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HIV pt. Give Prophylaxis for PCP when CD4 Less than 200. Best Prophylaxis - TMP_SMX. If pt has Rash to TMP_SMX, Switch to 1 Atovoquone or 2 Dapsone. Dapsone Cannot be used if there is G6PD deficiency. Aerosolized Pentamidine has Poorest Efficacy.

HIV pt. G6PD deficiency. Med to avoid in Prophylaxis - Dapsone. Prophylaxis for PCP Pneumonia.

Use Atovoquone - 1 PCP Prophylaxis when pt has TMP_SMX rash, 2 PCP Tx when Mild Pneumocystis.

Use Dapsone - PCP Prophylaxis when TMP_SMX cause Rash. Not to use Dapsone when Pt has G6PD Deficiency. Dapsone is Only for PCP Prophylaxis.

Use IV Pentamidine in PCP Tx when pt has TMP_SMX Rash.

HIV pt. Give Prophylaxis for MAI when CD4 Less than 50. Prophylaxis Tx - Azithromycin Once a Week Orally.

HIV pt. PCP Px - 1 Shortness of Breath, 2 Dry Cough, 3 Hypoxia, and 4 Increased LDH.

HIV pt. PCP Lx - Best Initial CXR - Increased Interstitial Markings Bilaterally. Lx - Most Accurate - Bronchoalveolar Lavage.

HIV pt. PCP Tx - IV TMP_SMX. If pt has Rash to TMP_SMX, use IV Pentamidine. Atovoquone for Mild Pneumocystis. Dapsone is Not IV, so Only for Prophylaxis, Not Tx. If PCP is severe (pO2 Less than 70 or A-a Gradient More than 35), then give Steroids.

HIV pt. PCP is severe (pO2 Less than 70 or A-a Gradient More than 35), then give Steroids.

HIV pt. CD4 Less than 200, Shortness of Breath, Dry Cough, Hypoxia, and Increased LDH. Dx - PCP pneumonia. PCP Lx - Best Initial CXR - Increased Interstitial Markings Bilaterally. Lx - Most Accurate - Bronchoalveolar Lavage. Tx - IV TMP_SMX. If pt has Rash to TMP_SMX, use IV Pentamidine. Atovoquone for Mild Pneumocystis. Dapsone is Not IV, so Only for Prophylaxis, Not Tx. If PCP is severe (pO2 Less than 70 or A-a Gradient More than 35), then give Steroids.

HIV pt. CD4 Less than 100, Headache, Nausea, Vomiting, and Focal Neurologic findings. Best Initial Lx - Head CT with Contrast for Ring or Contrast Enhancing Lesions in Toxoplasmosis

HIV pt. CD4 Less than 100, Headache, Nausea, Vomiting, and Focal Neurologic findings. Head CT shows Ring or Contrast Enhancing lesions. Dx - Toxoplasmosis. Tx - 1 Pyrimethamine and 2 Sulfadiazine for 2 weeks, and Repeat CT. CT shows Smaller lesions - Confirms Toxoplasmosis. CT shows Same size lesion - Perform a Brain Biopsy - Most likely Lymphoma.

Toxoplasmosis. HIV pt. CD4 Less than 100, Headache, Nausea, Vomiting, and Focal Neurologic findings. Head CT shows Ring or Contrast Enhancing lesions. Dx - Toxoplasmosis. Tx - 1 Pyrimethamine and 2 Sulfadiazine for 2 weeks, and Repeat CT. CT shows Smaller lesions - Confirms Toxoplasmosis. CT shows Same size lesion - Perform a Brain Biopsy - Most likely Lymphoma.

Toxoplasmosis. HIV pt. CD4 Less than 100, Headache, Nausea, Vomiting, and Focal Neurologic findings. Head CT shows Ring or Contrast Enhancing lesions. Dx - Toxoplasmosis. Tx - 1 Pyrimethamine and 2 Sulfadiazine for 2 weeks, and Repeat CT. CT shows Smaller lesions - Confirms Toxoplasmosis. CT shows Same size lesion - Perform a Brain Biopsy - Most likely Lymphoma.

HIV pt. CD4 Less than 100, Headache, Nausea, Vomiting, and Focal Neurologic findings. Head CT shows Ring or Contrast Enhancing lesions. Dx - Toxoplasmosis. Tx - 1 Pyrimethamine and 2 Sulfadiazine for 2 weeks, and Repeat CT. CT shows Smaller lesions - Confirms Toxoplasmosis. CT shows Same size lesion - Perform a Brain Biopsy - Most likely Lymphoma.

HIV pt. CD4 Less than 50. Blurry Vision. Dx - CMV. Lx - Perform a Dilated Ophthalmologic exam. CMV diagnosed by appearance of lesions on exam. Tx - 1 Ganciclovir or 2 Foscarnet. Maintenance therapy with 3 Oral Valganciclovir Lifelong, Unless CD4 goes Up with HAART. If CD4 rises, can stop CMV meds

HIV pt. CD4 Less than 50. Fever and Headache. Neck Stiffness and Photophobia Not alway present. Dx - Cryptococcus. Lx - Lumbar Puncture - finding Increase in Level of Lymphocytes in CSF. Best Initial Lx - India Ink Stain (60 perc sensitivity). Most Accurate Lx - Cryptococcal Antigen test (over 95 perc sensitive and specfic.) Tx Initially - 1 Amphoteriacin, followed by 2 Fluconazole. Fluconazole continued Lifelong unless CD4 count Rises.

HIV pt. CD4 Less than 50. Focal Neurologic Abnormalities. Dx - Progressive Multifocal Leukoencephalopathy PML. Lx Best Initial - Head CT or MRI. Lesions do Not show Ring Enhancement and No Mass Effects. Tx - No Specific Tx available for PML. So Tx with HAART. When CD4 count Rises, PML will Resolve.

HIV pt. CD4 Less than 50. Wasting, Weight Loss, Fever, and Fatigue. Anemia is frequent from Invasion of Bone Marrow. Increased Alkaline Posphatase and GGTP with Normal Bilirubin is characteristic of Hepatic involvement. Dx - Mycobacterium Avium Intracellulare MAI. Lx - Bone Marrow (More Sensitive), Liver biopsy is (Most Sensitive). Blood culture (least sensitive). Tx - 1 Clarithromycin and 2 Ethambutal.

HIV pt. CD4 levels and Opportunitic infections. CD4 More than 200 (1 Tuberculosis, 2 Bacterial Pneumonia, 3 Oral and Vaginal Candidiasis, 4 Herpes Simplex, 5 Varicella Zoster - Shingles). CD4 Less than 200 (PCP). CD4 Less than 100 (1 Toxoplasma, 2 Histoplasma). CD4 Less than 50 (1 MAI, 2 Progressive Multifocal Leukoencephalopathy, 3 CMV, 4 Cryptococcus).

HIV pt. Opportunitic infections. CD4 More than 200 - 1 Tuberculosis, 2 Bacterial Pneumonia, 3 Oral and Vaginal Candidiasis, 4 Herpes Simplex, 5 Varicella Zoster - Shingles

HIV pt. Opportunitic infections. CD4 Less than 200 - 1 PCP

HIV pt. Opportunitic infections. CD4 Less than 100 - 1 Toxoplasma, 2 Histoplasma

HIV pt. Opportunitic infections. CD4 Less than 50 - 1 MAI, 2 Progressive Multifocal Leukoencephalopathy, 3 CMV, 4 Cryptococcus.