Therapeutics - HIV 6

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  1. What can be used for prophylaxis for heterosexual transmission of HIV-1?
    1% tenofovir gel
  2. What is used for prophylaxis for MSM transmission of HIV-1?
    Truvada QD
  3. Most opportunistic infections occur when CD4+ cells have fallen to what level?
    < 200/mm3
  4. 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
  5. 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
  6. 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
  7. 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
    • OR
    • clindamycin + pyrimethamine
    • OR
    • Atovaquone
  8. How do you prophylax for Toxoplasmic encephalitis?
    • 1st choice: PCP prophylaxis with Bactrim
    • Alternative: dapsone + pyrimethamine
  9. How do you treat TB in HIV patients?
    Isoniazid + pyridoxine QD x 12 months
  10. 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
  11. What is the Candidiasis prophylaxis regimen?
    • 1st choice: fluconazole
    • alternative: itraconzole
    • voriconazole
    • posoconazole
  12. 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
  13. What is the Histoplasmosis Prophylaxis regimen?
    • itraconazole
    • must have an acid environment to absorbed this drug (Diet soda)
    • Posaconazole – alternative option
    • Must take with food for absorption
  14. How do you treat Cytomegalovirus (CMV) in HIV?
    • Ganciclovir or foscarnet
    • Alternatives:
    • Oral valganciclovir
    • Cidofovir – hard on kidneys so try to avoid
  15. HSV is treated with what drug in HIV?
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Therapeutics - HIV 6
Therapeutics - HIV
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