Opportunistic Infections Flashcards
Give examples of common sites of opportunistic infections
- brain- cryptococcal meningitis
- eyes- CMV
- Mouth and throat- candidiasis (yeast)
- lungs- TB
- Gut- mycobacterium
- skin- shingles
- genitals- genital herpes, vaginal candidiasis
Give examples of conditions where HIV testing is strongly recommended
- non Hodgkins lymphoma
- bacterial infections such as mycobacterium tuberculosis
- viral infections such as herpes simplex
- fungal infections such as candidiasis
Give examples of conditions associated with undiagnosed HIV prevalence where HIV testing is strongly recommended
- sexually transmitted infections
- malignant lymphoma
- hepatitis B or C
What opportunistic infections are likely to be found in CD4 counts >500
- candidiasis
- TB
What opportunistic infections are likely to be found in CD4 200-500
- pneumococcal pneumonia
- pulmonary TB
- candidiasis- oropharyngeal
what opportunistic infections are likely to be found at CD4<200
- PCP
- miliary/extra pulmonary TB
- disseminated histoplasmosis
what opportunistic infections are likely to be found in CD4 <50
- disseminated cytomegalovirus
- disseminated atypical mycobacteria
Outline the characteristics of Pneumocystis jirovecii (PCP))
- fungus
- insidious onset
- dry cough, nbreathlesssness
what opportunistic infections are likely to be found in CD4 <100
- toxoplasmosis
- cryptococcosis
- candida oesophagitis
outline some of the physical signs of Pneumocystis jirovecii
- tachypnoea
- chest x ray may show: diffuse interstitial changes, pneumothorax, often appears normal in mild disease
- low CO2, low O2
Describe the association of CD4 count and viral load and the development of HIV
low CD4 count and high viral load increases risk of HIV
- but can still be at high risk without high viral load
outline the acute treatment of PCP
- oxygen
- Co-trimoxazole (IV for moderate-severe, oral for mild)
- 120mg/kg/day (day 1-3), then 90g/kg (day 4-21) in 2-3 divided doses - corticosteroids if pO2 <9.okPa (reducing need for ventilation)
- eg. prednisolone 75mg OM 5/7, 50mg OM 5/7, 25mg OM 5/7 - metoclopramide 10mg ads 30 mins pre cotrimoxazole
- nystatin liquid 1ml ads for oral candida
- loperamide 2mg prn for diarrhoea
Outline the CMV retinitis induction treatment
- 2-3/52 induction followed by maintenance
- first choice is valganciclovir 900mg BD with food
- if concerns about swallowing, absorption or oral intake: ganciclovir 5mg/kg IV BD - if myelosuppression- foscarnet or cidofovir (both nephrotoxic)
outline the secondary prophylaxis (maintenance) of PCP
- continue PCP Px until cD4>200 and VL<40 for >6/12
- 1st line is cotrimoxazole 480mg OD
- dapsone 100mg oD and pyrimethamine 50mg weekly
- atovaquone 750mg BD
- monthly nebulised pentamidine
how can pneumocystis jirovecii be diagnosed
induced sputum or bronchoalveolar lavage, bronchoscopy
outline the secondary prophylaxis (maintenance) of CMV
- continue until CD4>100 and VL<40 for >6/12
- 1st line is valganciclovir 900mg od
what are the problems with starting antiretrovirals immediately
- polypharmacy
- overlapping side effects (rash)
- immune reconstitution inflammatory syndrome
what are the problems with delaying starting antiretrovirals
risk of untreated HIV- opportunistic infections, neurological disease
when are antiretrovirals typically started with PCP treatment
usually 2nd week of PCP treatment
- but delayed if CMV
what factors should be considered when starting ART
- tailor regimen to patient
- concomitant medications
- Hepatitis coinfection
- pasta medical and psychiatric history
- adherence issues
6.baseline resistance test
when is valganciclovir and pyrimethamine stopped
when VL<40 on 2 occasions
when is dapsone stopped
if CD4>200
