Opportunistic Infections

Question 1

Immunocompromised States

Answer 1

• HIV; CD4 count <200
• Use of systemic steroids >20mg/day for 14+ days
• Asplenia
• Use of immunosuppressants (TNF-a inhibitors)
• Severe neutropenia (ANC <500)

Question 2

Pneumocystis jirovecii pneumonia (PCP)

Answer 2

Primary Prophylaxis:
CD4 <200
- Bactrim
- Sulfa allergy:
— Dapsone + pyrimethamine + leucovorin
Leucovorin is to decrease myelosuppression from pyrimethamine

Treatment:
Bactrim 21 days
Atovaquone or Pentamidine IV

Question 3

Toxoplasmosis gondii encephalitis (Toxo)

Answer 3

Primary prophylaxis:
CD4 <100
- Bactrim
- Sulfa allergy:
— Dapsone + pyrimethamine + leucovorin
Leucovorin is to decrease myelosuppression from pyrimethamine

Treatment:
Pyrimethamine + leucovorin + sulfadiazine
Bactrim

Question 4

Mycobacterium avium complex (MAC)

Answer 4

Primary prophylaxis:
Rule out active MAC
DO NOT use if patient initiated ART
CD4 <50
- Bactrim + Azithromycin 1200mg QW

Treatment:
Azithromycin or Clarithromycin + ethambutol
Add 3rd or 4th agent: rifabutin, amikacin, or quinolones

Question 5

Candidiasis

Answer 5

Treatment:
Fluconazole
Itraconazole
Posaconazole

Secondary prophylaxis NOT recommended

Question 6

Cryptococcal meningitis

Answer 6

Treatment:
Amphotericin B + flucytosine
Fluconazole High Dose + flucytosine

Secondary prophylaxis:
Fluconazole Low Dose

Question 7

Cytomegalovirus

Answer 7

Treatment:
Valganciclovir (PO)
Ganciclovir (IV)
If resistance or toxicities:
- Foscarnet or cidofovir

Secondary prophylaxis:
Maintain CD4 >100