HIV - Opportunistic Infections and Coinfections Flashcards
Why are usually-harmless pathogens able to make HIV sufferers ill?
Because pts w/ HIV have reduced CD4+ counts and hence weakened immune systems (i.e. they’re “opportunistic”)
What can cytomegalovirus retinitis infections result in?
Blindness
Cornerstone tx for cytomegalovirus in HIV pts?
ART
When would HIV ART begin for pts w/ CMV retinitis? Why?
2 weeks after CMV tx > to prevent further inflammation due to the virus (form of IRIS)
What is IRIS?
It’s when a pt’s pre-existing infectious dz process worsens following ART
When is IRIS usually worse?
When pts have lower CD4+ counts
T or F: If an HIV pt is prone to suffering from IRIS, ART should be started right away
F
It should be delayed somewhat, and started slowly
How should TB be tx’ed in HIV+ pts?
Tx the TB with normal TB drugs > delay tx of HIV w/ ART > tx w/ ART (2 or 8 weeks post-TB tx initiation, depending on CD4 count) (the is done to avoid IRIS)
When does mycobacterium avium complex (MAC) tend to appear in an HIV pt?
When their CD4 declines below 50
Tx options for MAC in HIV pts?
clarithro or azithromycin
Why would MAC be prophylaxed in HIV pts?
Because MAC is acquired rather than reactivated
What is used for MAC prophylaxis for HIV pts?
clarithro or azithromycin
Toxoplasmosis tx for HIV pts?
Sulfadiazine, pyremethamine, and leucovorin
When should HIV pts receive prophylaxis for toxoplasmosis?
when their CD4 drops below 100 cells/mm^3
What drug is used in HIV+ pts for prophylaxis for toxoplasmosis?
TMP/SMX
Most common opportunistic infection in AIDS pts?
PCP pneumonia
Tx for PCP pneumonia in HIV pts?
SMX/TMP
When should HIV pts receive prophylaxis for PCP pneumonia?
When their CD4 drops below 200 cells/mm^3
Common STI coinfection w/ HIV?
HSV
Tx of HSV in HIV+ pts?
valacyclovir
When is an HIV+ pt likely to have HSV episodes?
When their CD4 levels are low
Most common opportunistic infection in HIV+ individuals?
Oral thrush (candidia thrush)
T or F: Oral thrush can happen at ANY CD4 level in HIV+ pts.
T (but it’s more common when CD4 < 200)
Tx for oral candidiasis in HIV pts?
Systemic antifungals (fluconazole, itraconazole, posaconazole [for tx failure])
T or F: Topical nystatin is preferred for cases of oral thrush in HIV+ pts.
F (systemics preferred)
T or F: There’s double coverage for toxoplasmosis and PCP pneumonia when using SMX/TMP DS prophylaxis.
T
