ID

Question 1

when is occupational HIV post-exposure prophylaxis indicated? What are the drugs? For how long?

Answer 1

Immediately after a high-risk occupational exposure (e.g. mucous membranes, blood, semen, vaginal secretions, or body fluid w/ visible blood).

tenofovir, emtricitabine, and raltegravir for 4 weeks.

Question 2

Vaccines recommended for adults with HIV?

Answer 2

Hep A (for chronic liver disease, MSM, IV drug use)
HBV (unless already immune)
HPV (ages 9-26)
Influenza (annually)
meningitis (ages 11-18)
Pneumococcus (Prevnar 13 once, PPSV23 8 weeks later and again every 5 years)
Tdap once, followed by Td every 10 years.

Pts. with CD4

Question 3

Infection prevention for HIV+ patients?

Answer 3

All HIV+ should get a PPD to look for exposure to TB. Latent disease should be treated.

CD4 less than 250:
- coccidiomycosis (annual IgG and IgM screening in endemic areas)

CD4 less than 200:
- PCP (Bactrim)

CD4 less than 150:
- Histoplasmosis (treat with itraconazole)

CD4 less than 100:

• Toxoplasmosis (Bactrim)
• Cryptocoocus (no ppx)

CD4 less than 50:
- MAC (azithromycin)

Question 4

Causes of dysphagia and odynophagia in the HIV-infected patient

Answer 4

esophageal candidiasis: treat with oral fluconazole
CMV: large, linear ulcers, treat with ganciclovir
HSV: round, ovoid ulcers with vesicles, treat with acyclovir