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Infectious Diseases > HIV: Boards > Flashcards

HIV: Boards Flashcards

1
Q

PIs effect on other drugs (1)

A

Voriconazole: reduces

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2
Q

Fanconi’s syndrome: E, C, T

A

E: TDF
C: weakness, type II RTA, hypophosphatemia, glucosuria, hypokalemia, non-anion gap metabolic acidosis (may not have all present)
T: stop TDF

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3
Q

HIV-AN: E, C, D, T

A

E: more in blacks, moreif CD4<200
C: high-grade proteinuria, normal or large kidneys, no edema, rapid progression
D: biopsy, r/o other causes
T: ARVs

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4
Q

Vaccines (11)

A
  • -Influenza: inactivated vaccine annually
  • -Td/Tdap: every 10 years and once in adulthood with Tdap
  • -Varicella: if CD4 >200 (otherwise contraindicated); give 2 doses
  • -Zoster: maybe give if CD4 >200 (otherwise contraindicated) and age > 60
  • -HPV: up until age 26; give 3 doses
  • -MMR: if CD4 >200; give 1-2 doses
  • -PPSV-23: one dose and one booster at 5yrs (if <65)
  • -PCV-13: one dose
  • -Meningococcal: if risk factors; 1 or more doses
  • -Hepatitis A: if risk factors; 2 doses
  • -Hepatitis B: 3 doses
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5
Q

Causes of polyneuropathy (5)

A
  • -HIV-associated: subacute or chronic presentation
  • -Guillain-Barré syndrome: develops over 1-2wks
  • -ARVs: ddI, d4T, ddc
  • -Abx: dapsone, ethionamide, INH, metronidazole, linezolid
  • -Others: phenytoin, thalidomide
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6
Q

Primary OI PPx: Start, Stop, Use

A

PCP

  • -start: CD4 <250 AND new positive IgG or IgM (screen yearly)
  • -stop: ???
  • -use: fluconazole 400mg daily
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7
Q

PCP: D, T

A

D: B-D-glucan sensitive (92%) but not specific (65%); induced sputum uncertain if sensitive (55-95%) but specific (99%)
T: 1) TMP-SMX, 2) clindamycin + primaquine, 3) dapsone + trimethoprim, 4) atovaquone, 5) parenteral pentamidine

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8
Q

Toxo: T

A

1) sulfadiazine + pyrimethamine + leucovorin
2) clindamycin + pyrimethamine + leucovorin (need PCP ppx)
3) TMP-SMX
4) atovaquone +/- (pyrimethamine + leucovorin)

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9
Q

Cryptococcus: T (2)

A

Meningitis: ampho B + flucytosine x2wks (consider LP then and consider extending if cx positive) → fluconazole 400mg x8wks → fluconazole 200mg x >52wks; also daily LP if CSF OP >20-25 (goal is 50% reduction or bring to 100 x3mo and VL undetectable

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10
Q

CMV: D, T

A

D: CMV PCR in blood and BAL has poor positive and negative predictive value (but pretty reliable with CSF and vitreous fluid); inclusion bodies on organ bx also non-specific
T: valganciclovir +/- intravitreal ganciclovir

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11
Q

HIV and diarrhea: D, T

A

D: modified acid fast stain (Cryptosporidum, Isospora, Cyclospora); trichrome or Giemsa or PAS (Microsporidia), Giardia stool antigen, C. diff toxin PCR, O&P (Entamoeba, Cyclospora, Cryptosporidium, Giardia), c-scope (CMV, MAC), Rotavirus ELISA, stool cx, AFB (MAC)

T: Salmonella → if recurs suppress for 6mo; Isospora → TMP-SMX, ciprofloxacin, or pyrimethamine; Cyclospora → TMP-SMX, ciprofloxacin; Cryptosporidium → ART (maybe paromomycin or nitazoxanide but not good data); Microsporidium → ART, albendazole

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12
Q

HIV and encephalopathies: C

A

–HIV encephalopathy: CD4 <50; acute; no sensory deficit; symmetrical; imaging → periventricular enhancement and micronodularity characteristic

