Opportunist Inf - HIV

jwendi4's version from 2016-11-27 03:03

Section 1

Question Answer
MACCD4<50, prophylax with 1200mg azithromycin q weekly until cd4>100 >3 months (also can use clarithromycin 500mg/twice a week)
MACTX - clarithromycin 500mg twice weekly + ethambutol (15mg/kg) PO QD, +/- rifabutin 300mg PO QD - for >/= 1 year
MACTX - 12 mo AND until last 6 mo CD4>100
MACfever, night sweats, weight loss, fatigue, diarrhea, abdominal pain

Section 2

Question Answer
PCPCD4<200 - prophylax with Bactrim DS QD until CD4 >200 for >3 mo
PCPdry cough, rales, diffuse bilateral pneumonia
hypoxemiatreat severe pO2<70 - candidate for corticoid steroid therapy
PCPsilver stain sputum sample
PCPalternative prophylaxis - dapsone 50mg PO BID or 100mg po qd, +/- pyrimethamine 50mg PO qweek + leucovorin 35mg PO qweek, OR atovaquone 1500mg PO QD
PCPTx - Bactrim 15-20 mg/kg/d TMP divided doses q6-8h
PCPalt tx - primaquine 15-30mg po qd+ clindamycin 600-900 mgIV q6-8h (or 300-450 mgpo q6-8h)
PCPalt tx - pentamidine 4 mg/kg IV QD (over 60 min)
PCPalt tx - dapsone 100mg PO QD + TMP 15 mg/kg/d in divided doses TID
PCPalt tx - atovaquone 750 mg PO BID (w/food) - not as effective as bactrim
Septra DS160mg of tmp and 80 of smx, iv is 16mg/ml
steroid prednisone 40 mg PO BID days 1-5, 40 mg PO QD days 6-10, 20 mg PO QD days 11-21

Section 3

Question Answer
CryptococcosisCD4<50 - no primary prophylaxis, CrAg, LP
cryptococcosisfever, malaise, headache, neck stiffness, photophobia, meningeal signs, lethargy, altered mental status, nuchal rigidity, seizures
Cryptofatal if not treated
induction (2weeks)lipo ampho B 3-4 mg/kg IV QD+ flucytosine 25 mg/kg PO QID
consolidation (8weeks)fluconazole 400 mg PO or IV QD (6mg/kg)
chronic (1 year & asympto)fluconazole 200 mg PO QD
cryptomay delay starting ART

Section 4

Question Answer
Toxoplasma gondii encephalitis (TE)protozoan
TECNS - cysts in brain
TECD4 <200, esp <50
TEserum antitoxo IgG +, IgM -
CTring in brain
primary prophyIgG+ and CD4<100 with Bactrim DS 1 PO QD until CD4>200 >3mo
prophylaxis altdapsone 50mg PO Qd+ pyrimethamine 50 mg po qweek+ leucovorin 25 mg Po q week
altatovaqoune 1500 mg po qd
TXpyrimethamine 200 mg PO first dose then 50 mg (if <60kg), 75mg (>=60kg) + sulfadiazine 1000mg or 1500mg (depending on wt) + leucovorin 10-25 mg PO qd
2nd prophypyrimethamine 25-50 mg qd + sulfadiazine 2-4 gm qd (divided) + leucovorin 10-25 mg/d
prophylaxuntil CD4>200 >6 mo

Section 5

Question Answer
Cytomegalovirusds DNA virus (herpesevirus fam)
retinitistypically unilateral, floaters, scotomata, visual field defects (or asymptomatic)
colitisfever, wt loss, anorexia, abd, pain, diarrhea, malaise
tx - sight threateningIntravitreal inj of ganciclovir (2mg/inj) or foscarnet (2.4 mg/inj) for 1-4 doses over 7019 d + valganciclovir 900 mg PO (BID for 14-21 d then qd)
txuntil 3-6 mo and CD4>100>3-6 mo