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Step III

Step III - HIV

QuestionAnswer
In what scenarios would you start HIV therapy CD count <350, needle stick, pregnant pt, symptomatic pts regardless of viral load or CD count
What are the different HAART regiments 2 NRTI + PI; 2 NRTI + NNRTI; NRTI + NNRTI + PI
What do protease (-) drugs end in -NAVIR
What do NRTI drugs usually end in -VUDINE
Name the NRTI drugs that do not end in –VUDINE Didanosine, Zalcitabine, abacavir, emtricitabine
Name the NNRTI drugs Efavirenz, nevirapine, delavirdine
As a class, what is the AE of NRTI drugs Lactic acidosis
As a class, what is the AE of PI drugs HYPER-glycemia, lipidemia, LFTs
As a class what is the AE of NNRTI Nothing
MC AE of Indinavir hyperbilirubinemia > Kidney stones
MC AE of Zidovudine Anemia, leucopenia, GI
MC AE of Didanosine Pancreatx, peri-neuropathy
MC AE stavudine Peri-neuropathy
MC AE of abacavir Rash
Which NRTI has the best efficacy in reducing viral load Abacavir
MC AE of Efavirenz neurologic; somnolence, confusion, or psychiatric disturbance
What is the treatment for needlestick injury from HIV+ pt HAART x1mos
What other types of exposure to HIV+ would warrant HAART tx Mucosal surfaces and unprotected sex
What do you do for a pregnant HIV+ pt who is already on HAART Continue HAART
What do you do with a patient who is HIV+, pregnant and not on HAART Find CD count. If <350, start HAART, if >350 w/ low viral load, do HAART in 2nd and 3rd trimester to avoid transmission to fetus
When CD count < 200 prophylaxis against what should be initiated using what drug PCP; TMP/SMZ
If pt has a rash using TMP/SMZ for prophylaxis against PCP what can you switch to Atovoquone or dapsone
Dapsone can not be used as PCP prophylx if pt has this deficiency G6PD
When CD count < 50 prophylaxis against what should be initiated using what drug MAI; azithromycin PO qweek
Pt HIV+ c/o SOB, dry cough, inc LDH, hypoxia. Dx PCP
Best initial test for PCP pneumonia XR
What does CXR in PCP pneumonia pt look like Inc B/L interstitial markings
Most accurate test for dx of PCP pneumonia Bronchoalveolar lavage
Tx of PCP pneumonia IV TMP/SMZ
Pt has PCP pneumonia and develops rash from IV TMP/SMZ. What can you use next IV pentamidine
What other drug should be added to PCP pneumonia tx if dz is severe (pO2 <70, Aa > 35) Steroids
What best initial test for dx toxoplasmosis CT w/ contrast
At what CD count would you suspect Toxo infection CD < 100
How do you tx toxo Pyrimethamine + sulfadiazine/Clindamycin x2wks ; repeat CT scan
Pt suspected of having toxo and put on tx. Repeat CT head shows lesion unchanged in size. What should you do and dx Brain biopsy; Lymphoma
Pt with CD < 50. What bugs/dz are you thinking MAI, CMV, PML
Pt CD<50 c/o blurry vision. Dx CMV
Tx of CMV Ganciclovir/foscarnet/cidofovir
Maintenance tx for CMV Lifelong PO valganciclovir
Pt CD <50 c/o fever, HA. Dx Cryptococcus
Pt CD<50 c/o fever, HA. Next best step LP to look for inc WBCs
Best initial test for Cryptococcus India ink stain (low sens)
Most accurate test for Cryptococcus Cryptococcus Ag (high sens + spec)
Tx for Cryptococcus Amphotericin IV then Fluconazole PO lifelong
Pt CD <50 w/ focal neuro abnormalities. Dx PML
Best inicial test for PML CT head or MRI
What do you tell the pt dx w/ PML about tx There is non. It will resolve when CD count rises
Pt CD <50 w/ weight loss, fever, fatigue, anemia +/- inc alk phos and GGTP. Dx MAI
Diagnostic testing for MAI from most sens to least sens Liver bx > bone bx > blood cx
Tx for MAI Clarithro + ethambutol
Created by: DrINFJ