Opportunistic Infections Exam 4 Flashcards
What is primary prophylaxis?
Therapy given to a patient in order to prevent a first episode of an OI
What is secondary prophylaxis?
Therapy given to a patient after having already received treatment for an active OI in order to prevent a second occurrence
What is the CD4 count that puts pts at risk for Candidiasis?
CD4 <200 cells/mm^3
Primary prophylaxis for Candidiasis
- Not recommended
- Very minimal morbidity and mortality is associated with infections
- Acute treatment is often highly effective
- Routine prophylaxis may lead to development of drug resistant species
Secondary prophylaxis for Candidiasis
- Only recommended in patient who have frequent or severe recurrences
- Fluconazole 100-200 mg by mouth once daily
- Can be stopped when CD4 increases above 200 cells/mm^3
Treatment for Candidiasis
Fluconazole 100 mg-200 mg by mouth once daily for 7-14 days
What is the CD4 count that puts pts at risk for Pneumocystis Pneumonia?
CD4 <200 cells/mm^3
Primary prophylaxis for Pneumocystis Pneumonia
- Should be started in all patients with a CD4 count <200 cells/mm^3, CD4% <14%, or history of an AIDS-defining illness.
- Preferred Therapy: Bactrim 160/800 mg PO once daily; Can cause allergic reactions, rash, pancytopenia, nausea and vomiting
- Alternative Therapy: Dapsone 100 mg PO once daily, Atovaquone 1500 mg PO once daily with food (Poor adherence)
Secondary prophylaxis for Pneumocystis Pneumonia
- Same as primary prophylaxis unless patient experienced an episode of PJP with a CD4 >200 cells/mm^3, in which case
prophylaxis should be continued for life. - Start prophylaxis with preferred drug regimen when CD4 <200 cells/mm^3 (14%) and can discontinue once CD4 >200 cells/mm^3 (14%) for greater than 3 months
Treatment for Pneumocystis Pneumonia
- TMP-SMX dosed based off TMP 15–20 mg/kg/day IV or PO divided into 3 to 4 daily doses for 21 days
- Adjunctive steroid treatment in patient with PaO2 <70mmHg on room air:
+ Prednisone 40 mg PO BID days 1 - 5
+ Prednisone 40 mg PO Daily days 6 – 10
+ Prednisone 20 mg PO Daily days 11 – 21
When can Primary and Secondary prophylaxis for Pneumocystis Pneumonia be discontinued?
- Can be discontinued when CD4 count increased to ≥200 cells/mm^3 (14%) for at least 3 months in response to HIV treatment.
What is the CD4 count that puts pts at risk for Toxoplasmic Encephalitis?
CD4 <100 cells/mm^3
Primary prophylaxis for Toxoplasmic Encephalitis
- Should be started in patients with anti-toxoplasma IgG antibodies and CD4 counts <100 cells/mm^3
- Preferred Therapy: Bactrim 160/800 mg PO once daily
- Alternative Therapy: Atovaquone 1500 mg PO once daily with food
Secondary prophylaxis for Toxoplasmic Encephalitis
Pyrimethamine 25–50 mg PO daily + sulfadiazine 2000–4000 mg PO daily (in 2 to 4 divided doses) + leucovorin 10–25 mg PO daily
Treatment for Toxoplasmic Encephalitis
- Pyrimethamine 200 mg PO once, followed by dose based on body weight:
- Body weight ≤60 kg: pyrimethamine 50 mg PO daily + sulfadiazine 1000 mg PO q6h + leucovorin 10–25 mg PO daily (can increase to 50 mg daily or BID)
- Body weight >60 kg: pyrimethamine 75 mg PO daily + sulfadiazine 1500 mg PO q6h + leucovorin 10–25 mg PO daily (can increase to 50 mg daily or BID)
When can Primary prophylaxis for Toxoplasmic Encephalitis be discontinued?
when CD4 count increased to ≥200 cells/mm^3 (14%) for at least 3 months in response to HIV treatment
When can Secondary prophylaxis for Toxoplasmic Encephalitis be discontinued?
when CD4 count increased to ≥200 cells/mm^3 (14%) for at least 6 months in response to HIV treatment and the patient no longer has any signs or symptoms
