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21 Cards in this Set
- Front
- Back
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Primary prophylaxis
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Prevention of the first episode of disease - reduced the incidence of transmission (e.g., fewer people become HIV infected)
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Secondary prophylaxis
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Reduces the prevalence and severity of the disease through early detection and prompt intervention (e.g, fewer HIV positive people progress to AIDS)
Patient previously developed OI -Treated aggressively -Maintenance therapy -Prevention from developing "full blown" again |
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When to start primary prophylaxis?
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CD4 <200 (PCP)
CD4 < 100 (toxo) CD4 <50 (MAC) |
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Oropharyngeal Candidiasis (OPC) - Symptoms
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"Thrush"
Creamy white, painless plaques on buccal, pharyngeal mucosa or tongue surface OR Erythematous patches without white plagues on anterior or posterior upper palate or diffuse on tongue (less common) Angular chelosis (occassionaly) |
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Oropharyngeal Candidiasis (OPC) - Treatment
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Length of therapy: 7-14 days
Preferred: Fluconazole (Diflucan) 100 mg PO daily Chronic suppression: Fluconazole 100 mg PO TIW |
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Esophageal Candidiasis (EC) - Symptoms
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AIDS - defining illness
Retrosternal burning pain/discomfort Odynophagia Occasionally asymptomatic |
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Espphageal Candidiasis (EC) - Treatment
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Length of therapy: 14 - 21 days
Preferred: Fluconazole 100 mg (up to 400 mg) PO or IV daily Chronic suppression: Fluconazole 100-200 mg PO daily |
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Vulvovaginitis - Symptoms
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May appear similar to STDs - common among healthy women
White adherent vaginal discharge Mucosal burning/itching might be more severe and more frequent |
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Vulvovaginitis - Treatment
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Fluconazole 150 mg PO (1 dose) or
Topical azoles for 3-7 days Chronic suppression: Fluconazole 150 mg PO weekly |
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Pneumocystis jiroveci pneumonia (PCP) - Symptoms
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Most common, dangerous OI
CD4 <200 Dyspnea Nonproductive cough CXR - bilateral infiltrates PaO2 <70 mmHg Fever, chills, sweats, cough, fatigue r/o bacterial pneumonia |
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PCP prophylaxis
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Start in HIV pt with CD4 <200, fever >100 or thrush
Preferred: 1 SMX/TMP DS (or SS) tab daily Alternative: 1 SMX/TMP DS PO TIW |
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PCP - Treatment
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Length of therapy: High dose IV/PO SMX/TMP for 21 days
15 - 20 mg/kg TMP per day divided into Q6H Significant hypoxia (PaO2 <70 mmg) - corticosteroids for 21 days |
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Toxoplasmosis gondii (toxo) - Symptoms
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Can cause CNS infection (encephalitis): TE
HA Confusion Fever Motor weakness |
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Toxoplasmosis gondii (toxo) - Prophylaxis
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CD4 <100
Preferred: SMX/TMP 1 DS PO daily |
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Toxoplasmosis gondii (toxo) - Treatment
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Length of therapy: 6 weeks
Preferred: sulfadiazine IV (wt based) + pyrimethamine PO (wt based) + leucovorin PO |
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Mycobacterium Avium Complex (MAC) - Symptoms
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Co-infection is a consideration
Weight loss Persistent fevers Night sweats Diarrhea, fatigue, wasting |
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Mycobacterium Avium Complex (MAC) - Prophylaxis
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CD4 <50
Preferred: clarithromycin (Biaxin) 500 mg PO BID OR Azithromycin (Zithromax) 1200 mg PO once a week (two 600 mg tabs) or 600 mg PO twice weekly |
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Mycobacterium Avium Complex (MAC) - Treatment
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Aggressive and treat for life!
Preferred (at least 2 drugs): Clarithromycin 500 mg PO BID + Ethambutol 15 mg/kg PO daily (Addition of rifabutin may be considered - 300 mg PO daily) |
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Cytomegalovirus (CMV) - Symptoms
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Major cause of blindness in AIDS pts
Fluffy white "floater" or flashes CD4 <100 Progress to retinal necrosis and loss of vision |
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Cytomegalovirus (CMV) - Treatment (Induction)
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Ganciclovir:
-Brand: Cytovene 5 mg/kg IV BID 14-21 days OR -Prodrug: Valcyte (valgangciclovir) 900 mg PO BID x 21 days |
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Cytomegalovirus (CMV) - Treatment (maintenance)
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Ganciclovir IV 5 mg/kg daily or
Valganciclovir (Valcyte) 900 mg PO daily |
