HIV Potpourri

Today we had an exhilarating morning report with so much high-yield content it's hard to know where to begin.

1) One highlight was a review of opportunistic infections and their corresponding CD4 levels.
Here is a diagram which summarizes it:

The usual prophylactic regimens:
- Septra for PJP if past PJP, CD4<200 or history of esophageal candidiasis. Dapsone or atovaquone are the best alternatives.
- Septra also covers Toxoplasma
- Azithromycin for MAC at CD4<50

Here is a link to the CDC Guidelines for Prevention and Treatment of HIV positive adults. 

2) Also touched on was treatment of PJP infection in a patient with HIV
- Septra DS- 2 tabs Q8 hours
  Can also use IV Septra, trimpethoprim/dapsone or clinda/primaquine

- Addition of steroids: several trials showing a clear mortality benefit in moderate or severe pulmonary dysfunction
- These guidelines (from 1990!) are still current:
- start steroids with anti-PJP antimicrobial if PaO2 on room air <70mmHg OR Aa gradient (always on room air) >35mmHg
- start as early as possible, within 24-72 hours of antibiotic therapy
- 21-day tapering oral regimen of prednisone
- 21 days of antimicrobial therapy