Term
| CD4+ count < 200 or <14% total lymphocytes |
|
Definition
|
|
Term
| Starting ART within 14 days of opportunistic infection (verses after OI) |
|
Definition
| Fewer AIDS progression/deaths; longer time to progression/deaths; short time to CD4 count > 50 cells/mL; no increase in adverse events |
|
|
Term
| Clinical syndromes associated with immume reconstitution (OIs are "unmasked") |
|
Definition
|
|
Term
|
Definition
| continue ART (unless active TB); encouragement of compliance/adherence; treat the unmasked opportunistic infection; treat the inflammation |
|
|
Term
|
Definition
| Immune Reconstitution Inflammatory Syndrome |
|
|
Term
| Inflammatory symptom management |
|
Definition
|
|
Term
| When to start primary prophylaxis: CD4+ <200 |
|
Definition
| pneumocystis jiroveci pneumonia (PCP) |
|
|
Term
| When to start primary prophylaxis: CD4 + <100 |
|
Definition
|
|
Term
| when to start primary prophylaxis: CD4 + < 50 |
|
Definition
| mycobacterium avium complex (MAC) |
|
|
Term
| Mucocutaneous Candidiasis |
|
Definition
| one of the most common infections |
|
|
Term
|
Definition
| "thrush", recognized as an indicator of immune suppression, Candida spp. |
|
|
Term
|
Definition
| creamy white PAINLESS plaques on buccal, pharyngeal mucosa or tongue surface; or erythematous patches without white plague on anterior or posterior upper palate or diffuse on tongue; angular chelosis |
|
|
Term
| Treatment of Oropharyngeal |
|
Definition
| length of therapy: 7-14 days; Preferred: Fluconazole (Diflucan), Clotrimazole (Mycelex) troches, Nystatin po suspension, Miconazole mucoadhesive tab |
|
|
Term
| Oropharyngeal Treatment Alternatives |
|
Definition
| Itraconazole (Sporanox) solution daily; Posaconazole (Noxafil) solution BID x 1 then daily |
|
|
Term
|
Definition
| AIDS-defining illness; often obsered in pts with CD4+ < 200 |
|
|
Term
| Esophageal Candidiasis SYmptoms |
|
Definition
| retrosternal burning pain/discomfort, odynophagia; occasionally asymptomatic |
|
|
Term
| esophageal candidiasis diagnosis |
|
Definition
| endoscopic visualization with histopath; plaques may progress to ulceration; can lead to candidemia (serious) |
|
|
Term
| Esophageal Candidiasis PReferred treatment |
|
Definition
| length of therapy: 14-21 days; Fluconazole , Itraconazole |
|
|
Term
| Esophageal Candidiasis alternatives |
|
Definition
| voriconazole, posaconazole, caspofungin, micafungin, anidulafungin, amphotericin B deoxycholate |
|
|
Term
|
Definition
| common among healthy girls/women |
|
|
Term
|
Definition
| white adherent vag. discharge; mucosal burning/itching; might be more severe and more frequent |
|
|
Term
|
Definition
| clinical presentation + KOH micro prep; in HIV pts non-albicans species > albicans |
|
|
Term
|
Definition
| fluconazole x 1 or topical azoles for 3-7 days |
|
|
Term
|
Definition
| really watch drug interactions! |
|
|
Term
| Posaconazole (po suspension only) |
|
Definition
| new, potent, very broad spectrum, drug interactions |
|
|
Term
|
Definition
| capsofungin, micafungin, anidulafungin |
|
|
Term
|
Definition
| watch hepatic dysfunction-- dose decrease |
|
|
Term
| amphotericin susp (compound) |
|
Definition
| flucon-refract oropharyngeal |
|
|
Term
| Chronic suppression: oropharyngeal |
|
Definition
| fluconazole 100 mg po TIW |
|
|
Term
| Chronic suppression: esophageal candidiasis |
|
Definition
| fluconazole 100-200 mg po daily |
|
|
Term
| Chronic suppression: Vulvovaginitis |
|
Definition
| fluconazole 150 mg po weekly |
|
|
Term
| Pneumocystis jiroveci pneumonia PCP |
|
Definition
| once was the most dangerous opportunistic infection |
|
|
Term
|
Definition
| CD4+ < 200, dyspnea, nonproductive cough, CXR- bilateral infiltrates, PaO2 < 70 mmHg; fever, chills, sweats, cough, fatigue; rule out bacterial pneumonia; sputum, bronchial washing, open lung biopsy |
|
|
Term
| PCP Prophylaxis Preferred |
|
Definition
| SMX-TMP 1 DS (or SS) tablet daily |
|
|
Term
| PCP Prophylaxis Alternatives |
|
Definition
| SMP/TMP 3x/week; Dapsone; aerosolized pentamidine |
|
|
Term
|
Definition
| High dose IV/po SMX/TMP x 21 days; Dapsone + TMP; IV Pentamidine; Clindamycin IV + Primaquine po |
|
|
Term
|
Definition
| hypotension, nephrotoxicity, metallic taste; pancreatic toxicity |
|
|
Term
| Clindamycin IV + Primaquine po |
|
Definition
| Clostridium difficile colitis |
|
|
Term
|
Definition
| PaO2 < 70 mmHg: Cortiosteroids x 21 days (i.e. pred or methylpred) |
|
|
Term
| PCP: Desensitization protocols: |
|
Definition
| SMX/TMP; Rapid (hours) vs. prolonged (days-month); cover for bacterial suprainfections: community-acquired, atypicals; hospital-acquired |
|
|
Term
| PCP- Immune Reconstitution- Primary Prophylaxis |
|
Definition
| stop when: CD4+ > 200 for > 3 months with ART response |
|
|
Term
