Infectious diseases Flashcards
What constitutes so-called “AIDS-defining” illnesses?
- CD4 <200
- PJP
- Kaposi sarcoma
- NHL
- HAND
- CMV
- cerebral toxoplasmosis
- oesophageal candidiasis
- Disseminated MAC
What is the treatment for PJP in HIV?
- Rx: Bactrim or pentamidine
- Proph: Bactrim or pentamidine if CD4 < 200
What is the treatment for Kaposi sarcoma?
- no eradication Rx available for latent HHV-8
- Observe
- Stockings for LL lymphoedema
- Local treatment - RT/ surgery/ intra-lesional injection of chemo
- Systemic treatment - chemo (vinblastine, doxorubicin, bleomycin)
What is the treatment for CMV in HIV?
- Rx: Valganciclovir/ Ganciclovir/ Foscarnet or Cidofovir for 21 days
- Proph: not recommended
What is the treatment for Cerebral Toxoplasmosis in HIV?
- Rx: Pyrimethamine, plus either 1) sulfadiazine 2) clindamycin or atovaquone for 6 weeks total
- Proph: Bactrim as per PJP when CD4 < 100
What is the treatment for oesophageal candidiasis in HIV?
- Rx: Fluconazole/ Itraconazole
- Proph: secondary prophylaxis with flu/ketoconazole
What is the treatment for disseminated MAC in HIV?
- Rx: Ethambutol with either 1) Clarithromycin or 2) Azithromycin +/- Rifabutin
- Proph: When CD4 < 50, Azithromycin weekly, clarithro BD or Rifabutin daily
What conditions occur in HIV at any CD4 count?
At <250?
At <100?
At <50?
#Any CD4 count -Kaposi, Pul TB, HZV, Bacterial pneumonia, Lymphoma #Less than 250 -PJP, oesophageal candidiasis, PML, HSV #Less than 100 -Cerebral toxoplasmosis, HIV encephalopathy, Cryptococcus, miliary TB #Less than 50 -CMV retinitis, Atypical mycobacteriosis
What are the common forms of acquisition of HIV?
What are their co-morbidities?
1) MSM
- coinfections with syphilis and HPV, Kaposi’s sarcoma
2) IVDU
- HBC, HCV, IE, heroin nephropathy
3) Blood donations
- Haemophiliac
What are important parts of HIV history?
- Manifestations and complications of HIV: Resp, GIT, Neuro, Renal (HIV related nephropathy), Ocular (CMV retinitis), Mouth (OHL - related to EBV), cardiac, haem
- Antiretrovirals and side effects
- Surveillance: (1) Viral loads (2) CD4 (3) Previous imaging, biopsy
- Non-infectious co-morbidities of HIV.
- Mention who is aware of diagnosis at the end of this
What are Non-infectious co-morbidities of HIV?
- Abnormality of body composition
- Lipoatrophy = Stavudine or Zidovidine;
- Visceral fat and buffalo hump = PI’s. - Glucose met impairment and T2DM.
- Dyslipidaemia.
- HAND.
- CVD.
- Hepatic steatosis.
- Bone and kidney disease.
- depression.
- Hypertension.
- Vit D deficiency.
- Cancer/ Malignancy.
- Frailty.
- Sexual dysfunction
What are Long term management considerations in HIV?
1) smoking/ ETOH
2) lipids
3) weight and exercise
4) malignancy surveillance
5) vaccinations
6) sexual health screening
What is the preferred treatment agents in HIV?
Integrase based therapy
- 2 NRTIs + integrase inhibitors (previously PI was preferred as third agent)
- PI’s = CYP inhibitors P450 3A4 = beware co-administration of steroids/ opioids/ methadone etc
- Rivaroxaban contraindicated with all PI’s, avoid in NNRTIs
What are SEs of Nucleoside reverse transcriptase inhibitors (NRTIs or “nukes”)? (-vir, -dine)
- mitochondrial toxicity: Lipoatrophy, peripheral neuropathy, lactic acidosis, pancreatitis
- Abacavir/ Zidovudine/ Stavudine/ Lamivudine/ Emtricitabine/ Tenofovir
- Abacavir - increase in MI risk, HLA-B5701 associated hypersensitivity 3-5%
- Tenofovir - renal toxicity - fanconi syndrome
What are SEs of NNRTIs? (-virine, -virenz, -virapine)
- Liver toxicity
- Efavirenz/ Rilpivirine/ Etravrine/ Nevirapine
- Nevirapine: CYP 3A4 inducer (e.g. Nevirapine + methadone = Methadone withdrawal)
