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ID 6.20

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Factors influencing whether an HIV patient will develop an opportunistic infection
(1) Immune status (CD4 count)
(2) Exposure
(3) Virulence of pathogen
OI: Bacterial Pneumonia
Pulmonary disorders are the leading cause of morbidity/mortality in HIV patients
Pneumococcus is the leading etiological agent
Resolve? Give them the pneumococcal vaccine!
OI: PCP
Pneumocystis Pneumonia
Pneumocystic jiroveci is a ubiquitous fungus
Clinical presentation: insidious onset, fever, night sweats, non-productive cough; diffuse, bilateral intersitial infiltrates (on CXR)
Treatment: Bactrim and/or steroids (if concerned about breathing problems)
OI: PCP
(Prophylaxis?)
Absolutely
Give Bactrim to patients w/CD4 count <200
NOTE: medication can be discontinued when CD4 count improves
When should you administer PCP prophylaxis?
When CD4 count drops below 200
OI: Candida
Problem when CD4 count nears 200
Treatment: PRN fluconazole therapy (preferred over chronic suppression)
OI: MTB
Mycobacterium Tuberculosis
Do annual PPD screening and follow positives w/CXR (will see apical infiltrates)
OI: Mycobacterium avium complex
Disseminated disease that presents most often in patients w/CD4 counts less than 50
Treatment: azithromycin
Patients w/CD4 count <50
(prophylatic considerations)
MAC attack, give weekly azithromycin
What pathogen should you consider as a patient's CD4 count drops below 50?
MAC

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