Opportunistic Infections

Question 1

What are normal CD4 levels in adults?

Answer 1

800-1200

Question 2

What CD4 levels are associated with opportunistic infections?

Answer 2

Less than 500 and especially less than 200

Question 3

What infections are common with a CD4 count less than 500?

Answer 3

-Candidiasis
-Leukoplakia

Question 4

What infections are common with a CD4 count less than 200?

Answer 4

-PJP
-CMV retinitis
-Toxoplasmosis
-MAC
-Cryptococcus meningitis or diarrhea
-Lymphomas
-Kaposis sarcoma

Question 5

What is primary prophylaxis for opportunistic infections?

Answer 5

Administration of an anti-infective agent to prevent the first episode of a particular opportunistic infection in a patient living with HIV when they are at risk for developing that opportunistic infection based on their CD4 counts

Question 6

What is secondary prophylaxis for opportunistic infections?

Answer 6

Administration of an anti-infective therapy to prevent further recurrences of a particular OI in a patient living with HIV after they have been successfully treated for that OI and remain at risk for developing that OI based in their CD4 count

Question 7

In what OIs would you want to start ART as soon as possible?

Answer 7

-PML
-Cryptosporidiosis
-Kapsosis sarcoma

Question 8

What are potential disadvantages to starting ART immediately during an acute OI?

Answer 8

-Potential development of IRIS
-Overlapping or additive drug toxicities
-Drug interactions between ART and OI therapy

Question 9

Symptoms of IRIS

Answer 9

-Fever
-Inflammation
-Worsening clinical manifestations of the OI

Question 10

In what OIs does IRIS potentially develop?

Answer 10

-MAC
-TB
-PJP
-Toxoplasmosis
-HBV/HCV
-CMV
-Cryptococcus
-Histoplasmosis
-VZV

Question 11

What patients are at risk for developing IRIS?

Answer 11

-Low CD4 levels
-High HIV RNA levels

Question 12

What is the onset of IRIS?

Answer 12

Within the first 4-8 weeks of ART

Question 13

When should you wait to start ART in a patient at risk for IRIS?

Answer 13

-Wait for a clinical response to OI therapy, usually 2 weeks
-Exception: start ART within 2 weeks of starting TB treatment if CD4 is less than 50 or within 8 weeks if CD4 count is higher

Question 14

How do you treat mild IRIS?

Answer 14

-Treat the OI
-Use NSAIDs for fever and pain
-Use inhaled corticosteroids for any bronchospasms

Question 15

How do you treat severe IRIS?

Answer 15

-Treat the OI
-Prednisone 1-2 mg/kg daily for 1-2 weeks then taper