Opportunistic Infections in HIV Flashcards
what is IRIS
immune reconstitution inflammatory syndrome- exaggerated reaction to a pathogen when the immune system begins to recover on ARTs
IRIS may ________ or ___________
unmask an undiagnosed infection
worsen a previously tx infection
what type of fungi are OIs
yeasts- candida + cryptococcosis
name 2 OIs
bacterial respiratory disease, cryptococcosis, cytomegalovirus (CMV), candidiasis, mycobacterium avium complex (MAC), mycobacterium tuberculosis (TB), pneumocystis pneumonia (PJP), toxoplasma gondii (Toxo)
when should you start prophylaxing for PCP
CD4<200
when should you start prophylaxing for toxo
CD4 <100
when should you start prophylaxing for MAC
Cd4<50
what is the best protection against OIs
ART
what is a normal CD4 count
500-1500
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
5- needs histopathologic/ cytopathologic demonstration of organisms in tissue
- either by BAL or induced sputum samples
describe the clinical presentation of PJP
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
which OI has symmetrical “ground glass” interstitial infiltrates
PJP
what is the pref tx for PJP
TMP-SMX F 21 d + adj steroids
what safety parameters need to be monitored for PJP tx with TMP-SMX
ARs high compared to pts without HIV (20-85%)- rash (30-55%), SJS, fever, leukopenia, thrombocytopenia, hepatitis, hyperkalemia
Renal dosing
when is used for primary prophylaxis for PJP
TMP-SMA SS 1 tab daily or DS 1 tab daily or 3x/wk
when should secondary prophylaxis for PJP start
ASAP after completion of PJP tx- same as primary prophylaxis = TMP-SMX
when should primary and secondary prophylaxis for PJP be stopped
when pt is on ART and experiences immune recovery with CD4 >200 for 3 months
toxoplasmic encephalitis is caused by
1. yeast
2. protozoan
3. mold
4. bacteria
5. virus
2
TE occurs due to ____________
reactivation of latent tissue cysts
primary infection of TE happens after ______ or ________
eating undercooked meat or oocytes shed in cat feces
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
3 is true
1- not transmitted person to person
2- IgG antibody used, not IgM
4- IgG antibodies + CT or MRI
primary prophylaxis for TE should be started if
IgG + and CD4<100
when should primary prophylaxis for TE be stopped (2)
when CD4 >200 for 3 months or
CD4 100-200 + HIV RNA undetectable for 3-6mths
what is primary prophylaxis for TE
TMP-SMX
what is used for TE tx
pryimethamine, sulfadiazine, leucovorin
what is maintenance tx or secondary tx for TE
pyrimethamine, sulfadiazine, leucovorin
when should secondary tx for TE be started
immediately after acute tx
when should secondary prophylaxis for TE be stopped
when CD4 >200 for 6 months
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
1, 2, 5
3- for people not on ART
4- onset is slow
6- colonization of resp and GIT is not indicative of disease
list 3 sx of MAC
Disseminated, multi-organ infection (localized may be seen)
Fever, night sweats, weight loss, fatigue, diarrhea
Localized manifestations (sx vary by site)
how long should cultures be watched for MAC?
4-6wks- v slow growing
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
6
what is the pref primary prophylaxis for MAC
azithro or clarithro
what is tx and maintenance tx for MAC
clarithro or azithro
when can secondary prophylaxis for MAC stop (3)
- at least _____ months after tx
- no _________
- CD4 _____ for ______
at least 12mths after tx
no s/sx of MAC
CD4 >100 for >6mths
