Chapter 25 (Infectious Diseases IV: Opportunistic Infections) Flashcards

PM has been on antiretroviral therapy for eight years. During the last clinic visit, he had signs of drug resistance on his laboratory workup. The CD4 count was 350 cells/mm³. Which of the following medications should be prescribed to prevent an opportunistic infection (OI)?

A 37-year-old female with HIV presented to her outpatient clinic. She was noted to have white plaques on her tongue and cheek. What treatment should be initiated?

GG is a 32-year-old female who comes to the office to discuss treatment options for HIV. She was recently diagnosed during an evaluation for fatigue and weight loss. She reports no rash, fever, cough, or night sweats, and her recent physical exam was unremarkable.

Past Medical History: IV drug use (stopped 3 years ago), chlamydia infection (8 months ago), migraine headaches

Social History: several sexual partners in her lifetime, currently in a monogamous relationship, no current use of recreational drugs or tobacco

Allergies: sulfa (hives)

CD4 count 180 cells/mm³

Additional Information: genotype results and all other baseline testing (hepatitis, tuberculosis, sexually transmitted infections) reviewed; initiate antiretroviral therapy with Truvada and Tivicay; counsel on adherence; follow-up in 2 weeks

In addition to antiretroviral therapy, which prophylactic medication is most appropriate for this patient?

LM is a 36-year-old female who was diagnosed with HIV in July. She was immediately started on ART with Tivicay and Descovy. She struggled with adherence and in September she stopped taking her ART medications altogether. In February, LM finally agreed to restart ART. Her recent CD4 count and viral loads are listed below.

7/14 (diagnosis)
Viral load: 44,732 copies/mL
CD4+: 137 cells/mm³

Which of the following should have been initiated on 7/14?

LM is a 36-year-old female who was diagnosed with HIV in July. She was immediately started on ART with Tivicay and Descovy. She struggled with adherence and in September she stopped taking her ART medications altogether. In February, LM finally agreed to restart ART. Her recent CD4 count and viral loads are listed below.

11/15
Viral load: 72,376 copies/mL
CD4+: 38 cells/mm³

Which of the following should have been initiated on 11/15?

TT, an HIV-positive male patient, comes to the emergency department accompanied by a friend. He has been noted to have altered mental status and has complained of severe headaches for the last 4 days. A lumbar puncture with cerebral spinal fluid Gram stain reveals many WBC and yeast. TT's CD4 count is 88 cells/mm³. TT is started on amphotericin B deoxycholate plus flucytosine. What condition has TT most likely developed?

QT is a 41-year-old male who was diagnosed with HIV in January after he presented to his primary care provider with severe oral candidiasis. At the time of his diagnosis he was started on Prezista, ritonavir, Descovy, Bactrim DS daily, azithromycin 1,200 mg weekly and fluconazole 200 mg daily for 10 days. He takes Crestor, hydrochlorothiazide and Protonix for his other medical problems. His most recent CD4 count and viral load results are listed below.

9/17 (today)
Viral load: <50 copies/mL
CD4: 206 cell/mm³

Which of the following is appropriate at this time?

TS is a 62-year-old male with multiple medical problems, including HIV. He was diagnosed with HIV one year ago and started on antiretroviral therapy. He has never had an opportunistic infection. He is currently taking the following medications: Truvada, Tivicay, Bactrim DS, Zestril, Lasix, Coreg, Lantus and Protonix. His most recent CD4 and HIV viral load results are listed below.

9/15 (today)

Viral load: <50 copies/mL CD4: 230 cell/mm³

What change in the medication regimen should be recommended today?

RB is a 38-year-old male who is HIV-positive with a CD4 count of 37 cells/mm³. He is not currently taking antiretroviral therapy but is taking Bactrim prophylaxis. Which medication should also be prescribed at this time?

A 45-year-old male with HIV has a CD4 count of 93 cells/mm³ and a positive toxoplasma IgG. Which of the following opportunistic infections should he receive prophylaxis against at this time? (Select ALL that apply.)

A patient is started on dapsone + pyrimethamine + leucovorin for primary prophylaxis of Pneumocystis pneumonia. What is the purpose of leucovorin in this regimen?

PS is an immunosuppressed transplant patient who requires a medication to prevent Pneumocystis pneumonia. She reports an itchy rash when taking Bactrim in the past. Which of the following drugs should be recommended?

VT is a 41-year-old male with HIV. He has recently recovered from an episode of esophageal candidiasis. Which of the following should be prescribed for him in order to prevent further episodes of candidiasis?

Which of the following would create an immunocompromised state? (Select ALL that apply.)

MK is a 31-year-old male who presents to the HIV clinic today for a routine appointment. He is doing well and has no complaints at this time.

Allergies: NKDA

Past Medical History: HIV x 9 years (no history of opportunistic infections), hypothyroidism

Social History: Smokes 1 pack of cigarettes per day (trying to quit)

Medications: Stribild 1 tablet daily, levothyroxine 150 mcg daily, nicotine patch 21 mg/day

CD4 (800 – 1,100 cells/mm³)=142

Which medication should be prescribed for MK?

CV is a 39-year-old male with HIV and CMV retinitis. His response to valganciclovir was poor and additional viral testing shows the development of resistance to valganciclovir. Which of the following alternatives would be expected to have activity in this case? (Select ALL that apply.)

What is the preferred regimen for the treatment of Toxoplasmosis gondii encephalitis?

Which of the following best represents guideline criteria for discontinuation of Mycobacterium avium complex primary prophylaxis?

All of the following disease-treatment pairs is correct EXCEPT:

An HIV-positive patient with a history of poor medication adherence has a CD4 count less than 50 cells/mm³. He develops cytomegalovirus (CMV) retinitis. Which of the following medications has activity against CMV?

History of Present Illness: SM is a 36-year-old male who presents to the HIV clinic for a routine appointment. He is doing well and has no major complaints at this time. He states that he uses his albuterol inhaler 4 days per week (about 6 puffs on each of those days) and has been trying over-the-counter medications to manage occasional heartburn.

Allergies: sulfa (hives)

Past Medical History: HIV (no history of opportunistic infections)AsthmaDyslipidemia

Medications: Truvada 1 tablet PO dailyTivicay 50 mg PO dailyAlbuterol MDI 1-2 inhalations 3-4 times daily, as neededAfrin 2-3 sprays in each nostril twice daily, as needed Simvastatin 20 mg PO QHS

CD4+ (cells/mm³) = 126 (800 – 1,100)

Which of the following should be added to SM's medication regimen?

What is a preferred regimen for primary prophylaxis of Pneumocystis pneumonia?