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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
Q

Presentation of esophageal candida?

A

Burning pain, discomfort, odynophagia (retrosternal)

26
Q

Indication for Candida primary prophylaxis?

A

NOT recommended

27
Q

Tx for oral candida?

A

Fluconazole for 7-14 days

28
Q

Tx for esophageal candida?

A

Fluconazole or Itraconzale for 14-21 days

29
Q

Is secondary candida prophylaxis recommended?

A

No, unless patients have frequent recurrences

30
Q

Secondary prophylaxis for candida?

A

Oral: Fluconazole or itroconazole
Eso: Fluconazole or posaconazole

31
Q

Where is histoplasma commonly found?

A

Ohio river and MS river valley

32
Q

Indications for primary prophylaxis?

A

CD4 count <150 and
High risk exposure

33
Q

Primary prophylaxis for histoplasma?

A

Itraconazole 200mg PO daily

34
Q

Tx for less severe desseminated histoplasma? Duration?

A

Itraconazole 200mg PO TID (for 3 days), then 200mg PO BID

Duration: 12 months

35
Q

Tx for moderate-severe desseminated histoplasma? Duration?

A

Induction: Liposomal amphotericin B until clinically stable
Maintenance: Itraconazole 200mg PO TID (for 3 days), then 200mg PO BID

Duration: 12 months

36
Q

Tx for histoplasmosis meningitis?

A

Induction: Liposomal amp B for 4-6 wks
Maintenance: Itraconazole 200mg PO BID or TID for ≥12 months
Duration: 12 months

37
Q

Secondary prophylaxis for histoplasma?

A

Itraconazole 200mg PO daily

38
Q

What are the fungi that cause Coccidioidomycosis?

A

C. immitis
C. posadasii

39
Q

What are the syndormes of Coccidioidomycosis?

A
  1. Focal pneumonia
  2. Diffuse pneumonia
  3. Extra-thoraicic involvement
  4. Positive serology tests without evidence of localized infection
40
Q

What are presentations of focal pneumonia?

A
  1. CD4 count >250
  2. Persistant HA and progressive lethargy
41
Q

Non pharm for Coccidioidomycosis?

A
  1. Avoid extensive exposure to native soil
  2. Remain indoors during dust storms
42
Q

Indication for Coccidioidomycosis primary prophylaxis?

A

Not recommended for seronegative except:
1. IgM or IgG +
2. No signs of active Coccidioidomycosis
3. CD4 count <250

43
Q

Primary prophylaxis for Coccidioidomycosis?

A

FLuconazole

44
Q

Indication to dc Coccidioidomycosis prophylaxixs?

A

CD4 ≥250 for ≥6months

45
Q

Tx for mild-moderate pulmonary Coccidioidomycosis?

A

FLuconzazole or Itraconzale for 3-6 months

46
Q

Tx for severe pulmonary or extrapulmonary Coccidioidomycosis?

A

Liposomal amphotericin B or Amphotericin B deoxycholate for 12 months

47
Q

Tx for coccidiodomycosis meningitis?

A

Fluconazole indefinitely

48
Q

Diagnosis for cryptococcois?

A

CSF sample:
1. Elevated protein, low-normal glucose
2. Opening pressure elevated
3. CrAg+

49
Q

Non pharm for cryptococcosis?

A

Avoid exposure to dried birf feces

50
Q

Is prophylaxis recommended for cyrptococcis?

51
Q

What is the preferred tx for cryptococcus? Duration

A

Induction:
Liposomal amp B + flucytosine OR
Amp B deoxcholate + flucytosine
Duration: 2 weeks

Consolidation: fluconazole for 8 wks
Maintenacne: Fluconazole for ≥1 yr

52
Q

Seconrady prophylaxis for cryptococcosis?

A

Fluconaole 200 mg PO QD

53
Q

Presentation of Cytomegalovirus retinitis?

A
  1. Peripheral retinitis (necrotizing)
  2. Posterior retinal lesions (fluffy, yellow white)
  3. Lesion borders (tiny, dry appearing, satelites)
54
Q

Non pharm CMV retinitis?

A
  1. Advise patients that CMX is shed in bodily fluids
  2. Condoms should be used
55
Q

Indications of primary CMV prophylaxis?

A

Not recommended
Maintain CD4 >100 to prevent end organ damage

56
Q

Preferred tx for CMV retinitis?

A

Immediate sight-threatenign lesions: Ganciclovir or Valganciclovir with or without Intravitreal injections of ganiclovir or foscarnet

57
Q

Tx for peripheral lesions from CMV?

A

Valganiciclovir for 14-21 days

58
Q

Maintenace tx for CMV?

A

Valganiciclovir for 3-6 months

Therapeutics IV (39 decks)

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