• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

Card Range To Study



Play button


Play button




Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

47 Cards in this Set

  • Front
  • Back

What are 4 OIs that have no effective therapy?

What do they require? When?

When should it be initiated for TB?

4 opportunistic infections that have no effective therapy:

1. cryptosporidiosis,

2. microsporidiosis

3. promyelocytic leukemia

4. Kaposi sarcoma

These infections require ART initiation w/ in two weeks

For TB; initiate ART when CD4 < 50

How does PCP present?

When does PCP risk increase?


PCP (pneumocystitis jirovecii pnumonia)

i. presents w/ fever, SOB, nonproductive cough

ii. elevated lactate dehydrogenase

iii. diffuse pulmonary infiltrates

iv. hypoxemia

**at risk for PCP if CD4 < 200

For prophylaxis

DOC - Bactrim DS or SS once daily

Alternative - Bactrim DS MWT (3x wk)

DOC for PCP be treatment?


treat for 21 days

Moderate to severe PCP

a. IV Bactrim 15-20 mg/kg/day every 6-8 hrs for 21 days

Mild to Moderate

b. Bactrim DS 2 tabs tid

What are some alternative PCP treatments?

All used for 21 days

a. clindamycin and primaquine

b. pentamidine

c. trimethoprime and dapsone

d. atovaquone

What drug can be used as adjuvant treatment w/ corticosteroids?

corticosteroids for pts w/ sever PCP (A-a gradient of 35 or more; or PO2 of 70 or less); start w/in 72 hours

decreases mortality

When can PCP prophylaxis be stopped?

When CD4 count is > 200 for 3 consecutive months

How are candida infections diagnosed?

S/S of infections

-creamy white, curd like patches on tongue or other oral mucosal surfaces

-pain, decreased food/fluid intake

Fungal culture, potassium hydroxide smear

Endoscopic evaluation

What drugs can be used to treat oral candidiasis?

Treatment duration?

Treatment duration 3-14 days duration, but it relapses w/in 30 days

-indicated for mucous membrane and cutaneous Candida infections

1. Nystatin

-for initial episode in pts w/ CD4 > 50 cells/mm3

2. clotrimazole (alternative to nystatin)

-for initial episode in pts w/ CD4 > 50

-indicated for oropharyngeal and esophageal candidiasis

3. fluconazole

4. intraconazole

When are pts at the highest risk for cryptococcosis infections?

CD4 less than 50 cells/mm3

What are S/S of cryptococcosis infections?

How is cryptococcosis infection diagnosed?

a. almost always meningitis

b. usually present for weeks or months (average 31 days)

c. insidious onset

i. low grade fever

ii. headaches

iii. altered sensorium, irritability, somnolence, clumsiness, impaired memory and judgement, behavior changes

iv. seizures may occur late in course


i. positive CSF

ii. CSF india ink

iii. CSF cryptococcal antigen titer

What is the preferred agent for cryptococcosis treatment?

Lipid amphotericin 3-4 mg/kg/day plus flucytosine 25 mg/kg q6hr for at least 2 wks followed by fluconazole 400 mg/day for at least 8 wks

What is secondary prophylaxis for cryptococcosis treatment?

fluconazole 200 mg/day

may consider d/c afer a minimum of 1 yr chronic maintenance therapy if CD4 is > 100 cells/mm3 x 3 mos after initiation of potent combo ART

reinitiate if CD4 ever drops below 100 cells/mm3

What should be used as primary prophylaxis for cyrptococcosis?

Primary prophylaxis not recommened

At what CD4 cell count does M. avium complex (MAC) risk increase?

CD4 < 50 cells/mm3

What is the preferred regimen for treating MAC?

macrolide plus ethambutol for 12 months

clarithromycin 500 mg BID; or

azithromycin (if can't take clarith)


ethambutol 15 mg/kg/day

What are some other MAC treatments?


fluoroquinolones: levoflox, moxiflox

aminoglycoside such as amikacin or streptomycin

When can chronic maintenance or secondary prophylaxis cease for MAC?

after 12 months of therapy if CD4 > 100 cells/mm3 for 6 months or longer because of potent combination ART and if pt is asymptomatic

restart if CD4 drops below 100 cells/mm3

When should primary prophylaxis for MAC begin?

What agents should be used?

Primary prophylaxis for MAC should begin if CD4 < 50 cells/mm3


clarithromycin 500 mg bid (preferred)

azithromycin 1200 mg weekly

azithromycin 600 mg BID

rifabutin 300 mg/day

-do not give alone to pts w/ TB

-can cause rash, GI disturbances, neutropenia, body fluid discolorations

How is cytomegalovirus (CMV) diagnosied?


virus isolation

-tissue culture can take up to 6 wks

What are GI manifestations of CMV?


esophagitis and gastritis (uncommon)

hepatitis w/ histologic evidence but minimal clinical importance

What pulmonary infections can CMV manifest?'

When should you initiate treatment?


however, CMV is commonly in bronchial secretions and it is of of questionable importance

initiate treatment if:

documented tissue infection

CMV is only pathogen

deteriorating illness

What is the most important clinical manifestation of CMV?



generally occurs in pts w/ CD4 < 100

begins unilaterally and spreads bilaterally

Early complaints are "floaters" pain behind eye

In general this is progressive and does not spontaneously resolve

***can lead to blindness in weeks

26% progression even w/ treatment; retinal detachment very common

How is CMV treated?

Why is this drug a good choice?

