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  1. AIDS
    • HIV + CD4<200
    • or AIDS-defining Opportunistic Infection (OI)
    • or malignancy
  2. What is the most reliable marker of risk for OI?
    CD4 ct
  3. Best predictor of LT progression of AIDS?
    • Viral Load (Plasma HIV-RNA)
    • Shows risk of Dz progression
    • Responses to Tx
  4. Diagnostic Tests
    • ELISA: for HIV-1 Ab/Ag (+) 1-12wks post acute infxn; >99% Se; 1' screening test
    • Western Blot: (+) if >= 2 bands from HIV genome; >99% Sp; conf after (+)ELISA
    • Rapid Prelim Test: 4 Ab tests; saliva, plasma, blood or serum 99% Se & 96-99% Sp
    • CD4 is not a dx test, bc can be HIV(+) w nml CD4 or HIV(-) w low CD4
  5. Start ARV Tx when CD4<?
    CD4 < 500
  6. OI
    Indication(I) and Prophylaxis(Pr)?
    • Tb: (I) (+) PPD (<=5mm)/IGRA or high risk; (P) INH + vit B6 X 9mo; (Tx) RIPE(S)
    • Pneumocystis jiroveci (PCP): (I) CD4< 200 or <14% or Thrush present; (P) 1stL=TMP-SMX, 2ndL=(Dapsone/Dapsone+Pyrimethamine), or Atovaquone, or Pentamidine; (Tx) if PaO2 >70 TMP-SMX, if <70 Prednisone before Abx
    • Toxoplasmosis: (I) CD4< 100 (but is already covered by PCP Prx @ 200) and (+) Toxo IgG; (P) 1stL=TMP-SMX 2ndL= (Dapsone or Atovaquone)+Pyrimethamine; (Tx) {1stL=(TMP-SMX or Pyrimethamine)+Sulfadiazine 2ndL=Pyrimethamine+Clindamycin}+ Leucovorin (incr Folate) + Corticosteroids (for neurologic Sx) + consider Anti-convulsants.
    • MAC: (I) CD4<50; (P) Azithromycin or Clarithromycin; (Tx) Azithromycin or Clarithromycin + Ethambutol +/- Rifabutin
    • Stop 1' Proph if CD4 >initiation threshold >3-6mo on ARVs
  7. CMV
    • Image Upload
    • In the eye: CMV most commonly presents as a viral necrotizing retinitis with a characteristic ophthalmoscopic appearance (see image). 
    • Untreated CMV retinitis inexorably progresses to visual loss and blindness.
    • Retinitis:  typically starts in the midperiphery and can progress in a "brush fire" pattern.
  8. Adverse Effects of HIV Medications
    • Zidovudine: Anemia
    • Stavudine and Didanosine: peripheral neuropathy and pancreatitis
    • Abacavir (HLA B5701): HSRxn, Steven-Johnson rxn
    • Protease inhib: Hyperlipidemia, Hyperglycemia
    • Indinavir: Nephrolithiasis
    • Tenofovir: Renal Insufficiency
Card Set:
2014-08-07 22:11:10
Infectious Dz
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