Opportunistic Infections & HIV + Drugs (Class/Brand/Generic) Flashcards
(68 cards)
Name the 5 immunocompromised states.
1) HIV with a CD4 T-lymphocyte count < 200
2) Use of systemic steroids for 14 days or longer at a prednisone dose >20mg/d or > 2mg/kg/d
3) Asplenia
4) Use of immunosuppressants
5) Use of cancer chemotherapy agents esp. with severe neutropenia (ANC < 500)
Common opportunistic infections requiring primary prophylaxis include:
1) Pneumocystis jirovecii pneumonia (PJP or PCP)
2) Toxoplasmosis gondii encephalitis
3) Mycobacterium avium complex (MAC)
Common opportunistic infection that occurs in patients at a higher risk but prophylaxis is NOT recommended:
Candida infections in the mouth/esophagus “thrush”
Primary Prophylaxis Regimens in HIV:
Pneumocystis jirovecii pneumonia (PJP or PCP)
Criteria for Starting: CD4 < 200 cells/mm^3
Criteria for Discontinuing: CD4 >200 x > 3 months on ART
DOC: SMX/TMP DS or SS daily
Alternatives:
1) Dapsone or
2) Dapsone + Pyrimethamine + Leucovorin or
3) Atovaquone
Primary Prophylaxis Regimens in HIV:
Toxoplasmosis gondii encephalitis
Criteria for Starting: CD4 < 100 cells/mm^3
Criteria for Discontinuing: CD4 >200 x > 3 months on ART
DOC: SMX/TMP DS PO daily
Alternatives:
1) Dapsone + Pyrimethamine + Leucovorin or
2) Atovaquone
Primary Prophylaxis Regimens in HIV:
Mycobacterium avium complex (MAC)
Criteria for Starting:
1) Not recommended if ART is started STAT
2) If not taking ART and CD4 < 50 cells/mm^3
Criteria for Discontinuing: Taking fully suppressive ART
DOC: Azithromycin 1,200 mg PO weekly
Selection of alternative regimens in HIV (prophylaxis or treatment) depends on patient-specific factors:
- —options for PCP in the setting of a sulfa allergy—
- atovaquone *dapsone *pentamidine
- —options for G6PD deficiency—–
- atovaquone and *pentamidine
—-Leucovorin is added to all pyrimethamine-containing regimens as rescue therapy to reduce the risk of drug-induced myelosuppression—–
Secondary prophylaxis is initiated after initial treatment for what purpose?
Given to prevent recurrent of the infection regardless of the cause of immunosuppression
Treatment of OIs: Candidiasis
Appearance: white film in mouth/throat
DOC: Fluconazole
Alternative: Itraconazole
2ndary: NOT recommended
**thrush in HIV is treated with systemic steroids not local (nystatin, clotrimazole or miconazole)
Treatment of OIs: Cryptococcal meningitis
DOC: Amphotericin B (deoxycholate or liposomal) + flucytosine
Alt: Fluconazole +/- flucytosine
Treatment of OIs: Cytomegalovirus (CMV)
DOC: Valganciclovir or Ganciclovir
Alt: foscarnet or cidofovir (if toxicities to ganciclovir or resistant strains)
Treatment of OIs: Mycobacterium avium complex (MAC)
DOC: (Clarithromycin or azithromycin) + ethambutol
Treatment of OIs: PCP/PJP
DOC: Bactrim x 21 days +/ prednisone or methylpred
Alt: Atovaquone or Pentamidine IV
Treatment of OIs: Toxoplasmosis gondii encephalitis
DOC: Pyrimethamine + Leucovorin + sulfadiazine
Alt: Bactrim
All of the following diease-treatment pairs are correct EXCEPT:
- Mycobacterium avium complex - clarithromycin + ethambutol
- Oropharyngeal candidiasis - itraconazole
- Cytomegalovirus - ganciclovir
- Cryptococcal meningitis - liposomal amphotericin B + foscarnet
- Pneumocystis pneumonia - IV pentamidine
4
Cryptococcal meningitis - amphotericin (liposomal or conventional) + flucytosine
What is the DOC for PCP & Toxoplasma prophylaxis?
Bactrim DS daily
What drug is used for MAC prophylaxis?
Azithromycin 1200 mg weekly
When should Bactrim DS for primary prophylaxis of PCP be discontinued?
When CD4 > 200 for > 3 months on ART
DOC when CD4 < 50; indicates that patient needs prophylaxis due to which OI?
DOC: Azithromycin 1200mg PO weekly
OI: Mycobacterium avium complex (MAC)
An HIV-positive patient with a history of a poor medication adherence has a CD4 Count < 50. He develops CMV. What drug is used as first-line therapy for CMV?
Valganciclovir (Valcyte)
What is the preferred treatment of Toxoplasma gondii encephalitis?
Pyrimethamine + Leucovorin + Sulfadiazine
TGE - PLS (To go extra please!)
A patient has a CD4 count of 93 and a positive toxoplasma IgG. What OIs should he receive prophylaxis for at this time?
PCP (<200) and Toxoplasma (<100)
PS is an immunocompromised transplant patient who requires a medication to prevent PCP. She reports an itchy rash when taking Bactrim. What is an alternative?
Dapsone or atovaquone
CV is a 39 yoM with HIV and CMV. His response was poor and additional viral testing shows the development of resistance to valganciclovir. What alternatives would be expected to have activity in this case?
Foscarnet or cidofovir
