HIV - Opportunistic Infections and Coinfections

Question 1

Why are usually-harmless pathogens able to make HIV sufferers ill?

Answer 1

Because pts w/ HIV have reduced CD4+ counts and hence weakened immune systems (i.e. they’re “opportunistic”)

Question 2

What can cytomegalovirus retinitis infections result in?

Answer 2

Blindness

Question 3

Cornerstone tx for cytomegalovirus in HIV pts?

Answer 3

ART

Question 4

When would HIV ART begin for pts w/ CMV retinitis? Why?

Answer 4

2 weeks after CMV tx > to prevent further inflammation due to the virus (form of IRIS)

Question 5

What is IRIS?

Answer 5

It’s when a pt’s pre-existing infectious dz process worsens following ART

Question 6

When is IRIS usually worse?

Answer 6

When pts have lower CD4+ counts

Question 7

T or F: If an HIV pt is prone to suffering from IRIS, ART should be started right away

Answer 7

F

It should be delayed somewhat, and started slowly

Question 8

How should TB be tx’ed in HIV+ pts?

Answer 8

Tx the TB with normal TB drugs > delay tx of HIV w/ ART > tx w/ ART (2 or 8 weeks post-TB tx initiation, depending on CD4 count) (the is done to avoid IRIS)

Question 9

When does mycobacterium avium complex (MAC) tend to appear in an HIV pt?

Answer 9

When their CD4 declines below 50

Question 10

Tx options for MAC in HIV pts?

Answer 10

clarithro or azithromycin

Question 11

Why would MAC be prophylaxed in HIV pts?

Answer 11

Because MAC is acquired rather than reactivated

Question 12

What is used for MAC prophylaxis for HIV pts?

Answer 12

clarithro or azithromycin

Question 13

Toxoplasmosis tx for HIV pts?

Answer 13

Sulfadiazine, pyremethamine, and leucovorin

Question 14

When should HIV pts receive prophylaxis for toxoplasmosis?

Answer 14

when their CD4 drops below 100 cells/mm^3

Question 15

What drug is used in HIV+ pts for prophylaxis for toxoplasmosis?

Answer 15

TMP/SMX

Question 16

Most common opportunistic infection in AIDS pts?

Answer 16

PCP pneumonia

Question 17

Tx for PCP pneumonia in HIV pts?

Answer 17

SMX/TMP

Question 18

When should HIV pts receive prophylaxis for PCP pneumonia?

Answer 18

When their CD4 drops below 200 cells/mm^3

Question 19

Common STI coinfection w/ HIV?

Answer 19

HSV

Question 20

Tx of HSV in HIV+ pts?

Answer 20

valacyclovir

Question 21

When is an HIV+ pt likely to have HSV episodes?

Answer 21

When their CD4 levels are low

Question 22

Most common opportunistic infection in HIV+ individuals?

Answer 22

Oral thrush (candidia thrush)

Question 23

T or F: Oral thrush can happen at ANY CD4 level in HIV+ pts.

Answer 23

T (but it’s more common when CD4 < 200)

Question 24

Tx for oral candidiasis in HIV pts?

Answer 24

Systemic antifungals (fluconazole, itraconazole, posaconazole [for tx failure])

Question 25

T or F: Topical nystatin is preferred for cases of oral thrush in HIV+ pts.

Answer 25

F (systemics preferred)

Question 26

T or F: There’s double coverage for toxoplasmosis and PCP pneumonia when using SMX/TMP DS prophylaxis.

Answer 26

T