| PCP-Immune Reconstitution - Secondary Prophylaxis |
|
Definition
| stop when: CD4 + increase from <200 to > 200 for > 3 months in response to ART: if PCP occurred CD4+ > 200, continue for life |
|
|
Term
| PCP-Immune Reconstitution- Restarting |
|
Definition
| Primary CD4+ < 200; Secondary CD4 + < 200 |
|
|
Term
| SMX/TMP (additional protection) |
|
Definition
|
|
Term
| Atovaquone (additional protection) |
|
Definition
|
|
Term
| Trimetrexate (additional protection) |
|
Definition
| antineoplastic, fungi (including toxo) |
|
|
Term
| PCP-Immune Reconstitution: Primary prophylaxis stop when: |
|
Definition
| CD4+ > 200 for > 3 months on ART |
|
|
Term
| PCP- Immune Reconstitution: Secondary prophylaxis- stop when: |
|
Definition
| CD4+ > 200 for > 3 months on ART or PCP at CD4+ > 200 on prophylaxis for life |
|
|
Term
| PCP- Children--HIV+ mothers |
|
Definition
| SMX/TMP prophylaxis- start 4-6 weeks old; Continue through 1st year; reassess need after 1 year; Dapsone or aerosolized pentamidine |
|
|
Term
|
Definition
| Can use or discontinue SMX/TMP during 1st trimest; use DS tabs therafter, aerosolized pentamidine |
|
|
Term
|
Definition
| causes CNS infection (encephalitis); clinical presentation: HA, confusion, fever, motor weakness |
|
|
Term
|
Definition
| anti-toxoplasma IgG antibodies; CNS imaging (CT/MRI) for multiple ring contrast-enhancing lesions; positive toxo serology (PCR of CSF) |
|
|
Term
| Toxoplasmosis Prophylaxis PReferred |
|
Definition
|
|
Term
|
Definition
| 6 weeks; 1st line: Sulfadiazine IV (wt based) + pyrimethamine po (wt based) _ leucovorin po |
|
|
Term
| toxo-immune reconstitution primary prophylaxis: |
|
Definition
| stop when: CD4+ > 200 for > 3 months on ART |
|
|
Term
| toxo-immune reconstitution secondary prophylaxis |
|
Definition
| stop when: CD4+ > 200 for sustained period of time (>6 months on ART) plus complete txt courses for toxo (6 wks) and remain asymptomatic; consider CNS imaging for resolution |
|
|
Term
| toxo-immune reconstitution restarting prophylaxis |
|
Definition
| primary: CD4+ < 100-200 (200 for PCP med); Too: CD4+ < 200 |
|
|
Term
| Mycobacterium Avium Complex (MAC) |
|
Definition
| the most common bacterial infection in patients with AIDS |
|
|
Term
|
Definition
| pulmonary: cavitary, nodular; extrapulmonary: spleen, lymphs, liver, adrenals, colon, kidney, bone marrow |
|
|
Term
| MAC Prophylaxis Preferred: |
|
Definition
| clarithromycin or azithromycine |
|
|
Term
|
Definition
| Aggressive and treat for life unless immune reconstitution; Pt survival comonly < 1 year if untreated; multidrug to avoid resistance |
|
|
Term
|
Definition
| clarithromycin + ethambutol (Addition of rifabutin may be considered) |
|
|
Term
| MAC Treatment Alternatives |
|
Definition
| azithromycin sub for clarithromycin; 3rd and 4th drug additions: cipro/levo/moxifloxacin, amikacin, streptomycin |
|
|
Term
| MAC Immune Reconstitution Primary prophylaxis |
|
Definition
| stop when: CD4 > 100 for > 3 months with sustained suppression on ART |
|
|
Term
| MAC Immune Reconstitution Secondary prophylaxis |
|
Definition
| stop when: completed > 12 months of therapy plus, asymptomatic plus, CD4 > 100 for > 6 months on ART |
|
|
Term
| MAC Immune Reconstitution Restarting |
|
Definition
| primary: CD4 <50; Secondary: CD4 < 100 |
|
|
Term
|
Definition
| Major cause of blindness in AIDS patients |
|
|
Term
|
Definition
| ubiquitous virus (herpes virus-5); highly infectious; usually non-pathogenic except: acquired or congenital immunodeficiency i.e. HIV, transplant |
|
|
Term
|
Definition
| transmission: mucosal contact w/ infectious tissues, secretions and excretions; acquired by congenital, sexual, or person-to-person routes, transfusion, transplant |
|
|
Term
|
Definition
| Fluffy white 'floater" or flashes- ophthalmologist, Children will rarely complain of symptoms, CD4+ count < 100; CMV antibody- if pt is seronegative; culture virus; CMV PCR- RNA or DNA (qualitative) |
|
|
Term
|
Definition
| no vaccine; short-term passive immunity (CMV IG IV); consider ganciclovir CD4 < 50 (and seropositive for CMV)- lack of survival advantage, may induce resistance, high cost; recognize early manifestations |
|
|
Term
|
Definition
| most likely will need systemic therapy; unilateral retinitis commonly will spread; Induction: higher dose more frequent; maintenance: less often, possibly life-long |
|
|
Term
| CMV Acute Treatmnet- Induction |
|
Definition
|
|
Term
|
Definition
| Ganciclovir; Valganciclovir; Foscarnet; Cidofovir; renal dosing considerations |
|
|
Term
| CMV Immune Reconstitution |
|
Definition
| primary prophylaxis- NA; secondary proph. stop when: CD4> 100 for 3-6 months with ART, non isght threatening, good vision in contralateral eye, regular ophthalmic exam; restarting: CD4 <100 |
|
|
