S49 OI

Question 1

PJP Pneumonia prophylaxis

Answer 1

Indication: CD4 < 200 cells/mm3

Preferred therapy:
SMX – TMP 1 DS PO daily
SMX – TMP 1 SS PO daily

Question 2

PJP Pneumonia treatment

Mild to moderate:

Answer 2

SMX – TMP 5-7mg/kg PO TID x 21d

SMX – TMP 2DS PO TID x 21d

Question 3

PJP Pneumonia treatment

Moderate to severe:

Answer 3

SMX – TMP 15-20mg/kg/day IV q6-8h x 21d

Question 4

SMX – TMP for PJP

Answer 4

Dosed based on TMP component

Question 5

Dapsone for PJP

Answer 5

Requires G6PD testing prior

Question 6

Toxoplasmosis

Transmission:

Answer 6

ingestion of undercooked meat, cat feces, raw shillfish

Greatest risk is CD4 < 100 cells/mm3 if IgG positive

Question 7

Toxoplasmosis Prophylaxis

Indication:

Answer 7

CD4 < 100 cells/mm3

Question 8

Toxoplasmosis Prophylaxis

Preferred therapy:

Answer 8

SMX – TMP 1 DS PO daily

Question 9

Toxoplasmosis Prophylaxis

Treatment:

Answer 9

Three drug regimen:
Pyrimethamine
Sulfadiazine
Leucovorin

Question 10

Pyrimethamine

Answer 10

Only available through special pharmacy programs

Question 11

Sulfadiazine

Answer 11

Take with 8 ounces of water
Can cause methemoglobinemia, blood dyscrasias, pancreatitis, burning or numbness, depression, seizures, dermatologic reactions
Be careful of sulfa allergies and G6PD deficiency

Question 12

Leucovorin

Answer 12

Can be administered IM, IV, or PO
Be careful of infusion rate
Can cause fatigue, alopecia, dermatitis, stomatitis, n/v/d

Question 13

Mycobacterium avium Complex (MAC)

Answer 13

Acid fact bacilli (AFB) in the same genus as Mycobacterium tuberculosis
Ubiquitous in the environment

Question 14

Mycobacterium avium Complex (MAC)

Answer 14

Greatest risk is CD4 < 50 cells/mm3 and not suppressed on ART

Question 15

Mycobacterium avium Complex (MAC)

CD4 count is < 50 cells/mm3 AND not on suppressive ART

Answer 15

True

Question 16

Mycobacterium avium Complex (MAC)

Regimens:

Answer 16

Azithromycin 1200mg PO once weekly (patients usually prefer) OR
Clarithromycin 500mg PO BID

Question 17

Mycobacterium avium Complex (MAC)

Treatment

Answer 17

Clarithromycin 500mg PO twice daily + ethambutol 15 mg/kg PO daily

Question 18

Immune Reconstitution Inflammatory Syndrome (IRIS)

Answer 18

Proinflammatory cytokine cascade over reaction of the immune system to OIs

Question 19

PJP
Prophylaxis
Indication: CD4 < 200
SMX – TMP

Answer 19

True

Question 20

Toxoplasmosis
prohylaxis
Indication: CD4 < 100
SMX – TMP

Answer 20

True

Question 21

Mycobacterium avium Complex (MAC)
prophylaxis
Indication: CD4 < 50 only if not on suppressive ART
Azithromycin

Answer 21

True

Question 22

Immune Reconstitution Inflammatory Syndrome (IRIS)
prophylaxis
Delay ART by ~ 2 weeks of induction

Answer 22

True

Question 23

PJP
Treatment
Mild – Mod: SMX – TMP
Mod – Severe: SMX – TMP and prednisone

Answer 23

True

Question 24

Toxoplasmosis
Treatment
Combination of: pyrimethamine, sulfadiazine, and leucovorin
Potential addition of steroid and anticonvulsants

Answer 24

True

Question 25

Mycobacterium avium Complex (MAC)
Treatment
Clarithromycin + ethambutol

Answer 25

True

Question 26

Immune Reconstitution Inflammatory Syndrome (IRIS)
Treatment
Supportive care

Answer 26

True