E5 Opportunistic - Kania Flashcards
normal CD4 counts in adults
800-1200 cells/mm3
average decline of CD4 in HIV pts without antiretroviral therapy
50-100 cells/year
CD4 counts <____ and especially < ____ are associated with development of OI’s
500, 200
what 3 types of infections can occur at any CD4 count?
mycobacterium
pneumonias
varicella zoster (derm)
2 infections pts are at risk for with CD4 count <500
- candidiasis (fungus from yeast)
- leukoplakia (shit on your tongue)
7 ish infections pts are at risk for with CD4 count <200
- PJP
- CMV retinitis
- toxoplasmosis
- MAC
- cryptococcus meningitis
- lymphomas
- Kaposi’s sarcoma
__________ and _________ can increase HIV viral load which leads to what?
TB, syphilis, increased risk of viral transmission and progression
Primary prophylaxis def in OI:
administration of an anti-infective agent to prevent
the first episode of a particular OI in a patient living with HIV when they are at risk for developing that OI based on their CD4 count.
B. Secondary Prophylaxis (chronic maintenance or chronic suppressive
therapy) definition in OI:
administration of anti-infective therapy to prevent further recurrences of a particular OI in a patient living with HIV after they have been successfully treated for that OI and remain at risk for developing that OI based on their CD4 cell count.
3 conditions where you would want to start ART (acute OI):
- PML
- Cryptosporidiosis
- Kaposi’s sarcoma
why are some other OI’s at a disadvantage if you immediately start ART
potential development of immune reconstitution inflammatory syndrome (IRIS)
what is IRIS characterized by? (3)
- fever
- inflammation
- worsening clinical manifestations of the OI
IRIS is more likely to occur in pts with CD4 counts < ___ and high HIV RNA levels > __________ copies/mL
50, 100,000
when is IRIS more common regarding ART
first 4-8 weeks
T or F:
e. Most clinicians wait for a clinical response to OI therapy, usually 2 weeks, before initiating ART
true
what is the exception to starting ART prior to waiting for a clinical response to OI therapy?
Start ART within 2 weeks of starting TB treatment if CD4 count < 50 cells/mm3 or within 8 weeks if CD4 count is higher *
what is the first thing you should do considering the treatment of IRIS
treat the OI!!
IRIS treatment:
mild disease: what for fever and pain? when to use inhaled corticosteroids?
NSAIDs, bronchospasms
IRIS treatment:
severe disease: ?
prednisone 1-2 mg/kg daily for 1-2 weeks
IRIS treatment:
severe disease: when to avoid steroids? (2)
cryptococcal meningitis or Kaposi’s sarcoma due to worse outcomes
T or F:
infections with Candida species typically only occurs after 4-8 weeks of HIV infection presentation
false, can occur at any stage *
T or F:
esophageal candidiasis typically occurs at higher CD4 counts
F, lower
diagnosis for oropharyngeal candidiasis (thrush):
clinical exam, duh theres white shit all over your tongue
preferred treatment of oropharyngeal candidiasis (thrush): (1, drug + dosing regimen)
Fluconazole 200 mg loading dose, followed by 100-200 mg po daily for 7-14 days*
