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Therapeutics IV > HIV Opportunistic Infection - Block 3 > Flashcards

HIV Opportunistic Infection - Block 3 Flashcards

1
Q

What guides the initiation of primary OI prophylaxis?

A

CD4+ count threshold

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2
Q

What are the clinical presentations of PJP?

A
  1. Progressive dyspnea, fever, non-productive cough, chest discomfort
  2. Tachypnea, tachycardia
  3. Co-infection with oral thrush
  4. Hypoxemia
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3
Q

How do you diagnosis PJP?

A

Chest Xray (ground glass, butterfly pattern)
Spontaneous pneumothorax

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4
Q

INdication for PJP primary prophylaxis?

A
  1. CD4 count <200
  2. CD4 count <14%
  3. If ART initiation must be delayed, CD4 count 200-250, and monitoring of CD4 count Q3M is not possible
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5
Q

PJP primary prophylaxis? Secondary?

A

Bactrim 1 tablet PO QD

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6
Q

When do you discontinue primary prophylaxis?

A
  1. CD4 >200 for >3 months
  2. Consider when CD4 count is 100 – 200 cells/mm3 if viral load remains undetectable for 3 – 6 months
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7
Q

Preferred tx for PJP? Duration?

A

Bactrim DS 2 tablet PO TID for 21 days

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8
Q

What patient populations present as seronegative with toxoplasmosis?

A
  1. Primary infection
  2. Reactivation of latent dx in individuals who can’t produce antibodies
  3. Testings with insesitive assays
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9
Q

How is toxoplasma transmitted?

A
  1. Eating undercooked meat
  2. Ingesting oocycsts
  3. Eating raw shellfish
    Not person-to-person
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10
Q

Toxoplasma presnetations?

A

Focal encephalitis w/ HA, confusion, motor weakness, fever

Non-focal sx -> psychiatric sx

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11
Q

How do you diagnose toxoplasma?

A
  1. CT/MRI findings of brain lesions
  2. Seropositive for anti-toxoplasma IgG antibodies
  3. Lumbar puncture
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12
Q

Indication for primary prophylaxis?

A
  1. Toxoplasma IgG+
  2. CD4 count <100
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13
Q

Primary prophylaxis for TE?

A

Bactrim 1 tab PO QD

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14
Q

Preferred tx for TE? Duration?

A

Pyrimethamine 200 mg PO 1 dose then:

< 60kg: Pyrimethamine, Sulfadiazine 1000mg, Leucovorin
> 60kg: Pyrimethamine, Sulfadiazine 1500mg, Leucovorin

Duration: 6 weeks

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15
Q

Secondary prophylaxis of TE?

A
  1. Pyrimethamine
  2. Sulfadiazine 2-4 g
  3. Leucovorin
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16
Q

RF of MAC?

A
  1. Viral load >1000
  2. Ongoing viral replication despite ART
  3. Previous or concurrent OIs
  4. Reduced in vitro lymphoproliferative immune response to MAC antigens
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17
Q

S/s of MAC?

A

Sx: fever, night sweats, weight loss, fatigue, diarrhea, ab pain
Disseminated: anemia, elevated LFTs
Physical findings: hepatomegaly, splenomegaly, lymphadenopathy

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18
Q

MAC can be clincially indistinguishabel to what other disease state?

A

IRIS

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19
Q

Indication for MAC primary prophylaxis?

A
  1. Not recommended for those with HIV who started ART
  2. For patients with HIV not recieving ART and CD4 >50
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20
Q

Preferred MAC primary prophylaxis?

A
  1. Azithromycin QW
  2. Clarithromycin
  3. Azithromycin biweekly
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21
Q

Indication for DC MAC prophylaxis?

A

Effective ART

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22
Q

Tx for MAC? Duration?

A
  1. Clarithromycin + ethambutol
  2. Azithromycin + ethambutol

Duration: 12 months

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23
Q

Secondary prophylaxis of MAC?

A
  1. Clarithromycin + ethambutol
  2. Azithromycin + ethambutol
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24
Q

Clinical presentation for oral candida?

