Exam 5 lecture 1 Flashcards
What are the big 3 pathogens that we use prophylaxis for in opportunistic infections
Pneumocystitis Jiroveii pneumonia (PJP)
Toxoplasma gondii encephalitis (TE)
Mycobacterium avium complex (MAC)
What is an OI
Infections more frequent or more severe because of HIV mediated immunosuppression
What are common historical OI
Pneumocystitis pneumonia and other pneumonias
Toxoplasma encephalitis
CMV retinitis
Cryptococcal meningitis
TB
Disseminated mycobacterium avium complex (MAC) disease)
Histoplasmosis
Kaposi’s Sarcoma and other lymphoma
Normal CD-4 count in adults
800-1200
What CD4 counts are associated with development of OIs
<500 and especially <200
What CD4 cell counts do the OIs happen at
Mycobacterium TB, pneumonias and dermatomal varicella zoster can occur at any CD4 count
CD4 count < 500- candidiasis and leukoplakia
CD4 count < 200- PJP, CMV retinitis, toxoplasmosis, MAC, cryptococcus meningitis or diarrhea, lymphomas and kaposis
Which OIs can increase HIV viral load? WHat effect does this have?
TB and syphilis can Increase HIV viral load
It can increase risk of viral transmission and progression
define primary and secondary prophylaxis
primary- administration of an anti infective agent to prevent the first episode of an OI in a patient living with HIV
secondary- They have had OI already and need administration of anti infective therapy to prevent further recurrences of an OI
What situations should we start ART during OI
In situations when there are not good OI treatments
- PML
-Cryptosporidosis
-Kaposi’s Sarcoma
for other OI’s why can it be disadvantageous to strart ART
- potential development of immune reconstitution inflammatory syndrome (IRIS)
- Overlapping or additive drug toxicities
- Drug interactions between ART and OI therapy
What is IRIS (immune reconstitution inflammatory syndrome (IRIS) (what does it do? WHat is it seen with? Most likely to occur in who)
Fever, inflammation and worsening manifestation of the OI
Can be seen with MAC, TB, PJP, toxoplasmosis, Hep B and C, CMV, cryptococcus, histoplasmosis and V. zoster
More likely tp occur in pts with low CD4 count (<50) and high RNA levels (>100,000)
When is IRIS the most common
within 4-8 wks of starting ART
How to avoid IRIS
Wait for clinical response to OI therapy (2 wks) then start ART.
IRIS tx
Treat the OI
Mild disease- Use NSAIDs for fever or pain and inhaled corticosteroids for bronchospasms
Severe- prednisone 1-2 mg/kg daily for 1-2 wks followed by taper
When do infections with candida species occur in HIV
Any stage but most common when CD 4 is lower than 200
What infection does candida cause
albicans
