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446- ID and transplant > Opportunistic Infections in HIV > Flashcards

Opportunistic Infections in HIV Flashcards

1
Q

what is IRIS

A

immune reconstitution inflammatory syndrome- exaggerated reaction to a pathogen when the immune system begins to recover on ARTs

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2
Q

IRIS may ________ or ___________

A

unmask an undiagnosed infection
worsen a previously tx infection

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3
Q

what type of fungi are OIs

A

yeasts- candida + cryptococcosis

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4
Q

name 2 OIs

A

bacterial respiratory disease, cryptococcosis, cytomegalovirus (CMV), candidiasis, mycobacterium avium complex (MAC), mycobacterium tuberculosis (TB), pneumocystis pneumonia (PJP), toxoplasma gondii (Toxo)

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5
Q

when should you start prophylaxing for PCP

A

CD4<200

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6
Q

when should you start prophylaxing for toxo

A

CD4 <100

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7
Q

when should you start prophylaxing for MAC

A

Cd4<50

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8
Q

what is the best protection against OIs

A

ART

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9
Q

what is a normal CD4 count

A

500-1500

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10
Q

which of the following is false about PJP
1. it is transmitted by inhalation of ascospores
2. disease may occur if latent infection is reactivated
3. has a slower onset- worsens over days-weeks
4. 2/3s of healthy children have antibodies by age 2-4
5. sx, blood tests, and CXR may confirm dx

A

5- needs histopathologic/ cytopathologic demonstration of organisms in tissue
- either by BAL or induced sputum samples

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11
Q

describe the clinical presentation of PJP

A

Progressive dyspnea, fever, nonproductive cough, chest discomfort

Subacute onset: worsens over days-wks (sudden onset possible but not common)

Chest x ray: diffuse, bilateral, symmetrical “ground glass” interstitial infiltrates, butterfly pattern

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12
Q

which OI has symmetrical “ground glass” interstitial infiltrates

A

PJP

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13
Q

what is the pref tx for PJP

A

TMP-SMX F 21 d + adj steroids

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14
Q

what safety parameters need to be monitored for PJP tx with TMP-SMX

A

ARs high compared to pts without HIV (20-85%)- rash (30-55%), SJS, fever, leukopenia, thrombocytopenia, hepatitis, hyperkalemia
Renal dosing

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15
Q

when is used for primary prophylaxis for PJP

A

TMP-SMA SS 1 tab daily or DS 1 tab daily or 3x/wk

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16
Q

when should secondary prophylaxis for PJP start

A

ASAP after completion of PJP tx- same as primary prophylaxis = TMP-SMX

17
Q

when should primary and secondary prophylaxis for PJP be stopped

A

when pt is on ART and experiences immune recovery with CD4 >200 for 3 months

18
Q

toxoplasmic encephalitis is caused by
1. yeast
2. protozoan
3. mold
4. bacteria
5. virus

A

2

19
Q

TE occurs due to ____________

A

reactivation of latent tissue cysts

20
Q

primary infection of TE happens after ______ or ________

A

eating undercooked meat or oocytes shed in cat feces

21
Q

which of the following is true regarding TE
1. it is contagious
2. all pts should be tested for TE IgM antibody to TE immediately after HIV dx
3. may cause focal encephalitis and nonfocal sx
4. diagnosis is IgM antibodies + CT or MRI

A

3 is true
1- not transmitted person to person
2- IgG antibody used, not IgM
4- IgG antibodies + CT or MRI

22
Q

primary prophylaxis for TE should be started if

A

IgG + and CD4<100

23
Q

when should primary prophylaxis for TE be stopped (2)

A

when CD4 >200 for 3 months or
CD4 100-200 + HIV RNA undetectable for 3-6mths

24
Q

what is primary prophylaxis for TE

A

TMP-SMX

25
Q

what is used for TE tx

A

pryimethamine, sulfadiazine, leucovorin

26
Q

what is maintenance tx or secondary tx for TE

A

pyrimethamine, sulfadiazine, leucovorin

27
Q

when should secondary tx for TE be started

A

immediately after acute tx

28
Q

when should secondary prophylaxis for TE be stopped

A

when CD4 >200 for 6 months

29
Q

select all that apply to MAC
1. it is caused by a slow growing bacteria
2. is transmitted through inhalation or ingestion
3. 20-40% of people with HIV and advanced immunosuppression in ART error have it
4. onset is rapid and lethal
5. diagnosis requires isolation of MAC in blood cultures
6. colonization anywhere in the body is indicative of disease

A

1, 2, 5
3- for people not on ART
4- onset is slow
6- colonization of resp and GIT is not indicative of disease

30
Q

list 3 sx of MAC

A

Disseminated, multi-organ infection (localized may be seen)
Fever, night sweats, weight loss, fatigue, diarrhea
Localized manifestations (sx vary by site)

31
Q

how long should cultures be watched for MAC?

A

4-6wks- v slow growing

32
Q

when is primary prophylaxis for MAC recommended?
1. if the pt is HIV +, on ART, CD4 <50
2. if the pt is HIV +, not on ART, MAC blood culture negative
3. if the pt is HIV +, not on ART, CD4 <50
4. if the pt is HIV +, on ART, MAC blood culture negative
5. 1+3
6. 2+3

A

6

33
Q

what is the pref primary prophylaxis for MAC

A

azithro or clarithro

34
Q

what is tx and maintenance tx for MAC

A

clarithro or azithro

35
Q

when can secondary prophylaxis for MAC stop (3)
- at least _____ months after tx
- no _________
- CD4 _____ for ______

A

at least 12mths after tx
no s/sx of MAC
CD4 >100 for >6mths

446- ID and transplant (18 decks)

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