Opportunistic infections IV

Question 1

what brings down the immune system?

Answer 1

HIV w/ CD4 count <200
systemic steroids for 14 days or longer
Asplenia
immunosuppressants
cancer chemo

Question 2

primary prophylaxis regimens in HIV
Pneumocystis jirovecii pneumonia (PJP or PCP)

Answer 2

preferred SMX/TMP DS or SS daily

if sulfa allergy alternative:
dapsone or
dapsone + pyrimethamine + leucovorin or
atovaquone
or
atovaquone + pyrimethamine + leucovorin

d/c CD4 >200 for >3 months on ART

Question 3

primary prophylaxis regimens in HIV
toxoplasma gondii encephalitis

Answer 3

SMX/TMP DS daily
alternative: dapsone + pyrimethamine + leucovorin or
atovaquone
or
atovaquone + pyrimethamine + leucovorin

d/c CD4 >200 for >3 months on ART

Question 4

primary prophylaxis regimens in HIV
mycobacterium avium

Answer 4

azithromycin 1,200 mg weekly

d/c taking fully suppressive ART

Question 5

opportunistic infection
candidiasis (trush)

Answer 5

fluconazole

alternative: other azole and depends on the area, so oropharyngeal vs esophageal

Question 6

opportunistic infection
cryptococcal meningitis

Answer 6

amphotericin B + flucytosine

alternative: fluconazole + flucytosine or amphotericin B + fluconazole

Question 7

opportunistic infection
CMV

Answer 7

valganciclovir or ganciclovir

resistant or toxicity: foscarnet or cidofovir

Question 8

opportunistic infection
MAC

Answer 8

(clarithromycin or azithro) + ethambutol

alternative 3rd or 4th agent using rifabutin, amikacin, streptomycin, moxifloxacin. or levo

Question 9

opportunistic infection
PCP, or PJP

Answer 9

SMX/TMP

alternative:
Atovaquone or Pentamidine IV or clinda + primaquinone

Question 10

opportunistic infection
toxoplasmosis gondii

Answer 10

pyrimethamine + leucovorin + sulfadiazine

alternative: SMX/TMP