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HIV > Opportunistic Infections > Flashcards

Opportunistic Infections Flashcards

1
Q

Give examples of common sites of opportunistic infections

A
  1. brain- cryptococcal meningitis
  2. eyes- CMV
  3. Mouth and throat- candidiasis (yeast)
  4. lungs- TB
  5. Gut- mycobacterium
  6. skin- shingles
  7. genitals- genital herpes, vaginal candidiasis
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2
Q

Give examples of conditions where HIV testing is strongly recommended

A
  • non Hodgkins lymphoma
  • bacterial infections such as mycobacterium tuberculosis
  • viral infections such as herpes simplex
  • fungal infections such as candidiasis
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3
Q

Give examples of conditions associated with undiagnosed HIV prevalence where HIV testing is strongly recommended

A
  • sexually transmitted infections
  • malignant lymphoma
  • hepatitis B or C
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4
Q

What opportunistic infections are likely to be found in CD4 counts >500

A
  • candidiasis
  • TB
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5
Q

What opportunistic infections are likely to be found in CD4 200-500

A
  • pneumococcal pneumonia
  • pulmonary TB
  • candidiasis- oropharyngeal
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6
Q

what opportunistic infections are likely to be found at CD4<200

A
  • PCP
  • miliary/extra pulmonary TB
  • disseminated histoplasmosis
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7
Q

what opportunistic infections are likely to be found in CD4 <50

A
  • disseminated cytomegalovirus
  • disseminated atypical mycobacteria
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8
Q

Outline the characteristics of Pneumocystis jirovecii (PCP))

A
  • fungus
  • insidious onset
  • dry cough, nbreathlesssness
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9
Q

what opportunistic infections are likely to be found in CD4 <100

A
  • toxoplasmosis
  • cryptococcosis
  • candida oesophagitis
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10
Q

outline some of the physical signs of Pneumocystis jirovecii

A
  • tachypnoea
  • chest x ray may show: diffuse interstitial changes, pneumothorax, often appears normal in mild disease
  • low CO2, low O2
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11
Q

Describe the association of CD4 count and viral load and the development of HIV

A

low CD4 count and high viral load increases risk of HIV
- but can still be at high risk without high viral load

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12
Q

outline the acute treatment of PCP

A
  1. oxygen
  2. 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
  3. corticosteroids if pO2 <9.okPa (reducing need for ventilation)
    - eg. prednisolone 75mg OM 5/7, 50mg OM 5/7, 25mg OM 5/7
  4. metoclopramide 10mg ads 30 mins pre cotrimoxazole
  5. nystatin liquid 1ml ads for oral candida
  6. loperamide 2mg prn for diarrhoea
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13
Q

Outline the CMV retinitis induction treatment

A
  1. 2-3/52 induction followed by maintenance
  2. first choice is valganciclovir 900mg BD with food
    - if concerns about swallowing, absorption or oral intake: ganciclovir 5mg/kg IV BD
  3. if myelosuppression- foscarnet or cidofovir (both nephrotoxic)
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14
Q

outline the secondary prophylaxis (maintenance) of PCP

A
  1. continue PCP Px until cD4>200 and VL<40 for >6/12
  2. 1st line is cotrimoxazole 480mg OD
  3. dapsone 100mg oD and pyrimethamine 50mg weekly
  4. atovaquone 750mg BD
  5. monthly nebulised pentamidine
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15
Q

how can pneumocystis jirovecii be diagnosed

A

induced sputum or bronchoalveolar lavage, bronchoscopy

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16
Q

outline the secondary prophylaxis (maintenance) of CMV

A
  1. continue until CD4>100 and VL<40 for >6/12
  2. 1st line is valganciclovir 900mg od
17
Q

what are the problems with starting antiretrovirals immediately

A
  • polypharmacy
  • overlapping side effects (rash)
  • immune reconstitution inflammatory syndrome
18
Q

what are the problems with delaying starting antiretrovirals

A

risk of untreated HIV- opportunistic infections, neurological disease

19
Q

when are antiretrovirals typically started with PCP treatment

A

usually 2nd week of PCP treatment
- but delayed if CMV

20
Q

what factors should be considered when starting ART

A
  1. tailor regimen to patient
  2. concomitant medications
  3. Hepatitis coinfection
  4. pasta medical and psychiatric history
  5. adherence issues
    6.baseline resistance test
21
Q

when is valganciclovir and pyrimethamine stopped

A

when VL<40 on 2 occasions

22
Q

when is dapsone stopped

A

if CD4>200

23
Q
A

HIV (11 decks)

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