Respiratory Disorders In HIV Flashcards
Effect of ART has greatest reductions in these opportunistic infections
- EPTB
- PTB
- PCP
Highest incidence of pneumonia in this age group
First 6 months of life
Common pathogens in bacterial pneumonia
S. pneumoniae
S. aureus
H. influenzae
E. coli
Salmonella
B. pertussis
First-line antibiotics for bacterial pneumonia
Ampicillin + gentamicin OR ceftriaxone
Cotrimoxazole
When to reimmunize with PCV for HIV-infected who are not on ART
After 3-5 years
Cotrimoxazole prophylaxis after at least 2 years on ART protects against:
Pneumonia
Malaria
Sepsis
Meningitis
4-6 weeks to 12 months: all
1-5 yo: CD4 <500 or 15%
5+ yo: CD4 <200 or 15%
HIV and TB association
HIV predisposes to TB
TB worsens immunosuppression and hastens progression to AIDS
Positive PPD measurement in HIV
5 mm
IGRA is more sensitive and specific
First-like investigation to replace smear microscopy as initial diagnostic test
Xpert - rapid diagnosis of TB and rifampicin resistance
Empiric treatment of TB
2HRZE 4HR, may be increased to 9 months
CS if endobronchial, tapered over 6-8 weeks
Interactions between ART and TB meds
Rifampicin - induces cytochrome P450, not compatible with PI and NNRTI
>3 yo: 2 NRTI + 1 NNRTI (efavirenz)
<3 yo: 2 NRTI + 1 NNRTI (nevirapine)
Alternative: ritonavir + lopinavir/ritonavir
When to start ART
<5 yo: all, within 8 weeks of TB treatment
CD4 < 750 or 25%, stage 3 or 4: within 2 weeks
> 5 yo: all, prioritize CD4 < 350, stage 3 or 4
Defer for 2 weeks if with mild immunosuppression (IRIS risk)
MDR TB treatment
Minimum of 3 drugs to which organism is susceptible
Streptomycin, cycloserine, ethionamide may be substituted for ethambutol
2nd line: clarithromycin, azithromycin, ciprofloxacin
At least 12 months
Duration of primary INH prophylaxis
Up to 3 years in high TB prevalence areas
Duration of secondary prophylaxis
6-9 months following exposure once TB disease ruled out
If INH-resistant, give rifampicin
If MDR, give 2 drugs
Most common NTM
MAC (localized or disseminated)
Prophylaxis for disseminated MAC
Minimum of 2 agents
Discontinued in children older than 2 years who are stable on ART for 6 months
Treatment for MAC
Should include either azithromycin or clarithromycin with ethambutol as 2nd drug
If disseminated, add 3rd or 4th drug (clofazamine, ciprofloxacin, amikacin, rifampin, refabutin)
When to give ART?
2 weeks after starting anti-mycobacterial therapy to avoid IRIS
Most common viral pathogen
RSV, may shed up to 90 days
Clinical presentation of NTM
- Localized - cervical adenitis, pneumonitis, hepatic dysfunction, abscess
- Disseminated
Treatment for varicella in HIV
Acyclovir or valacyclovir
PostEP: VZIG/VariZIG within 96 hrs
Treatment for influenza in HIV
Oseltamivir for 5 days (within 72 hrs)
Histologic findings of CMV
Cytomegaly of macrophages, type II pneumocytes, epithelial cells
Nuclear and cytoplasmic inclusions
