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46 Cards in this Set

  • Front
  • Back
how does immune reconstitution inflammatory syndrome occur
if you have an OI and are on HIV therapy it will increase CD4 count and illicit a strong immunologic response which makes outcomes worse
under what circumstances would you treat the OI before HAART
MAC
cryptococcal meningitis
TB
prevent infection by starting drug prophylaxis before pt gets disease

primary or secondary prophylaxis
primary
continuation of therapy after pt has completed treatment of active disease

primary or secondary
secondary
what OI do you not start primary prophylaxis for
crytococcus
CMV
mucocutaneous candidiasis
when do you D/C prophylaxis in PCP, TOXO, MAC
PCP CD4 > 200
TOXO CD4 > 200
MAC CD4 >100
when do you start prophylaxis in PCP, TOXO, MAC and what drug do you use for each
PCP CD4 < 200 Bactrim
TOXO CD4 < 100 Bactrim
MAC CD4 < 50 Azithromycin or Clarithromycin
at what CD4 does PCP occur
CD4 < 200
how long is the treatment duration for PCP and what is the primary drug used to treat
duration - 21 days
primary drug - bactrim
if a pt has PCP and has pO2 < 70 what do you do
add on steroids 72 hrs after initiation of PCP therapy and taper over 21 days
what drug for PCP do you need to check for G6PD deficiency and hwat happens if the pt does have said deficiency
check for deficiency in pt on Dapsone

if pt given this drug and has deficiency will experience hemolytic anemia
other than Bactrim what else can be used to prophylaxis in PCP
atovaquone
dapsone
aerosolized pentamidine
if pt has started HAART therapy and CD4 > 200 for > 3 months can you stop the prophylaxis
yes
what is the presentation of PCP
chest x ray showing diffuse billateral interstitial infiltrates
fever, productive cough, severe hypoxia (pO2 <70)
what OI are ring enhancing lesions indicative of
toxoplasma
where is toxoplasma found in
raw/under cooked meat
cat litter
what CD4 does toxoplasmosis occur
CD4 < 100
what is the presentation for Toxoplasma
seizures, altered mental status, motor weakness, confusion
what is the diagnosis for Toxoplasma
ring enhancing lesions by CT w/ contrast or MRI
positive toxoplasma IgG
what is the treatment of choice for Toxoplasma
sulfadiazine + pyrimethamine + leucovorin
how long is treatment for toxoplasma
6 weeks
what is used as primary prophylaxis for toxoplasma
Bactrim
what causes toxoplasma
protozoan
what CD4 does cryptococcus begin
CD4 < 50
what are the Ssx of cryptococcus
meningitis signs: neck rigidity, photophobia, pneumonia, disseminated infection
what is the treatment for cryptococcus induction and for how long
amphotericin B, flucytosine

2 weeks
what is the treatment for cryptococcus consolidation and for how long
fluconazole

8 weeks
what is the treatment for cryptococcus maintenance and for how long
fluconazole

> 6 months
what is the treatment for cryptococcus meningitis
amphotericin B + flucytosine
at what CD4 does CMV occur
CD4 < 50
when do you tx CMV
if end organ disease
how does CMV present
retinitis - blurry vission that can progress to both eyes if left untreated for 10-21 days
what is the treatment for CMV
severe: ganciclovir intraocular implant + PO valganciclovir
how long is treatment of CMV
until CD4 > 100 for > 3-6 months
what must be done if you treat a pt with cidofovir
saline hydration before and after each treatment
if sulfa allergy can't use regimen (due to probenecid which must be given and is the sorce of the sulfa allergy)
at what CD4 does MAC occur
CD4 < 50
what is the primary cause of MAC
M avium
what are the SSX of MAC
splenomegally
hepatosplenomegally
lymphadenopathy
night sweats
weight loss
how long is tx for MAC
12 months
what is the preferred treatment for MAC
clarithromycin + ethambutol
what drug is used for prophylaxis for MAC
azithromycin or clarithromycin
when can you stop prophylaxis in mAC
CD4 > 100 for > 3 months
what CD4 does Candidiasis occur
CD4 < 200
what are symptoms of candidiasis
creamy, white plaques, mucosa ulcerations
what is the treatment for candidiasis
fluconazole 7-14 days oropharyngeal

14-21 days esophageal
when can you D/C prophylaxis in candidiasis
CD4 > 200