Ganciclovir and valganciclovir

ganciclovir and valganciclovir must be triphosphorylated; the rate limiting step in this process is the first phosphorylation. CMV induces the production of the enzyme necessary for the monophophorylation of ganciclovir but not acyclovir

What are some adverse effects of ganciclovir and valganciclovir?



confusion, convulsions, dizziness, headache

N/V, diarrhea, abnormal LFTs

What are alternative CMV treatments?

Why is ganciclovir preferred?

When is *** preferred?

Adverse reactions?


foscarnet and ganciclovir are equally effective against CMV, however, foscarnet decreases mortality because of its anti-HIV effects

foscarnet is preferred if ganciclovir resistent CMV w/ mutations in the UL97 region of viral genome

Adverse reactions

renal impairment

-esp if pt is dehydrated

-2-3 fold increase in SCr

-usually reversible

-hydration w/ 2.5 L/day will prevent

decreased hemaglobin/hematocrit

electrolyte abnormalities

penile ulcerations

What is another alterative CMV treatment besides ganciclovir and foscarnet?


requires intracellular activation

Also active against ganciclovir resistant CMV w/ mutations in UL97 region

When is secondary prophylaxis recommended for CMV?

What about primary prophylaxis?

Secondary proph should continue until CD4 > 100 cells/mm3 for 3-6 mos

primary proph is not recommended


What can be hosts for sporozoite (Toxoplasma gondii) production?

FELINES; keep liter box changed daily

What are S/S of toxoplasmosis?

fever, headache, altered mental status

focal neurologic deficits


CSF: mild pleocytosis, increased protein, normal glucose

How can toxoplasmosis be diagnosed?

Brain bx: only definitive diagnosis; not usually done

Antibodies or T. gondii isolation in serum of CSF

Who is standard toxoplasmosis therapy?

a. pyrimethamine 50-75 mg/day (loading dose 200 mg in two dose); plus,

b. sulfadiazine 1000-1500 mg every 6 hours

i. watch for bone marrow suppression, thombocytopenia, granulocytopenia, anemia

ii. can add folinic acid (leucovorin) 10-25 mg/day to reduce bone marrow effects of pyrimethamine

iii. treat for 6 wks or after S/S resolve

What are alternative toxoplasmosis treatments?

used in combo w/ pyrimethamine/leucovorin for sulfa intolerance

a. clindamycin

b. atovaquone

c. azithromycin

When should patients receive prophylaxis for toxoplasmosis?

What agent should be used?

Primary proph for pts who are tosoplasma-seropositive w/ a CD4 100 or less

Bactrim DS daily; or,

dapsone/pyrimethamine/leucovorin; or

atovaquone w/out pyrimethamine

can d/c once CD4 > 200 for 3 months

What can be used for secondary prophylaxis for toxoplasmosis?

pyrimethamine plus leucovorin



can d/c once CD4 > 200 for 6 months

How is tuberculosis transmitted?

person to person:

airborne droplets carrying M. tuberculosis are inhaled

What vaccine can interfere with the TB skin test (PPD)?

bacille calmette-guerin

What is the booster effect of the TB PPD?

What should be done if a person has a + PPD?

The TB test can restimulate hypersitivity in those exposed in the past year.

Those with small TB test reactions can be retested in 1 wk, if positive, result should be attributed to boosting of subclinical hypersensitivity; chemoprophylaxis not necessary.

If a person is PPD positive (no HIV dx) what therapy should they receive?

a. isoniazid 300 mg/day or 900 mg weekly for 9 months

b. rifampin 600 mg/day for 4 months

c. rifapentine 900 mg plus isoniazid 900 mg/wk for 12 wks

If a pt has a positive PPD and they are HIV+ what treament should they receive?

isoniazid 300 mg/day for 9 months *Preferred*

isoniazid 900 mg 2x week for 9 months w/ directly observed therapy (lower strength evidence)

With a PPD of 5 mm what groups TB positive?

pts w/ chest radiograph consistent w/ TB


pts receiving prednisone >15 mg/day for greater than 1 month

With a PPD of 10 mm what groups are TB positive?

recent immigrants from countries w/ a high prevalence of TB

IV drug abusers

residents and employees of prisons, jails, nursing homes, hospitals, and homeless shelters

pts w/ DM, silicosis, leukemias, lymphomas, chronic renal failure

children < 4 y/o

With a PPD of 15 mm what groups are TB positive?

Pts w/ no identifiable risk factors

What drugs are first line agents for TB treatment of active infections?






What drugs should be used to treat a pt w/ active TB who is HIV- or HIV+?

option 1: isoniazide, rifampin, pyrazinamide, ethambutol for 2 months, followed by isoniazid and rifampin for 4 months

option 2: isoniazid, rifampin, and ethambutol for 2 months followed by isoniazid and rifampin for 7 months

What should be initiated in pts w/ active TB who are HIV+ and when?

ART with in 2 wks of CD4 count decreasing to 50 cells/mm3 or less

What ART should not be administered w/ rifampin?

What can be substituted for rifampin?

PIs and NNRTIs (except for efavirenz or nevirapine) should not be given w/ rifampin

Rifabutin can be substituted for rifampin

What should be used for TB w/ known resistance to isoniazide?

rifampin, pyrazinamide, themabutol, and moxifloxacin/levofloxacin for 2 months for 2 months; followed by rifampin plus ethambutol plus moxifloxacin/levofloxacin for 7 months