Day 4- OI's and Hepatitis Flashcards
What are common OI’s to know?
What are your risk factors for PCP?
What are your clinical manifestations for chest radiograph?
PJP, CMV, Toxoplasmosis, MAC.
CD4 <200 cells. CD4 <14%, previous episodes, thrush, recurrent bacterial pneumonia, unintentional weight loss, high plasma HIV RNA levels.
diffuse, bilateral, symmetrical interstitial infiltrates in a butterfly pattern.
How do you treat PCP?
What are some common A/E’s of Bactrim?
When should you start primary prophylaxis for PCP?
TMP-SMX is treatment of choice for 21 days. If allergic to sulfa it is Dapsone and TMP. Begin steroids w/I 72 hours and take Prednisone for 21 days.
Rash, Fever, Leukopenia, Thrombocytopenia,Azotemia, Hepatitis, Hyperkalemia.
CD4 <200.
What is prophylaxis for PCP?
What are your CMV risk factors?
What is your clinical manifestation of CMV?
TMP-SMX 1 SS PO daily, maintain until CD4 is >200 for at least 3 months. If diagnosed with PCP with CD4 >200 continue prophylaxis indefinitely.
CD4 <50, Previous OI’s, high level of CMV and HIV RNA.
Retinitis, Typically unilateral in 2/3 patients, peripheral retinitis may be asymptomatic
How do you treat CMV?
What are TE risk factors?
What is TE treatment?
Intravitreal injections of Foscarnet(1-4 doses over 7-10 days) + Valganciclovir for 14-21 days then 900 mg once daily. Continue for at least 3-6 months and lesions are inactive and CD4 >100 cells for 3-6 months in response to ART. Restart when <100.
Rare among patients with CD4 >200, highest risk is CD4 <50, eating undercooked meat containing tissue cysts( raw shellfish), 50% of patients do not have an identifiable risk factor and it is NOT transmitted through person to person contact.
Pyrimethamine PO once followed by Pyrimethamine + sulfadiazine + leucovorin.
How do you prevent toxoplasmosis?
When do you give prophylaxis for TE?
What is the regiment for TE treatment?
Patients who are seronegative and own cats should have someone change the litter box, wash hands througholy if they have to take it, watch for raw meats.
Toxoplasma IgG positive patients with CD4 count <100.
TMP-SMX 1 DS tablet daily.
When do you discontinue prophylaxis for TE?
What are MAC risk factors and clinical manifestations?
What is primary prophylaxis for MAC?
CD4 count >200 for > 6 months. Reinitiate if it falls <200 again.
CD4 <50. Anemia and Elevated liver alkaline phosphatase.
Azithromycin 1200 mg PO once weekly.
When do you want to discontinue MAC prophylaxis?
What is MAC treatment?
Which type of hepatitis usually resolves without treatment?
CD4 >100 for >3 months, start if <50 again.
Azithromycin + Ethambutol for 12 months. Must complete at least 12 months of therapy and no signs and symptoms of MAC and have sustained CD4 >100 for > 6 months.
A, approximately 70-80% of people with HCV don’t have symptoms.
Is hepatitis C more common than A and B?
What to know about HEP C?
How do you prevent HEP A?
YES, baby boomers are 5X’s more likely to have it.
Native Americans have higher incidence and 20-29 age group is higher.
Avoid contaminated water or food, WASH HANDS!,Vaccination.
What allergy CI’d in HEP A vaccine?
What do you give people who can’t receive the HepA vaccine?
How many doses of Hep B vaccine are required?
Neomycin allergy.
Can give Immunoglobulin(gamastan) but it’s only good for 3 months. For patients allergic to HepA vaccine, <12 months, unable to receive vaccine prior to travel.
3, 0,1, and 6 months. Higher doses required for immunocompromised or dialysis patients.
What is in the Hep B vaccine?
Which Hep B antibody indicates a recent acute infection?
What are your 1st line HepB treatment?
HBsAg antigen.
IgM. IgG is chronic.
Peginterferon alfa-2a, Entecavir, TDF. PET.
How do you treat HIV and HepB?
What treat all genotypes of HepC?
What are NS3/4A inhibitors?
Emtrictabine, Lamivudine, and Tenofovir.
Genotype 1A and 1B can be treated with Harvoni(ledipasvir and sofosbuvir).
Previr’s.
What are NS5A inhibitors?
What are NS5B inhibitors?
asvir’s
buvir’s
