Therapeutics - HIV 6
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What can be used for prophylaxis for heterosexual transmission of HIV-1?
1% tenofovir gel
What is used for prophylaxis for MSM transmission of HIV-1?
Most opportunistic infections occur when CD4+ cells have fallen to what level?
How is acute Pneumocystis jerovici pneumonia (PCP) (Protozoal infection of the lungs) treated in AIDS?
- DOC: TMP-SMZ for 21 days (DOC)
- Alternative: Pentamidine if rash develops with Bactrim
- Prophylaxis - TMP-SMZ 1 DS or SS qd for life
What is the MOA of Bactrim?
- Sulfamethoxazole: Inhibits dihydrofolate formation from PABA, thus interfering with bacterial folic acid synthesis and growth
- Trimethoprim: inhibits dihydrofolate reduction to tetrahydrofolate
What is the Spectrum for Bactrim?
- G(+): MSSA, MRSA, Strep, Listeria
- G(-): Enterobacteriaceae, E. coli, H. influenzae, Stenotrophomonas
- Does not cover: Pseudomonas
- Other organisms: Pneumocystis jiroveci, Nocardia, Toxoplasma, Legionella
Toxoplasmic encephalitis is a Protozoan parasite that usually invades CNS in AIDS patients, what is the treatment?
- Pyrimethamine QD + sulfadiazine QID for 6-12 weeks
- clindamycin + pyrimethamine
How do you prophylax for Toxoplasmic encephalitis?
- 1st choice: PCP prophylaxis with Bactrim
- Alternative: dapsone + pyrimethamine
How do you treat TB in HIV patients?
Isoniazid + pyridoxine QD x 12 months
What is the Prophylaxis regimen for M. avis (MAC)?
- 1st choice: clarithromycin BID or azithromycin Qw
- Clarithro has P450 DDIs, so go for Azithro first
What is the Candidiasis prophylaxis regimen?
- 1st choice: fluconazole
- alternative: itraconzole
Cryptosporidiosis is a Protozoan parasite that causes mild to intractable diarrhea in AIDS patients, how is it managed?
- fluid therapy
- nutritional support
- anti diarrheals
- Nitazoxanide FDA approved
- octreotide (Sandostatin) may control severe diarrhea
- Usually NPO
What is the Histoplasmosis Prophylaxis regimen?
- must have an acid environment to absorbed this drug (Diet soda)
- Posaconazole – alternative option
- Must take with food for absorption
How do you treat Cytomegalovirus (CMV) in HIV?
- Ganciclovir or foscarnet
- Oral valganciclovir
- Cidofovir – hard on kidneys so try to avoid
HSV is treated with what drug in HIV?
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