OIs

Question 1

Overview

Answer 1

More severe/frequent due to HIV immunosuppression

Occur 7-10 years after HIV infection

Question 2

Common infections

Answer 2

Pneumocystitis pneumonia (PJP)–>CD4 < 200
Toxoplasma encephalitis–>CD4 < 200
Cytomegalovirus retinitis (CMV)–>CD4 < 200
Cryptococcal meningitis–>CD4 < 200
Tuberculosis–>any CD4 count
- Increases HIV viral load & increases risk of viral transmission
Mycobacterium avium complex (MAC)–>CD4 < 200
Histoplasmosis
Kaposi sarcoma–>CD4 < 200
Lymphomas–>CD4 < 200

Question 3

HIV–>OI

Answer 3

All patients infected with HIV, without treatment, develop immunodeficiency due to CD4 depletion–>50-100 cells/year decline

Normal CD4: 800-1200 cells/mm^3
OI CD4: 200-500 cells/mm^3

Question 4

Primary prophylaxis

Answer 4

administration of anti-infectives to prevent the first episode of OI in patient living with HIV

Question 5

Secondary prophylaxis

Answer 5

administration of anti-infective to prevent further recurrences in a patient living with HIV after they have successful treated an OI prior

Question 6

When to start ART immediately

Answer 6

PML, cryptosporidiosis, Kaposi’s sarcoma

No treatment–>try to decrease viral load ASAP

Question 7

Delayed (due to these risks)

Answer 7

Immune Reconstitution Inflammatory Syndrome (IRIS)
- Fever, inflammation, worsening OI within 4-8 weeks
- Seen during tx of MAC, TB, PJP. Toxoplasmosis, Hep B/C, CMV, cryptococcoses, histoplasmosis, VZV
- Low CD4 levels < 50 and high HIV RNA levels > 100,000

Treatment:
- treat OI
- Mild: NSAIDS or inhaled corticosteroids
- Severe: prednisone 1-2 mg/kg QD x 1-2 weeks followed by taper: Do not give steroids in cryptococcal meningitis or Kaposi
sarcoma

Drug interactions