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Kendig > Respiratory Disorders In HIV > Flashcards

Respiratory Disorders In HIV Flashcards

1
Q

Effect of ART has greatest reductions in these opportunistic infections

A
  1. EPTB
  2. PTB
  3. PCP
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2
Q

Highest incidence of pneumonia in this age group

A

First 6 months of life

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3
Q

Common pathogens in bacterial pneumonia

A

S. pneumoniae
S. aureus
H. influenzae
E. coli
Salmonella
B. pertussis

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4
Q

First-line antibiotics for bacterial pneumonia

A

Ampicillin + gentamicin OR ceftriaxone
Cotrimoxazole

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5
Q

When to reimmunize with PCV for HIV-infected who are not on ART

A

After 3-5 years

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6
Q

Cotrimoxazole prophylaxis after at least 2 years on ART protects against:

A

Pneumonia
Malaria
Sepsis
Meningitis

4-6 weeks to 12 months: all
1-5 yo: CD4 <500 or 15%
5+ yo: CD4 <200 or 15%

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7
Q

HIV and TB association

A

HIV predisposes to TB
TB worsens immunosuppression and hastens progression to AIDS

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8
Q

Positive PPD measurement in HIV

A

5 mm
IGRA is more sensitive and specific

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9
Q

First-like investigation to replace smear microscopy as initial diagnostic test

A

Xpert - rapid diagnosis of TB and rifampicin resistance

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10
Q

Empiric treatment of TB

A

2HRZE 4HR, may be increased to 9 months
CS if endobronchial, tapered over 6-8 weeks

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11
Q

Interactions between ART and TB meds

A

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

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12
Q

When to start ART

A

<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)

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13
Q

MDR TB treatment

A

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

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14
Q

Duration of primary INH prophylaxis

A

Up to 3 years in high TB prevalence areas

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15
Q

Duration of secondary prophylaxis

A

6-9 months following exposure once TB disease ruled out
If INH-resistant, give rifampicin
If MDR, give 2 drugs

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16
Q

Most common NTM

A

MAC (localized or disseminated)

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17
Q

Prophylaxis for disseminated MAC

A

Minimum of 2 agents
Discontinued in children older than 2 years who are stable on ART for 6 months

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18
Q

Treatment for MAC

A

Should include either azithromycin or clarithromycin with ethambutol as 2nd drug
If disseminated, add 3rd or 4th drug (clofazamine, ciprofloxacin, amikacin, rifampin, refabutin)

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19
Q

When to give ART?

A

2 weeks after starting anti-mycobacterial therapy to avoid IRIS

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20
Q

Most common viral pathogen

A

RSV, may shed up to 90 days

21
Q

Clinical presentation of NTM

A
  1. Localized - cervical adenitis, pneumonitis, hepatic dysfunction, abscess
  2. Disseminated
22
Q

Treatment for varicella in HIV

A

Acyclovir or valacyclovir
PostEP: VZIG/VariZIG within 96 hrs

23
Q

Treatment for influenza in HIV

A

Oseltamivir for 5 days (within 72 hrs)

24
Q

Histologic findings of CMV

A

Cytomegaly of macrophages, type II pneumocytes, epithelial cells
Nuclear and cytoplasmic inclusions

25
Q

Treatment of CMV

A

Ganciclovir for 6-8 weeks
Shift to oral valganciclovir if improved
Prophylactic valganciclovir for severe immunosuppression

26
Q

Treatment of measles

A

Vitamin A
Passive immunization: IM immunoglobulin within 6 days

27
Q

Histologic findings in PCP

A

Diffuse desquamative alveolitis
Foamy macrophage
Cysts containing sporozoites

28
Q

Most common pathogen in HIV-infected with pneumonia not taking ART

A

PCP
Highest in the first year of life peaks at 3-6 months

29
Q

Strong predictor of PCP

A

high plasma HIV RNA load
Rapid rate of decline of CD4

30
Q

Laboratory findings in PCP

A

High LDH > 1000 usually
Normal WBC, IgG
Hyperinflation, bilateral diffuse opacification, reticulonodular infiltrates in perihilar extending peripherally

31
Q

Treatment for PCP

A

High dose CTX (6-12/30-60) for 21 days
High dose steroid if hypoxemic (PaO2 < 70, AaDO2 > 35)

Alternative:
Pentamidine - pancreatitis, renal dysfunction
Ativaquone
Dapsone + trimethoprim
Trimetrexate + leucovorin
Clindamycin + primaquine

32
Q

Common presentation of cryptococcus

A

Meningitis

33
Q

Often found in oropharynx and esophagus

A

Candida

34
Q

Treatment for fungal infection

A

Amphotericin B + chronic suppressive therapy after infection

Alternatives:
Fluconazole
Itraconazole

35
Q

Chronic lung disease in HIV

A

LIP
Chronic/recurrent infections
Bronchiectasis
BO

36
Q

Most common finding of CLD on CXR

A

Increased bronchovascular markings

37
Q

Age of onset of LIP

A

2.5-3 years old

38
Q

Possible pathophysiology of LIP

A

Lymphoproliferation in response to HIV alone or confection with another virus (EBV)

39
Q

Laboratory findings in LIP

A

Elevated IgG > 2500

40
Q

PE in LIP

A

Cough, tachypnea
Generalized LAD
Hepatosplenomegaly
Clubbing
Parotid gland enlargement

41
Q

Malignant potential of LIP

A

Lymphoma

42
Q

Treatment of LIP

A

Nonspecific
Inhaled bronchodilators
O2
Steroid

43
Q

Most common pulmonary tumor

A

NHL
*KS in Africa

44
Q

Esophagitis pathogens

A

Candida
HSV
CMV

45
Q

Onset of TB IRIS

A

Weeks to months after ART initiation, from unrecognized mycobacteria infection or florid immune response to therapy

46
Q

IRIS manifestation

A

Paradoxical worsening in signs
Increased LAD
New clinical and radiological respiratory signs

47
Q

How to minimize risk for IRIS

A

Start anti-TB drugs 2 weeks before commencing ART
If IRIS develops in a child who was unknown to have TB, start TB meds without stopping ARDS
Corticosteroids if with respiratory distress or LAD

48
Q

PFT in CLD in HIV

A

Obstructive, restrictive, mixed
Decreased FEV1
Reduced DLCO
AHR

Kendig (8 decks)

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