Opportunistic Infections

Question 1

PCP (Pneumocystis pneumonia):

Primary Prophylaxis (1st line)

Answer 1

DS TMP/SMX PO QD (160/800)
or
SS TMP/SMX PO QD (80/400)

Question 2

PCP (Pneumocystis pneumonia):

Secondary Prophylaxis (5 options)

Answer 2

• DS Bactrim TIW
• Dapsone 50mg PO QD + pyrimethamine 50mg PO QW + leukovorin 25mg PO QW
• Aerosolized pentamidine
• Atovaquone

G6PDH Allergy –> atovaquone

Question 3

PCP (Pneumocystis pneumonia):

INDICATION for Primary Prophylaxis

Answer 3

CD4+ Count < 200cells/mm3

or

Presence of oral candidiasis

Question 4

PCP (Pneumocystis pneumonia):

DISCONTINUATION of Primary Prophylaxis

Answer 4

CD4 + Count ≥ 200 cells/mm3 for > 3 months (while on ART)

Question 5

Oral Candidiasis (Thrush):

Primary Prophylaxis

Answer 5

None

Question 6

Toxoplasma gondii:

Primary Prophylaxis

Answer 6

DS TMP/SMX PO QD (160/800)

Question 7

Toxoplasma gondii:

Secondary Prophylaxis (3 options)

Answer 7

• Bactrim DS PO TIW
• Dapsone 50mg PO QD + pyrimethamine 50mg PO QW + leucovorin 25mg PO QW
• Atovaquone +/- pyrimethamine + leucovorin

leucovorin added b/c myelosuppression from pyrimethamine

Question 8

Toxoplasma gondii:

INDICATION for Primary Prophylaxis

Answer 8

Toxoplasma + IgG
+
CD4+ count < 100cells/mm3

Question 9

Toxoplasma gondii:

DISCONTINUATION for Primary Prophylaxis

Answer 9

CD4+ count > 200cells/mm3 for > 3 months

Question 10

Mycobacterium avium complex (MAC):

Primary Prophylaxis

Answer 10

Azithroymcin 1200mg PO QW

Question 11

Mycobacterium avium complex (MAC):

Secondary Prophylaxis (3 options)

Answer 11

• Clarithromycin 500mg PO BID
• Azithromycin 600mg PO BIW
• Rifabutin (dose adjust based on ART)
• *RED + rule out TB before use**

Question 12

Mycobacterium avium complex (MAC):

INDICATION for Primary Prophylaxis

Answer 12

CD4+ Count < 50cells/mm3

active dissemination needs to be ruled out

Question 13

Mycobacterium avium complex (MAC):

DISCONTINUATION for Primary Prophylaxis

Answer 13

CD4+ count > 100cells/mm3 for ≥ 3 months

Question 14

Candidiasis (oropharyngeal + esophagela) Treatment

Answer 14

CD4+ @ < 200cells/mm3
1.) Fluconzole

2.) Itraconazole, Posaconazole

Secondary: None

Question 15

Cytomegalovirus (CMV) Treatment

• retinitis
• encephalopathy
• gastroenteritis

Answer 15

CD4+ < 100cells/mm3
1.) Valganciclovir, Ganciclovir
or
(resistance) Foscarnet, cidofovir

2.) Valganciclovir

Question 16

Cryptococcal meningitis Treatment

Answer 16

1.) AmpB deoxycholate + flucytosine
or 
AmpB (liposome) + flucytosine
or 
Fluconazole + flucytosine 

2.) Fluconazole (low dose)

Renal Issues: Deoxy&raquo_space; Liposome

Question 17

MAC Infection Treatment

Answer 17

1.) Azithromycin or Clarithromycin + Ethambutol
or
Add 3rd or 4th Line:
[Rifabutin, amikacin, streptomycin, moxifloxacin, levofloxacin]

2.) same as alternatives for 1st line

Question 18

Pneumocystis pneumonia (PCP) Treatment

Answer 18

1.) SMX/TMP +/- Corticosteroid (21d)
or Atovaquone 
or (clindamycin + primaquine) 
or pentamidine IV
or (dapsone + trimethoprim)

2.) SMX/TMP 
or dapsone
or (dapsone + dyrimethamine)
or atovaquone
or inhaled pentamidine

Question 19

Toxoplasmosis meningoencephalitis Treatment

Answer 19

1.) Pyrimethamine + sulfadiazine
or SMX/TMP
or Pyrimethamine + (clindamycin + azithromycin)
or atovaquone
or sulfadiazine +/- pyrimethamine

Question 20

Pyrimethamine Myelosuppression Tx

Answer 20

LEUCOVORIN 25mg PO QW