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Spach/Cutaneous/PP

Prevention of Opportunistic Infections David H. Spach, MD Medical Director, Northwest AIDS Education and Training Center Associate Professor of Medicine,Division of Infectious Diseases University of Washington, Seattle. Spach/Cutaneous/PP. Prevention of Opportunistic Infections

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Spach/Cutaneous/PP

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  1. Prevention of Opportunistic InfectionsDavid H. Spach, MDMedical Director, Northwest AIDS Education and Training CenterAssociate Professor of Medicine,Division of Infectious DiseasesUniversity of Washington, Seattle Spach/Cutaneous/PP

  2. Prevention of Opportunistic Infections 2001 USPHS/IDSA GuidelinesProphylaxis to Prevent First EpisodeStrongly Recommended as Standard of Care From: 2001 USPHS/IDSA Guidelines www.hivatis.org Spach/HIV/OIs/PP

  3. Mycobacteriumtuberculosis ProphylaxisIsoniazid-Sensitive PPD > 5 mm IndurationorContact with Case of Active Tuberculosis Isoniazid: 300 mg qd x 9 monthsplusPyridoxine: 50 mg qd x 9 months orIsoniazid: 900 mg 2x/week x 9 monthsplusPyridoxine: 50 mg qd x 9 months *Rifampin600 mg qd x 2 monthsplusPyrazinamide20 mg/kg/d x 2 months *Use Rifabutin 300 mg qd if patient on PI From: 2001 USPHS/IDSA Guidelines www.hivatis.org Spach/OI/PP

  4. Prevention of Tuberculosis in HIV-InfectedIsoniazid vs. Rifampin plus Pyrazinamide Study Design Results (% Patients) • Design - Randomized, Double-blinded • Patients (N = 1583) - HIV-infected, Age >13 - Multinational • Regimens - INH: 300 mg/d x 12 months - RIF 600 mg/d x 2 months + PZA 20 mg/kg/d x 2 months P = 0.28 P = 0.87 From: JAMA 2000;283:1445-50. Spach/ HIV/OIs/PP

  5. Rifampin + Pyrazinamide for Latent TuberculosisFatal & Severe Liver Injuries, Feb 12-Aug 24, 2001 • Patients (N =21)- Mean age = 44- One with known HCV- 11 tested for HIV, 0/11 with HIV- 3/21 with prior INH-associated liver toxicity • Outcome- 5 (24%) of 21 died- None had liver transplantation From: MMWR 2001;50:733-5. From Spach/HIV/OIs/PP

  6. Pneumocystiscarinii Pneumonia Prophylaxis CD4 Count < 200 cells/mm3orHistory of Oropharyngeal Candidiasis 2 1 2 2 TMP-SMX1 DS PO qd Dapsone100 mg PO qd Atovaquone1500 mg PO qd *AP300 mg q month Picture *AP = Aerosolized Pentamidine From: 2001 USPHS/IDSA Guidelines www.hivatis.org Spach/OI/PP

  7. Discontinuation of PCP ProphylaxisRecommendations from USPHS/IDSA Guidelines Criteria Setting CD4 > 200 for > 3 months CD4 > 200 for > 3 months Primary Prophylaxis Secondary Prophylaxis From: MMWR 2001;50 (RR-11):1-52. Spach/OI/PP

  8. Toxoplasmagondii Prophylaxis CD4 Count < 100 cells/mm3andToxoplasma IgG Antibody 1 2 TMP-SMX1 DS PO qd Dapsone:50 mg PO qdplusPyrimethamine:50 mg PO q weekplusLeucovorin:25 mg PO q week Picture From: 2001 USPHS/IDSA Guidelines www.hivatis.org Spach/OI/PP

  9. Discontinuation of Toxoplasmosis ProphylaxisRecommendations from USPHS/IDSA Guidelines Criteria Setting CD4 > 200 for > 3 months CD4 > 200 for > 6 months Completed Initial RX Asymptomatic for Toxo Primary Prophylaxis Secondary Prophylaxis From: MMWR 2001;50 (RR-11):1-52. Spach/OI/PP

  10. Mycobacteriumavium complex Prophylaxis CD4 Count < 50 cells/mm3 1 1 Azithromycin1200 mg PO once weekly Clarithromycin500 mg PO bid Picture From: 2001 USPHS/IDSA Guidelines www.hivatis.org Spach/OI/PP

  11. Discontinuation of MAC ProphylaxisRecommendations from USPHS/IDSA Guidelines Criteria Setting CD4 > 100 for > 3 months CD4 > 100 for > 6 months Completed 12 months MAC RX Asymptomatic for MAC Primary Prophylaxis Secondary Prophylaxis From: MMWR 2001;50 (RR-11):1-52. Spach/OI/PP

  12. Discontinuation of CMV ProphylaxisRecommendations from USPHS/IDSA Guidelines Criteria Setting Not Applicable CD4 > 100-150 for > 6 months No evidence of active disease Regular ophtho examinations Primary Prophylaxis Secondary Prophylaxis From: MMWR 2001;50 (RR-11):1-52. Spach/OI/PP

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