AIDS Opportunitistic Infection

PCP (CD4<200): first occuring opportunitistic disease

Dx: bronchoscopy with lavage
lab: increased LDH
Txt: TMP-SMZ, steroid if severe
Prophylaxis: TMP/SMZ, Dapsone, Atovaquane, Pentamidine, if CD4<200

Cryptococcosis (CD4<100)
meningitis
Dx: CSF: india ink + antigen test, lower CSF cell count --> worse
Txt: amphotericin + fluconazole
Prophylaxis: not recommended

Cytomegalovirus (CD4<50)

retinitis + colitis + esophagitis + encephalitis
Dx: fundoscopy of retinitis + endoscopic biopsies
Txt: Valganciclovir P.O., IV ganciclovir if sever, foscarnet and cidofovir if resistant
A.E.: ganciclovir --> neutropenia foscarnet and cidofovir --> renal toxicity


MAC (CD4<50)
fever + night sweats + bacteria + wasting + anemia + diarrhea
Dx: culture of blood, BM, and other tissues
Txt: clarithromycin + ethambutol
Prophylaxis: azithromycin, clarithromycin if CD4<100

Toxoplasmosis (CD4<50)
Brain mass lesion
Dx: CT or MRI contrast shows ring enhancing lesion, shrink after trial therapy
serology, CSF PCR
Txt: Pyrimethamine + sulfadiazine
Prophylaxis: TMP/SMZ