HIV
-Use universal precautions when dealing w pts.
DX: Elisa and Western Block… (need both)
Viral Loads – (use same methods)
< 200 copies= undectable…can go up to 60K
New pts, every 3-6 months, after changing drug or dose, anytime CD4 count drops.
Do testing when worried about infections.,
If can’t get viral to undetecable … considered treatment failure…
CD4 Counts
Normal 500-1500
Drop to 350- A1 category to start therapy
HIV
If CD4 drops to 350… immunologic failure to therapy.
4 catagories:- review agents, when to use them, how they work
When to treat: Any pregnant, anyone with aids symptoms, CD4 < 350, CD4 300-500 – possibly
Once start, must never stop… Better to never start, then to half-hapzard take meds.
If resistance, change the classes..
Prophylaxis of secondary infections:
Pneumocystis Pneumonia- CD4 < 200 .
Cryptococcus Meningitis—would need azole anti-fungal=fluconazole, not prophylaxis recommended.
CMV--- retinitis.. no prophylaxis <50… get eye exams
MAC…. CD4 < 50 … add macrolide
Cryptosporidium - protazoa that causes diarrhea
Toxoplasmosis < 100
PNEUMONIA – (high LDL) .. assume PCP…. TX: BACTRIM, Pentamidine, Dapsone,
- if PaO2< 70%, AG –gradient… 150-(pCO2 + O2) IF AG > 35 = severe – use steroid dose
Course of therapy is 21 days…..
is when CD4 < 200. ..
Tuberculosis
Prophylaxis given after treatment… usu bactrim.. Primary propyxlaxis
Antifungals -see medical letter
Maternal-fetal transmission--- if not on antiretro-viral tx… start them on it. Want viral load as low as
possible.. zidovidine… DOC….. also give iv zidovidine at delivery unless viral load is < 400
- all enfants should have zidovidine x 6 weeks postpartum… and add novrapine if mother had no
tx
exposure –(2013 ) tx within hours of DOC Teretenovir, and novavir and truvada