Opportunistic Infections of HIV (Dr. Pogue)
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What is the most common opportunistic infection seen in HIV patients? What is the best used treatment for this infection and what is the duration of therapy? What is the most common alternative treatment?
Pneumocystis pneumonia (PCP); Bactrim (TMP/SMX) and prophylaxis once daily for 21 days; Dapsone with Bactrim
When should HIV patients receive prophylaxis for Pneumocystis?
when CD4 count is <200
What is the alternative drug used for PCP that is also used for leishmaniasis? What is its mechanism of action? Most common adverse drug effects?
pentamidine; interferes with RNA/DNA protein synthesis; bone marrow suppresion
When should mycobacterium avium complex (MAC) prophylaxis be initiated? What is the best treatment and duration of treatment?
when CD4 count is <50; high dose of Clarithromycin (macrolides) once weekly (can use Azithromycin to decrease DDIs)
When are HIV patients at the greatest risk for developing cryptosporidiosis?
when CD count is <100
What are the signs/symptoms of cryptosporidiosis in HIV patients? What is the best prophylaxis?
acute onset of nonbloody, watery diarrhea with abdominal symptoms (pain, discomfort, cramps); HAART
There is a complete clinical resolution of Cryptosporidiosis in HIV patients when their CD count is at what level?
What is the best drug treatment for cryptosporidiosis (secondary to rehydration) and what is the duration of treatment?
Initiation of HAART (can use Nitazoxanide; > 3 days)
What is the most common T. gondii infection seen in HIV patients?
When is prophylaxis for T. gondii encephalitis recommended? What is the drug of choice? Drug alternative?
CD4 count <100; Bactrim (TMP/SMX); Inhaled pentamidine
What is the drug of choice for treatment of T. gondii encephalitis?
Pyrimethamine + sulfadiazine + leucovorin
What is the mechanism of action for pyrimethamine?
inhibits parasitic DHF reductase (similar to trimethoprim)
Why are sulfadiazine and leucovorin co-administered with pyrimethamine?
has synergistic effect with sulfadiazine and leucovorin decreases bone marrow suppresion
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