Opportunistic Infxns Flashcards
Pneumocystitis Jirovecii Pneumonia (PJP) - Secondary PTx
- Give to ALL pts after completing Tx course
- Bactrim DS or SS QD or DS MWF
Toxoplasmosis gondii Encephalitis - Primary PTx
- pts who are Toxoplasma IgG (+) w/ CD4<100
- TMP-SMX DS QD
Toxoplasmosis gondii Encephalitis - Acute Infxn
- Pyrimethamine 200 x1dose, then weight based dosing, +Sulfadiazine + Leucovorin
- TMP-SMX 5mg/kg (TMP) IV/PO BID
- ≥ 6 weeks
Vulvovaginal Candidiasis
- Uncomplicated: Fluconazole 200 x1dose or Topical azoles x 3-7 days
- Severe: Fluc PO or topical x ≥7 days
Oropharengeal Candidiasis
- Fluconazole 200mg x 7-14days
- Nystatin Suspension or Clotrimazole Troches x 7-14days
(topical for initial, mild/mod infxns)
MAC Primary PTx
- if CD4<50 AND not on ART, viremic on ART, or no options for a fully suppressive ART regimen
- Azithro 1200 qweekly
- D/C if pt starts ART
Pneumocystitis Jirovecii Pneumonia (PJP) - Moderate-Severe
- TMP-SMX 15-20mg/kg/day (TMP) IV q6-8h x21days
- Sulfa Ax: Primaquine or Pentamidine
- pO2<70: Prednisone x21d
When to D/C or Restart: PJP Secondary PTx
- D/C when CD4 ≥200 for >3mo in response to ART
- Restart if CD4 <100
Pneumocystitis Jirovecii Pneumonia (PJP) - Mild-Moderate
- TMP-SMX 15-20mg/kg/day (TMP) PO divided TID
- TMP-SMX two DS tabs PO TID
Who gets PJP Primary PTx
- Give to ALL pts (HIV-Infected) WITH: CD4 100-200 + HIV RNA above detection OR CD4<100 (regardless of HIV RNA levels)
Pneumocystitis Jirovecii Pneumonia (PJP) - Primary PTx
Bactrim DS or SS QD or DS MWF
IRIS Tx
- Mild: NSAIDS, Inhaled corticosteroids (if bronchospasms)
- Severe: Prednisone taper
When to D/C or Restart: MAC Secondary PTx
- D/C if ≥12 months, No S/Sx of MAC, + >6mo of CD4 >100
- restart if CD4 <100
Toxoplasmosis gondii Encephalitis - Chronic Maintenance
- Pyrimethamine + Sulfadiazine + Leucovorin
- TMP-SMX DS PO BID
- ≥ 6 weeks
Mycobacterium Avium Complex (MAC) Tx
- Clarithromycin 500 BID + Ethambutol 15 mg/kg PO QD
- Azithro 500-600 QD + Ethambutol 15mg/kg PO QD
- If more severe: add Rifabutin
- if more severe/CD4<50: add levo, moxi, amikacin, or strepto
- Tx for ≥12 months
- D/C if CD4>100 for ≥6months
When to D/C: Toxo Primary PTx
- D/C when CD4>200 for >3mo OR CD4 100-200 + HIV RNA undetectable for 3-6mo
What infxns have a concern for IRIS?
- MAC
- PJP
- Toxoplasmosis
Esophageal Candidiasis
- Fluconazole 200mg IV/PO x 14-21days
MAC Secondary PTx
- Same Tx as if treating the infxn (≥12 months)
- Clarithro 500 BID + Ethambutol 15mg/kg +/- Rifabutin
Toxoplasmosis gondii Encephalitis - Secondary PTx
- ALL pts after completion of acute infxn Tx
- Pyrimethamine + Sulfadiazine + Leucovorin OR Bactrim DS TID (same as Chronic Maintenance)
When to D/C or Restart: Toxo Secondary PTx
- D/C when CD4 >200 for >6mo + pt had successful completion w/ initial Tx + pt is ASx
- Restart if CD4 <200
