ID Pt2 Flashcards
Preferred ART for HIV+ pregnant women
dual NRTI + ritonavir boosted PI (atazanavir or darunavir) or an INSTI (raltegravir)
PCP/PJP prophylaxis (preferred)
CD4 < 200
Bactrim DS daily
Bactrim SS daily
Bactrim DS three times weekly
PCP/PJP preferred treatment
Bactrim: 2 DS tabs TID or 15-20mg/kg/day trimethoprim divided q6-8h for 21 days IV
PCP/PJP prophylaxis alternative
atovaquone 1500 mg once daily OR dapsone 100 mg daily OR dapsone 50 mg weekly + leucovorin and pyrimethamine weekly
PCP/PJP alternative treatment regimens
Clindamycin & primaquine: 600 mg q6h or 900mg q8h IV + primaquine 30 mg daily.
Pentamidine: 4mg/kg/day IV for 21 days (more severe disease)
Trimethoprim + dapsone: trimethoprim 15 mg/kg/day divided q8h + dapsone 100 mg daily for 21 days
Atovaquone (Mepron): 750 mg BID for 21 days with high fat meal (mild/moderate)
PCP/PJP Primary & Secondary prophylaxis initiation/discontinuation
Primary: CD4 < 200 to initiate
Secondary: Post PCP/PJP if CD4 < 200
D/C when CD4 > 200 for more than 3 months OR 100-200 with undetectable viral load for 3-6 months
Cryptococcosis preferred treatment - induction
liposomal amphotericin B 3-4 mg/kg/day + flucytosine 25 mg/kg q6h OR amphotericin B 0.7-1mg/kg/day + flucytosine 25 mg/kg q6h
duration: 2 weeks (need negative CSF)
cryptococcosis consolidation therapy
fluconazole 400 mg daily for 8 weeks
cryptococcosis maintenance therapy and secondary prophylaxis
fluconazole 200 mg daily.
Can DC after 1 year if CD4 > 100
No primary prophylaxis
MAC treatment
macrolide + ethambutol for 12 months
clarithromycin 500 mg BID or azithro 500-600 mg daily + ethambutol 15 mg/kg/day.
May add rifabutin, fluoroquinolone, or aminoglycoside if CD4 < 50.
MAC Primary Prophylaxis
Indicated if CD4 < 50 who are not on ART. Not recommended if on ART.
Consider clarithromycin 500 mg BID or azithro 1200 mg weekly or 600 mg BID. Alternative is rifabutin 300 mg daily
MAC Secondary Prophylaxis
DC treatment after 12 months if CD 4 > 100 for 6 months, asymptomatic, and on ART. Restart if CD4 < 100.
CMV retinitis treatment
Valganciclovir 900 mg PO BID for 14-21 days, followed by 900 mg PO daily + injections of ganciclovir or foscarnet for 1-4 doses over 10 days.
Continue until CD4 > 100 for 3-6 months
CMV esophagitis or colitis treatment
ganciclovir 5 mg/kg IV q12h then valganciclovir 900 mg PO BID when tolerated
Continue until CD4 > 100 for 3-6 months
CMV prophylaxis
No primary prophylaxis
Secondary - continue treatment until CD4 > 100 for 3-6 months.
Toxoplamosis primary prophylaxis
If prophylaxis for PCP, then covering toxoplasmosis. Initiate if CD4 < 100 - Bactrim DS daily.
Can DC if CD4 > 200 for 3 months. If viral load undetectable for 3-6 months and CD4 100-200 can also DC.
Toxoplasmosis treatment
Pyrimethamine 50-75 mg/day (loading dose of 200 mg) + sulfadiazine 1000 – 1500 mg every 6 hours plus leucovorin
ADE: thrombocytopenia, granylocytopenia, add leucovorin 10-25 mg/day to reduce bone marrow effects from pyrimethamine.
Alternative: clindamyacin 600 mg IV or PO q6h + pyrimethamine (use in sulfa allergy) + leucovirin. Also consider Bactrim or atovaquone.
Toxoplamosis secondary prophylaxis
DC if CD4 > 200 for 6 months or longer
Lower dose tx:
Pyrimethamine 25-50 mg/day + leucovorin 10-25 mg/day + sulfadiazine 2-4 g/day
Latent TB Treatment - non-HIV
Isoniazid 300 mg daily or 900 twice weekly for 9 months, or rifampin 600 mg daily for 4 months
Latent TB Treatment - HIV
Isoniazid 300 mg daily for 9 months or DOT isoniazid 900 mg twice weekly for 9 months
Active TB treatment: non-HIV
Intensive Phase: Isoniazid, rifampin, pyrazinamide, ethambutol for 2 months.
Can drop ethambutol if cultures are sensitive to isoniazid and rifampin.
Continuation phase: isoniazid + rifaminpin for 4 months
Add pyridoxine (vit b6) to isoniazid to reduce neuropathy
Active TB treatment: HIV
Intensive Phase: Isoniazid, rifampin /rifabutin, pyrazinamide, ethambutol for 2 months.
Can drop ethambutol if cultures are sensitive to isoniazid and rifampin.
Continuation phase: isoniazid + rifampin/rifabutin for 4 months
TB - Rifampin HIV drug considerations
- Do no use with PI’s or NNRTI’s (except efavirenz or nevirapine)
- If using rifabutin (pt’s on PI’s or NNRTI’s): dose increase for NNRTI and dose decrease for PI’s
- Cannot use rifabutin with elvitegravir or bictegravir
- Only use rifapentine if on efavirenz or raltegravir regimen
TB - resistance to isoniazid
Intensive phase: Replace isoniazid with moxifloxacin or levofloxacin for 2 months
Continuation phase: rifampin + ethambutol + moxi/levo for 7 months
