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29 Cards in this Set
- Front
- Back
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describe PCP
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-Most common life-threatening OI in AIDS patients
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risk is greater in PCP when
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CD4 <200
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Sx of PCP
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Subacute: fever, dyspnea, tachypnea, non- to mildly productive cough
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CX of PCP shows
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interstitial, bilateral infiltrates
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ABG of PCP shows
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mild-severe hypoxia
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Identification of PCP
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organisms or spores in sputum or bronchoalveloar lavage (BAL)
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1st line Tx of PCP
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TMP/SMX
DS tabs = 160/800 mg 15-20 mg/kg/d TMP divided q6-8h x 21 days |
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ADRs of SMX/TMP
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rash
leukopenia LFTs HYPERKALEMIA TCP |
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because HIV pts tend to be more allergic to sulfas, a 2nd line Tx of PCP is
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pentamidine 4 mg/kg/d IV x 21 days
but also has many ADRs |
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adjunctive therapy for PCP
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prednisone x 21 days w/ moderate to severe disease
-PaO2 <70 mmHg (death!) -A-a gradient > 35 mmHg |
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when to use PCP prophylaxis
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1' - CD4 <200 (oral candidiasis)
2' - after having had PCP before |
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PCP Px regimens (1st line)
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TMP/SMX 1 DS QD
TMP/SMX 1 DS TIW, 1 SS QD |
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PCP Px regimnes (second line)
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dapsone, aerosolized pentamidine, atovaquone
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when to DC PCP Px with HAART
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-CD4 >200 x 3-6 months AND
-undetectable VL x 3-6 months |
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describe Mycobacterium avium complex
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-organism in soil, water
-same genus as TB |
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risk of MAC is greater if
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CD4 <100 (<50)
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Tx of MAC
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Minimum of 2 drugs
-clarithromycin 500 mg po BID -ethambutol 15 mg/kg/d po -+/- rifabutin 300 mg QD |
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duration of treatment of MAC
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lifelong suppression
can D/C rifabutin after initial suppression |
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when to start Px of MAC
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Start if CD4 <50
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Px regimens of MAC
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-azithromycin 1200 mg QW
-clarithromycin 500 mg BID |
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D/C Px of MAC w/ HAART if
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-CD4 >100 x 3-6 months AND
-undetectable VL x 3-6 months |
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restart Px of MAC w/ HAART if
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CD4 <50
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describe CMV
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-common in 60-70% of US
-minimal Sx in normal hosts (mononucleosis) -may become latent following acute infection, and subject to reactivation |
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risk of CMV increases if
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CD4 <100
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Sx of CMV
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Retinitis
-painless progressive vision loss -eyes affected only in HIV GI – ulceration, diarrhea |
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Tx of CMV (first line)
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ganciclovir
-daily IV induction therapy -daily maintenance -eventually can be BIW Oral prodrug = valganciclovir |
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ADRs of ganciclovir
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neutropenia
thrombocytopenia |
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Tx of CMV (second line)
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-ocular implants
-foscarnet -cidofovir |
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Px of CMV
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none, due to toxicity and resistance of drugs
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