemia / drug-fever / hepatitis
↑K+

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9
Q

PJP

Outpatient Treatment

ALTERNATIVES

A

sulfa allergy is COMMON in HIV patients

Primaquine 30mg qd** + **Clindamycin 300-450 TID-QID
hemolytic anemia, G-6PD deficient test + CDIFF

or

Atovaquone Suspension 750mg BID
GI issue / Rash / ↑LFTs

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10
Q

PJP

Preferred INPATIENT treatment

A

similar to OUTpatient, but IV

  • *Bactrim 15mg/kg/qd IV**
  • *TID-QID for 21 days**

+

If HYPOXEMIA pO2 <70 mmhg
PREDNISONE
40mg BID x 5days
40mg qd x 5 days
20mg qd x 11 days

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11
Q

PJP

Alternate

INPATIENT treatment

A

PENTAMIDINE 3-4 mg/kg/day IV
NEPHROTOXIC, electrolyte abnormalities, HYPER/hypoGLYCEMIA
Neutropenia / thrombocytopenia
OR
Primaquine 30mg qd PO** + **Clindamycin IV** **600-900mg q6-8
G-6pD deficient / anemia + cdiff/rash

+

If HYPOXEMIA pO2 <70 mmhg
PREDNISONE
40mg BID x 5days
40mg qd x 5 days
20mg qd x 11 days

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12
Q

PJP PROPHYLAXIS

When to START & DC

A

INITIATE WHEN:
CD4 < 200

D/C primary (b4 infxn) or secondary when:
CD4 > 100
when on
ART & VL is undetectable >3 months

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13
Q

PJP PROPHYLAXIS

PREFERRED TREATMENT

INITIATE WHEN:
CD4 < 200

D/C primary (b4 infxn) or secondary when:
CD4 > 100
when on
ART + VL is undetectable >3 months

A

BACTRIM DS
qd or MWF (3xweek) - 1st choice
↓bacterial pneumonia, S aureus infxn, prevention of toxoplasmosis

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14
Q

PJP PROPHYLAXIS

Alternate Treatments

INITIATE WHEN:
CD4 < 200

D/C primary (b4 infxn) or secondary when:
CD4 > 100
when on
ART & VL is undetectable >3 months

A

bactrim QD is 1st choice

Dapsone 100mg qd
normal G-6pd - second choice

Aerosolized Pentamidine 300mg
once a month

Atovoquone 1500mg qd
same as TOTAL dose as PJP tx (750 bid)
GI / Rash / ↑LFT

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15
Q

MAC
Mycobacterium Avium Complex

Clinical Presentation

A

Disseminated + Multiorgan disease

S/sx:
Fever / night sweats / weight loss / diarrhea
CD4 <50
heptomegaly / splenomegaly / lymphadenopathy

Diagnosis:

  • *MAC culture** from NON-pulmonary site:
  • *blood / bone marrow / lymph node**
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16
Q

MAC
Mycobacterium Avium Complex

TREATMENT

A

AZITHROMYCIN 500-600 qd
+
ETHAMBUTOL 15mg/kg/qd

+add if clinical sxs dictate+

  • *Rifabutin** 300mg qd >> Quinolone (levo or moxi)
  • due to Rifabutins DI’s*

ONE YEAR TREATMENT

17
Q

MAC
Mycobacterium Avium Complex

When to START/STOP prophylaxis

A

D/C SECONDARY prophylaxis if:

1) completed >12 months of treatment
2) CD4 >100 for >6mo + ART
3) n_o S/Sx of MAC_

MAC is often found in environmental sources
food/water/soil - hard to avoid
Inhaled / Ingested

NO NEED FOR PRIMARY PROPHYLAXIS** of on **ART

18
Q

Which OI drugs requires G-6PD testing?

A

PRIMAQUINE
Helolytic Anemia / methemoglobinemia
Caution if G-6PD Deficient

DAPSONE
same + rash, NEEDS the G-6PD Test
if deficient –> DO NOT USE

19
Q

Which is the OI that recommends to start
ART 2-10 weeks AFTER treatment?

due to:
IRIS

A

CRYTOCOCCAL INFECTION
Liposomal Amph + Flucytosine 2 weeks
Fluconazole 400mg qd for 8 weeks
Maintanence:
Fluconazole 200mg qd for 1 year

20
Q

Fungal Associated OIs
do not need Primary Prophylaxis

Cryptococcal

PRESENTATION + DIAGNOSIS

A

Risk is GREATEST when CD4 <50, but still occurs <200

Meningitis-Like
HA / Fever / AMS / neck stiffness / photophobia

Diagnosis:
Cryptococcal Antigen in CSF or serum
Lumbar puncture: india ink smear for cryptococcus

21
Q

Fungal Associated OIs
do not need Primary Prophylaxis

Histoplasmosis

PRESENTATION + DIAGNOSIS

A

Endemic disease:
Ohio / Mississippi River Valley / Chicago

DISSEMINATED DISEASE
occurs usually when CD4 <150

Fever / Fatigue / Wt loss >1-2 mo / respiratory issues / lymph

HISTO ANTIGEN
in urine or blood = 95% sensitive

22
Q

Fungal Associated OIs
do not need Primary Prophylaxis

Thrush = Candida Albicans

PRESENTATION + TREATMENT

A

If Disseminated / Systemic = AIDS diagnosis
Topical / Oral = not common, INDICATOR FOR IMS –> CHECK HIV
can be seen when CD4>200

Oral Thrush:
White painless patches on cheeks + Tongue

Treatment:

  • *FLUCONAZOLE**
  • *100mg qd 7-10days**
23
Q

Cryptococcal Infx

TREATMENT

A

Liposomal Amphotericin B** + **Flucytosine
for 2 weeks

Fluconazole 400mg qd
for 8 weeks

Maintanance tx:
Fluconazole 200mg qd
for >1 year

24
Q

Cryptococcal Infx

When can we D/C maintenance treatment?

Liposomal Amphotericin B** + **Flucytosine
for 2 weeks

Fluconazole 400mg qd
for 8 weeks

Maintanance tx:
Fluconazole 200mg qd
for >1 year

A

>12 months tx
+
CD4 > 100 for >3 months
+
HIV VL undetectable** on **ART
+
ASYMPTOMATIC
no meningitis symptoms / HA / AMS / NECK stiffness

25
Q

Histoplasmosis

TREATMENT

A

Liposomal Amphotericin B
for 2 weeks

Itraconazole SOLUTION 200mg BID
on an EMPTY STOMACHfor12 months
hIstoplasmosis = Itraconazole

Maintanence >12 months
for SEVERE DISSEMINATED or CNS infection
Itraconazole 200mg qd

26
Q

Histoplasmosis

When can we DC maintenance TX?

Maintanence
(after >12 months of treatment)
for SEVERE DISSEMINATED or CNS infection
Itraconazole 200mg qd

A

1 year Histo tx
+
CD4 > 150 for 6 months
(MAC is also 6mo)
ONLY OI that needs CD4 > 150 (others are >100)
+
ART
+
↓Serum Histo antigen** & **Negative Fungal blood cultures

PDAT6 ID (31 decks)

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