opportunistic infections in AIDS - dr sing

what is an opportunistic infection?

infections that are more frequent or more severe because of HIV-mediated immunosuppression

what is the CD4 count threshold for PCP and candidiasis?

< 200

what is the CD4 count threshold for MAC?

< 50

what is the CD4 count threshold for toxoplasma encephalitis?

< 100

what opportunistic infection is widespread throughout the body?

MAC

what part of the body is most commonly affected by CMV?

eyes!!!

oropharyngeal candidiasis is characterized by _______

painless, creamy white, plaque-like lesions in mouth

esophageal candidiasis is characterized by ________

retrosternal burning pain or discomfort

odynophagia

toxoplasma encephalitis is characterized by _______

headache

neurologic deficits

fever

seizures

when should people with HIV/AIDS NOT get live vaccines?

CD4 < 200

should HIV/AIDS pts get a live influenza vaccine?

NO

who is a candidate for PCP prophylaxis?

what is the preferred prophylaxis regimen for PCP?

candidates: CD4 100-200 if plasma HIV RNA level is above detection limits OR CD4 count < 100

regimen: bactrim 1 DS PO QD — bactrim 1 SS PO QD

when should you stop PCP prophylaxis?

CD4 incr. from < 200 to ≥ 200 for ≥ 3 months

CD4 count 100-200 if viral load undetectable for ≥ 3-6 months

who should NOT get prophylaxis for MAC?

what are the preferred agents?

anyone immediately initiating ART

azithromycin, clarithromycin, or azithromycin

who is a candidate for MAC prophylaxis?

when should you stop it?

candidates: CD4 < 50 and NOT receiving ART

stop: initiation of fully suppressive ART

is primary prophylaxis recommended for CMV?

how can you prevent it?

NO

prevention: ART, maintain CD4 > 100

is primary prophylaxis recommended for candidiasis?

how can you prevent it?

NO — can lead to drug resistant candida

prevention: ART and immune restoration

who is a candidate for toxoplasma encephalitis prophylaxis?

what is the preferred prophylaxis regimen for toxoplasma encephalitis?

candidate: CD4 < 100 with positive toxoplasma IgG

regimen: bactrim 1 DS PO QD

when do you stop toxoplasma encephalitis prophylaxis?

CD4 > 200 for > 3 months and sustained HIV RNA below limits of detection

CD4 100-200 and HIV RNA below limits of detection for 3-6 months

what is the preferred treatment regimen for mild-moderate PCP?

bactrim PO in 3 divided doses for 21 days

bactrim DS 2 tablets PO TID for 21 days

what is the preferred treatment regimen for moderate-severe PCP?

bactrim IV divided Q6H or Q8H for 21 days

when is chronic maintenance therapy indicated for PCP?

PCP diagnosed when CD4 count ≥ 200 while on ART

what are the preferred treatment regimens for MAC?

at least 2 drugs to prevent/delay resistance

-clarithromycin + ethambutol for 12 months

-azithromycin + ethambutol for 12 months

what are the preferred treatment regimens for CMV retinitis?

remember it is acute treatment followed by chronic maintenance therapy

valganciclovir PO for 14-21 days (minimum)

ganciclovir IV followed by valganciclovir PO for 14-21 days

when can chronic maintenance therapy for CMV retinitis be stopped?

needs tx for at least 3-6 months until ART has induced immune recovery: CD4 > 100 for ≥ 3 months

what is the preferred treatment regimen for candidiasis?

duration for oropharyngeal?

duration for esophageal?

fluconazole

oropharyngeal: 7-14 days

esophageal: 14-21 days

what is the preferred treatment regimen for toxoplasma encephalitis?

pyrimethamine + sulfadiazine + leucovorin PO

or

bactrim IV or PO BID

for at least 6 weeks

why is leucovorin used as part of the tx regimen for toxoplasma encephalitis?

reduces risk of developing hematologic toxicities from pyrimethamine therapy