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13
Q

Secondary OI PPx: Use, Stop

A 
PCP
--use: TMP-SMX daily
--stop: CD4 >200 x3mo
Toxo
--use: usual treatment regimen at lower dose
--stop: CD4 >200 x6mo
MAC
--use: treatment regimen
--stop: CD4 >100 x6mo
CMV
--use: valganciclovir
--stop: CD4 >100 x3-6mo
Crypto
--use: fluconazole (then itra)
--stop: CD4 >100 AND HIV VL undetectable for > 3mo AND minimum of 12mo therapy
Histo
--use: itraconazole 200mg daily
--stop: Negative blood cx AND serum Ag = 150 AND ART x > 6mo
Cocci
--use: fluconazole 400mg daily
--stop: indefinitely if disease was severe
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14
Q

Side effects: dapsone, pentamidine, primaquine, pyrimethamine, sulfadiazine, TMP-SMX

A
  • -dapsone: hemolytic anemia from G6PD deficiency (screen high risk – African and Mediterranean descent), methemoglobinemia, hepatitis, rash; 50% with TMP-SMX rash are cross reactive to dapsone
  • -pentamidine: ARF, hypotension, electrolyte abnormalities, pancreatitis, prolonged QTc
  • -primaquine: methemoglobinemia
  • -pyrimethamine: similar to TMP-SMX
  • -sulfadiazine: GI upset, rash, bone marrow suppression, renal stones, hepatitis
  • -TMP-SMX: leukopenia, thrombocytopenia, rash, fever, increased Cr, K, amylase, LFTs
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15
Q

When to start ARVs in HIV+ patient with TB

A

CD4 < 50: within 2wks
CD4 > 50 and severe clinical disease (weight loss, low Karnofsky score, low BMI, etc): 2-4wks
CD4>50 and no severe clinical disease: 8-12wks

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16
Q

ARV considerations with rifampin and rifabutin

A

Rifampin: no PIs, increase EFV to 800mg if >60kg, dose RTG at 800mg q12
Rifabutin: decrease rifabutin with ATV, NFV, increase wtih EFV (no change NVP, ETV, RTG)

17
Q

HIV Dx algorithm with 4th generation ELISA

A

–Ag+/Ab-: likely acute infection, check HIV VL
–Ag+/Ab+: likely acute infection, check HIV VL
–Ag-/Ab+: likely chronic infection, check Western blot (see below)
–Ag-/Ab-: negative
If checking Western Blot…
–Positive: HIV
–Indeterminate: do HIV VL; if positive HIV, if negative check HIV-2 Western blot
–Negative: check HIV-2 Western blot

18
Q

ARVs and PPIs

A

Can’t take PPIs and ATV/r or RPV

Can take H2 blocker with the above meds but must be at leats 12hrs before or 4hrs after dose of ARV

19
Q

When to avoid starting NVP

A

In men if CD4 >400

In women if CD4 >250

20
Q

Reommended ARVs for pregnancy

A

Most experience with AZT, 3TC, NVP, LPV/r

21
Q

TAMs

A

TAM1: M41L, L201W, T215Y, all NRTIs (especially if all three present)
TAM2: D67N, K70R, K219Q/E, all NRTIs

22
Q

K65R

A

TDF, ABC (increased AZT susceptibility)

23
Q

T69ins

A

all NRTIs

24
Q

L74V

A

ABC (increased AZT susceptibility)

25
Q

K103N

A

NVP, EFV (RPV, ETV ok)

26
Q

Q151M

A

all NRTIs

27
Q

M184V

A

3TC, FTC, some ABC (increased AZT susceptibility)

28
Q

M184I + E138K

A

RPV

29
Q

N155H, then Y153C, then Q148H/R/K

A

RTG, ETG (DTG resistant if first and last of these present)

30
Q

Y181C

A

NVP, some drop in EFV susceptibility, moderate impact on ETV

Infectious Diseases (11 decks)

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