HIV opportunistic infections

No!

• fluconazole 100 mg po qday x 7-14 days
• or
• clotrimazole troches 10 mg fid
• nystatin susp 4-6 ml qid
• alternative: itrconazole soln 200 mg qday

• fluconazole 100 mg (up to 400mg) po or IV qday
• itraconazole soln 200 mg qday

• fluconazole 150 mg po for 1 dose
• topical azole for 3-7 days
• alternative: itraconazole soln 200 mg bid x 1 day or 200 mg qday x 3 days
• complicated or recurrent: fluconazole 150 mg po q 72 hrs for 2-3 doses, topical antifungal agents greater than 7 days

<200

• when patients are unaware they have HIV
• those who are not in care
• CD4 count <100

• CD4 count <200
• prior PCP
• CD4% <14%
• oral thrush
• recurrent bacterial pneumonia
• unintentional weight loss
• high viral load

• CD4 count <200 or hx of oropharyngeal
• d/c with CD4 >200 for >3 months, but reinitiate when CD4 <200
• bactrim (ss or ds) 1 po qday
• dapsone 100 mg po qday (test for G6PD first)

• TMP-SMX 15-20 mg/kg/day in divided doses q 6-8 hours
• or
• Bactrim DS 2 ts po tid
• alternative (moderate to severe): pentamidine 4 mg/kg IV qday or
• primaquine 15-30 mg (base) po qd + clinda 600-900 mg IV q6-8h
• atovaquone 750 mg po bid
• could add steroids for moderate to severe disease (room air <70 mmHg or A-a gradient >35 mmHg) but need to taper x 21 days

• bactrim ds or ss 1 po qday
• patient can d/c if cd4 count >200
• but if patient gets PCP while cd4 >200 will be on bactrim for life

• injection drug users
• occurs at any CD4 count
• patients with TB have higher HIV viral loads and faster progression of HIV
• all HIV patients should be screened for latent TB at HIV diagnosis
• annual testing is also recommended

• INH 300 mg PPO qd or 900 mg BIW for 9 months
• plus
• pyridoxine 50 mg po qd to reduce risk of peripheral neuropathy
• alternative: rifampin 300 mg qd x 4 months

• Initial phase (2 months)- RIPE
• Continuation phase (4 months)- INH + RIF or (RFB)
• if positive cultures after initial 2 months, contine RIPE for 3 more months (total of 9 months)

• PI
• CCR5
• Integrase inhibitors

• usually occurs in CD4 count <50
• risk factors: viral load >100,000 copies, previous opportunistic infection, previous colonization with MAC

• CD4 <50
• d/c in patient on ART with increase in CD4 count >100 for greater than 3 months
• restart prophylxis if CD4 <50 again

• azithromycin 1200 mg po qweek
• clarithromycin 500 mg po bid
• azithromycin po TIW
• alternative: RFB 300 mg po qd

• initial tx at least 12 months
• clarithromycin 500 mg po bid + ethambutol 15 mg/kg po qd
• alternative to clarithromycin: azithromycin 500-600 mg po qday
• consider adding RFB as 3rd drug- especially if CD4 <50
• consider adding fluoroquinolones, amikacin, streptomycin

• CD4 <50
• if relapse occurs, almost always fatal

• induction: greater than 2 weeks. amphotericin 0.7 mg/kg IV QD + flucytosine 25 mg/kg po QID
• Consolidation: 8 weeks. Fluconazole 400 mg po qd
• chronic maintenance: fluconazole 200 mg po qd
• consolidation therapy should not be started until at least 2 weeks of significant clinical improvment, and negative CSF culture on lumbar puncture

• grows in bird and bat droppings
• seen in CD4 <150

• itraconazole- can reduce frequency of disease but no survival benefit
• itraconazole 200 mg po qd for patients CD4 <200
• can d/c when CD4 >150 x 6 months

• induction: (2 weeks or until clinically improved) amp B
• maintenance: itraconazole 200 mg po tid x 3 days then bid
• total duration at least 12 months
• if meningitis: induction 4-6 weeks

acquired from tissue cysts in undercooked meat or ingestion of sporulated oocysts (from cat feces) in soil, water, or food

• CD4 <100
• bactrim ds 1 po qd
• d/c if on ART, CD4>200 for >3 months
• restart if CD4 <200

• pryrimethamine + sulfadiazine + leucovorin
• duration at least 6 weeks

• maintain CD4 >100
• primary prophylaxis with valganciclovir not recommended
• regular eye exams
• vigilance for increase in floaters

• IV ganciclovir followed by oral valganciclovir
• IV foscarnet
• IV cidofovir
• ganciclovir intraocular implant
• valganciclovir
• tx for colitis, esophagitis: IV ganciclovir or foscarnet; oral valganciclovir for 21-28 days, maintenance not necessary