ID-IV: Opportunistic Infections

Question 1

Immunocompromised criteria?

Answer 1

1. HIV with CD4 count <200
2. Systemic steroids for 14 days or longer at a prednisone equivalent dose of ≥20 mg/day or ≥2 mg/kg/day
3. Asplenia
4. Immunosuppresants for autoimmune conditions
5. Cancer chemotherapy, severe neutropenia ANC<500

Question 2

Criteria for starting PCP prophylaxis

Answer 2

CD4 <200 or AIDS defining illness

Question 3

Regimen for PCP prophylaxisis

Answer 3

1st: Bactrim DS or SS QD

Alternative:
- Dapsone
- Dapsone + pyrimethamine + leucovorin
- Atovaquone
- Atovaquone + pyrimethamine + leucovorin

Question 4

When to DC PCP prophylaxis

Answer 4

CD4 >200 for >3 months and remains on ART

Question 5

Criteria for Toxoplasma prophylaxis?

Answer 5

Toxoplasma IgG + and CD4 <100

Question 6

Toxoplasma prophylaxis

Answer 6

1st: Bactrim DS QD

Alt:
- Dapsone + pyrimethamine + leucovorin
- Atovaquone
- Atovaquone + pyrimethamine + leucovorin

Question 7

When to DC Toxoplasma prophylaxis

Answer 7

CD4 >200 for >3 months and remains on ART

Question 8

When to start MAC prophylaxis?

Answer 8

CD4 <50 and not on ART

Question 9

Regimen for MAC prophylaxis

Answer 9

1st: Azithromycin 1.2 g QW

Alt: Clarithromycin 500 mg BID

Question 10

When to DC MAC prophylaxis

Answer 10

Taking fully suppressive ART

Question 11

Candidiasis treatment? Secondary prophylaxis?

Answer 11

1st: Fluconazole
Alt:
- Orophanygeal: Itraconazole, posaconazole, topicals
- Esophageal: Voriconazole, Cresemba, Echinocandin

Secondary prophylaxis is not recommended

Question 12

Cryptococcal meningitis treatment? Secondary prophylaxis?

Answer 12

1st: Amphotericin B (liposomal preferred) + flucytosine
Alt:
- Fluconazole + Flucytosine
- Amphotericin B + fluconazole

Secondary prophylaxis: low dose fluconazole

Question 13

Cytomegalovirus treatment? Secondary prophylaxis?

Answer 13

1st: Valganciclovir, Ganciclovir
Alt: Foscarnet or cidofovir

No secondary prophylaxis

Question 14

MAC treatment? Secondary prophylaxis?

Answer 14

1st: Clarithro or Azithro + ethambutol
Alt: Add 3rd or 4th agents using rifabutin, amikacin, streptomycin, moxifloxacin, levofloxacin

Seoncarday: Azirthromycin 1.2 g QW

Question 15

PJP treatment? Secondary prophylaxis?

Answer 15

1st: Bactrim +/- methylprednisolone or prednisone x 21 days
Alt: pentamidine IV or Clindamycin + primaquine

Seconardy: Bactrim

Question 16

Toxoplasmosis treatment? Secondary prophylaxis?

Answer 16

1st: Pyrimethamine + leucovorin + sulfadiazine
Alt: Clindamycin + pyrimethamine + leucovorin or Bactrim

Secondary: Pyrimethamine + leucovorin + sulfadiazine (lower doses)