General OIs Flashcards
(9 cards)
PML Tx
HIV - ART - but beware of IRIS in which case steroids are warranted
Non-HIV:
●Checkpoint inhibitors – The immune checkpoint inhibitors nivolumab and pembrolizumab are monoclonal antibodies that target programmed cell death protein 1 (PD-1), an inhibitory T-cell surface receptor that promotes self-tolerance and is a marker of immune exhaustion. Upon binding with its ligand, PD-1 inhibits T-cell proliferation and cytokine production. Pembrolizumab and nivolumab block this inhibitory reaction and have been used to reinvigorate antitumoral T-cell activity.
- Cidofovir - unclear benefit and data packing
- Viral specific T cells
HHV8 clinical syndromes
Children – In some immunocompetent children, primary HHV-8 infection may be associated with fever and a maculopapular rash.
Kaposi sarcoma — Kaposi sarcoma (KS) is a multifocal angioproliferative tumor with four epidemiologic forms: Classic KS, endemic or African KS, AIDS-related KS, and organ transplant-associated
Multicentric Castleman disease — HHV-8 is the etiologic agent of a plasmablastic form of MCD that is most common in the setting of HIV but can also arise in transplant recipients and in other patients without HIV [66]. HHV-8 associated MCD is a polyclonal B cell disorder characterized clinically by intermittent flares of inflammatory symptoms and signs, including fevers, night sweats, fatigue, and cachexia, and edema, together with lymphadenopathy and hepatosplenomegaly. Common laboratory abnormalities include anemia, thrombocytopenia, hypoalbuminemia, hyponatremia, and elevated inflammatory markers, most notably C-reactive protein (CRP)
HHV-8 (Kaposi sarcoma) inflammatory cytokine syndrome (KICS) — HHV-8/Kaposi sarcoma inflammatory cytokine syndrome (KICS) is a syndrome characterized by severe inflammatory symptoms and elevated HHV-8 viremia [6,7]. The clinical manifestations are similar to those of MCD, and include fevers, night sweats, fatigue, and cachexia, and edema. Hepatosplenomegaly is common whereas lymphadenopathy is not [7]. Laboratory abnormalities include anemia, thrombocytopenia, hypoalbuminemia, hyponatremia, and elevated inflammatory markers including C-reactive protein
Primary effusion lymphoma (PEL) — PEL is a rare variant of B-cell non-Hodgkin lymphoma (NHL) notable for its unusual presentation and aggressive clinical course [68,69]. The great majority of reported cases occur in people with HIV, although it may also be seen following solid organ transplantation, in older adults, and in chronic hepatitis C virus infection [70]. PEL usually presents as a lymphomatous effusion in serous body cavities, with pleural involvement seen in 60 to 90 percent of patients, followed by involvement of other body cavity membranes, including peritoneal (30 to 60 percent), pericardial (up to 30 percent), joint spaces, and rarely meninges
CD4 200-500 infections
Lymphadenopathy
Thrombocytopenia
Oral hairy luekoplakia
Zoster
Oral candidiasis
Cervical dysplasia
Recurrent pneumonia
TB
Kaposi’s
CD4 100-200 infections
Oesophageal candida
PJP
Lymphoma
Persistent HSV
Cerebral Toxo
Crypto
HIV encephalopathy
Histo
CD4 < 100 infections
PML
Crypto
CMV retinitis
MAC
CMV retinitis Tx and secondary prophylaxis
2-4 weeks oral valgan
Maintanence until HIV VL <50, CD4 > 100
CMV retinitis eye zones
Zone 1 - around macula - needs Implant or intravitreal GCV
HIV & HPV incidence
Subtypes 16 & 18 - 70% cervical Ca
Subtypes 6 & 11 - 90% Genital HOV
CIN 5 times higher in HIV & HPV
Poor prognosis in Crypto meningitis
- BC positivity
- WCC < 20 in CSF
- CSF Ag > 1:1024
- Confusion
- Raised ICP
