ID Opportunistic and HIV Flashcards
What CD4+ T lymphocyte count is considered immunocompromised?
<200
Use of systemic steroids for ____ days or longer at a prednisone dose of ____mg/d or _____mg/kg/d can cause an immunocompromised state
14 days or longere
Dose of 20mg/d or more
2mg/kg/d or more
Lack of what organ can cause an immunocompromised state?
Spleen (asplenia)
Use of what medications can cause an immunocompromised state
Immunosuppressants
Cancer chemo
What is chemoprophylaxis?
Prophylaxis of opportunistic infections
What are common opportunistic infections that require primary prophylaxis?
Pneumocystitis pneumonia (PCP or PJP)
Toxoplasmosis gondii encephalitis
Mycobacterium avium complex (MAC)
Is prophylaxis recommended for candida infections in immunocompromised people?
Immunocompromised patients are at a higher risk but prophylaxis is not recommended
What ANC level is considered severe neutropenia?
ANC < 500 cells/mm3
What primary prophylaxis medications are good to use in the setting of sulfa allergy
atovaquone
dapsone
pentamidine
What primary prophylaxis medications are good to use in the setting of G6PD deficiency?
atovaquone
pentamidine
What medication is added to all pyrimethamine-containing regimens as rescue therapy to reduce the risk of pyrimethamine-induced myelosuppression?
Leucovorin
When to initiate and discontinue primary prophylaxis for Pneumocystitis pneumonia (PCP or PJP) in HIV
Initiate when CD4 count <200 cells, oropharyngeal candidiasis, or other AIDS-defining illness
D/C when CD4 >200 cells for 3 or more months on ART
Primary prophylaxis regimen for Pneumocystitis pneumonia (PCP or PJP) in HIV
Preferred: bactrim DS or SS daily
Alternative: bactrim DS 3x/wk OR dapsone +/- (pyrimethamine + leucovorin) OR atovaquone
When to initiate and discontinue primary prophylaxis for toxoplasma gondii encephalitis
Initiate when CD4 count < 100
D/c when CD4 >200 for >3 months on ART
Primary prophylaxis regimen for Toxoplasma gondii encephalitis
Preferred: bactrim DS daily
Alternative: bactrim DS 3x/wk OR dapsone + pyrimethamine + leucovorin OR atovaquone OR atovaquone + pyrimethamine + leucovorin
When to initiate and discontinue primary prophylaxis for Mycobacterium avium complex (MAC) infection
Initiate when NOT taking ART and CD4 <50 (if on ART - not recommended)
D/c when taking fully suppressive ART
Primary prophylaxis regimen for mycobacterium avium complex (MAC)
Preferred: azithromycin 1200mg weekly
Alternative: Azithromycin 600 twice weekly OR clarithromycin 500mg BID
When treating thrush in someone with HIV is systemic or topical treatment preferred?
Systemic
Preferred, alternative, and secondary prophylaxis regiment for
Candida (thrush)
Preferred: fluconazole
Alternative: itraconazole, posaconazole
Secondary prophylaxis: None
Preferred, alternative, and secondary prophylaxis regiment for
Cryptococcal menintigis
Preferred: Amphotericin B + flucytosine
Alternative: fluconazole +/- flucytosine
Secondary prophylaxis: Fluconazole (low dose)
Preferred, alternative, and secondary prophylaxis regiment for
Cytomegalovirus (CMV)
Preferred: Valganciclovir or ganciclovir
Alternative: Foscarnet, cidofovir
Secondary prophylaxis: None; maintain CD4 > 100 cells
Preferred, alternative, and secondary prophylaxis regiment for
Mycobacterium avium complex (MAC)
Preferred: (Clarithromycin or azithromycin) + ethambutol
Alternative: preferred PLUS rifabutin, amikacin or streptomycin, moxifloxacin, or levofloxacin
Secondary prophylaxis: Same as treatment regimen
Preferred, alternative, and secondary prophylaxis regiment for Pneumocystitis pneumonia (PCP)
Preferred: Bactrim +/- prednisone or methylprednisolone x 21 days
Alternative: Atovaquone OR pentamidine IV
Secondary prophylaxis: same as primary prophylaxis
Preferred, alternative, and secondary prophylaxis regiment for
Toxoplasmosis gondii encephalitis
Preferred: Pyrimethamine + leucovorin + sulfadiazine
Alternative: Bactrim OR (clinda or azithormycin) +/- pyrimethamine + leucovorin OR atovaquone +/- (atovaquone + sulfadiazine)
Secondary prophylaxis: Same as treatment; reduced dose
What cells does HIV use to replicate?
CD4+ T cells
When is AIDS diagnosed?
When a patient’s CD4 count falls below 200 cells/mm3 or the presence of an AIDS defining condition
Who should be tested for HIV?
Everyone at least once
Everyone ages 13-64 at high risk - annually
- Sharing drug equipment needles
- High-risk sexual behaviors
- History of a sexually transmitted infection
What are the 3 stages of HIV?
Acute infection
Chronic infection
AIDS
What happens during the acute infection stage of HIV?
Lasts 2-4 weeks
HIV multiplies rapidly
S/sx are flu-like
Highly infectious
What happens during the chronic infection stage of HIV?
ART suppresses the viral load OR the virus is replicating causing the viral load to increase and CD4 count to decrease
What happens during the AIDS stage of HIV?
Patient has AIDS-defining condition or CD4 count <200