A

Painless, creamy-white, plaque-like lesions in the mouth

25
Presentation of esophageal candida?
Burning pain, discomfort, odynophagia (retrosternal)
26
Indication for Candida primary prophylaxis?
NOT recommended
27
Tx for oral candida?
Fluconazole for 7-14 days
28
Tx for esophageal candida?
Fluconazole or Itraconzale for 14-21 days
29
Is secondary candida prophylaxis recommended?
No, unless patients have frequent recurrences
30
Secondary prophylaxis for candida?
**Oral:** Fluconazole or itroconazole **Eso:** Fluconazole or posaconazole
31
Where is histoplasma commonly found?
Ohio river and MS river valley
32
Indications for primary prophylaxis?
CD4 count <150 and High risk exposure
33
Primary prophylaxis for histoplasma?
Itraconazole 200mg PO daily
34
Tx for less severe desseminated histoplasma? Duration?
Itraconazole 200mg PO TID (for 3 days), then 200mg PO BID **Duration:** 12 months
35
Tx for moderate-severe desseminated histoplasma? Duration?
**Induction:** Liposomal amphotericin B until clinically stable **Maintenance:** Itraconazole 200mg PO TID (for 3 days), then 200mg PO BID **Duration:** 12 months
36
Tx for histoplasmosis meningitis?
**Induction:** Liposomal amp B for 4-6 wks **Maintenance:** Itraconazole 200mg PO BID or TID for ≥12 months **Duration:** 12 months
37
Secondary prophylaxis for histoplasma?
Itraconazole 200mg PO daily
38
What are the fungi that cause Coccidioidomycosis?
C. immitis C. posadasii
39
What are the syndormes of Coccidioidomycosis?
1. Focal pneumonia 2. Diffuse pneumonia 3. Extra-thoraicic involvement 4. Positive serology tests without evidence of localized infection
40
What are presentations of focal pneumonia?
1. CD4 count >250 2. Persistant HA and progressive lethargy
41
Non pharm for Coccidioidomycosis?
1. Avoid extensive exposure to native soil 2. Remain indoors during dust storms
42
Indication for Coccidioidomycosis primary prophylaxis?
**Not recommended for seronegative except:** 1. IgM or IgG + 2. No signs of active Coccidioidomycosis 3. CD4 count <250
43
Primary prophylaxis for Coccidioidomycosis?
FLuconazole
44
Indication to dc Coccidioidomycosis prophylaxixs?
CD4 ≥250 for ≥6months
45
Tx for mild-moderate pulmonary Coccidioidomycosis?
FLuconzazole or Itraconzale for 3-6 months
46
Tx for severe pulmonary or extrapulmonary Coccidioidomycosis?
Liposomal amphotericin B or Amphotericin B deoxycholate for 12 months
47
Tx for coccidiodomycosis meningitis?
Fluconazole indefinitely
48
Diagnosis for cryptococcois?
**CSF sample:** 1. Elevated protein, low-normal glucose 2. Opening pressure elevated 3. CrAg+
49
Non pharm for cryptococcosis?
Avoid exposure to dried birf feces
50
Is prophylaxis recommended for cyrptococcis?
No
51
What is the preferred tx for cryptococcus? Duration
**Induction:** Liposomal amp B + flucytosine **OR** Amp B deoxcholate + flucytosine **Duration:** 2 weeks **Consolidation:** fluconazole for 8 wks **Maintenacne:** Fluconazole for ≥1 yr
52
Seconrady prophylaxis for cryptococcosis?
Fluconaole 200 mg PO QD
53
Presentation of Cytomegalovirus retinitis?
1. Peripheral retinitis (necrotizing) 3. Posterior retinal lesions (fluffy, yellow white) 4. Lesion borders (tiny, dry appearing, satelites)
54
Non pharm CMV retinitis?
1. Advise patients that CMX is shed in bodily fluids 2. Condoms should be used
55
Indications of primary CMV prophylaxis?
**Not** recommended Maintain CD4 >100 to prevent end organ damage
56
Preferred tx for CMV retinitis?
**Immediate sight-threatenign lesions:** Ganciclovir or Valganciclovir with or without Intravitreal injections of ganiclovir or foscarnet
57
Tx for peripheral lesions from CMV?
Valganiciclovir for 14-21 days
58
Maintenace tx for CMV?
Valganiciclovir for 3-6 months

Therapeutics IV (39 decks)

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