Guest Speakers Flashcards
When is viral load high/low?
high: >100,000
low:
When should we screen for HIV?
-all patients ages 13-64
Tx of Cryptococcal Meningitis?
Amphotericin B & Flucytosine
Tx Toxoplasmosis
-already on bactrim for low CD4 count, so continute tx w/ pyrimethamine, sulfadiazine, leucovorin
Tx for PCP?
- mild/moderate
- severe
- mild: oral Bactrim
- severe: IV bactrim
Tx of Thrush?
-Fluconazole
What is IRIS? why does it happen?
- immune reconstitution inflamm syndrome.
- this happens when you were sick and your system is back and participating and making you sick.
What are the four indications for initiating antiretroviral therapy regardless of CD4 cell count?
- AIDS, prenancy, Chronic HBV, HIVAN (HIV assocaited nephropathy)
- actually…with 2015 guidlines we treat everyone always.
Why is early therapy preferred?
Although early therapy seems to have little proven effects short term, early treatment has proven to be overwhelming positive in long term results and quality of life.
Recommended Retro-Antiviral regimen?
-treat with atleast 3 drugs.
“2 Nukes” (backbone) truvada (emtricitabine/ tenofovir) & epzicom (abacavir/lamivudine)
and the third is dolutegravir
*be careful with abacavir, you need to do genetic testing, may cause life threatening hypersensitivity if they have HLA-B5701
What is Rotonavir used for>
-not used for treatment but to BOOST other drugs.
What is PEP? PREP?
post-exposure prophylaxis, its a hotline you may call when exposed.
-Pre-exposure prophylaxis
What is the likely diagnosis if you see bat wings on CXR? Treat it with?
- Pneumocystis Carinii Pneumonia
- treat w/ bactrim
When might you get wasting syndrome? tx
- un-treated AIDS
- Tx: antiretroviral therapy and protein
What is a clinical finding on MAC gram stain?
-“red snappers”
What is acute seroconversion?
-this is the acute illness stage when the pt has flu-like illness.
at what CD4 count does HIV progress to AIDS?
-CD4
WHat tests do we order to dx HIV/AIDS?
- Aby Testing
- -Elisa: always confirmed with westernblot if positive.
- -Rapid test: blood/saliva
- HIV Viral RNA Load:
- -may be positive in the window period. Also used to monitor infectivity and treatment effectiveness in pts.
What disease may be present at each of the follow CD4 counts: -1500-700 ->500 -500-200 -
- 1500-700: normal
- > 500: lymphadenopathy
- 500-200: TB, Kaposi Sarcoma, thrush, lymphoma, Zoster
-
Tx for the following
- TB
- PCP
- Histoplasmosis
- Toxoplasmosis
- Cryptococcus
- MAC
- CMV Retinitis
- TB: INH (isonzid)
- PCP: Bactrim
- Histoplasmosis: Itraconazole
- Toxoplasmosis: Bactrim
- Cryptococcus: Fluconazole
- MAC: azithromycin/clarithromycin
- CMV Retinitis: Ganciclovir
