– seeing someone with oral thrush, candida is a RED FLAG
– could be – pneumocystis jirovecii (fungus)
– if there are also bacterial infections, more destruction!
– know the HIV/AIDS drugs & MOA e.g., cytokine inbititors, protease inhib., intergrase inhib.
– (primary prophylaxis) Trimethoprim-sulfamethoxazole-induced Steven Johnson syndrome in an HIV-infected patient. Trimethoprim-sulfamethoxazole (TMP/SMX) is a widely prescribed antimicrobial.
– In the early stages, you might see acterial pneumonia, TB, or oral thrush and others..
– In the late stage where CD4 < 200 there maybe pneumocystis pneumonia, disseminated TB, atypical mycobacteria, cryptococcus, toxoplamosis.
(Pneumocystis pneumonia (PCP) is a form of pneumonia, caused by the yeast-like fungus, Pneumocystis jirovecii. Pneumocystis pneumonia is not commonly found in the lungs of healthy people, but, being a source of opportunistic infection, it can cause a lung infection in people with a weak immune system).
– when there is sustained CD4 >200, discontinuation of antibiotic prophylaxis is possible
– remember that with ACE inhib. (- pril), there is an increase in bradykinin which may lead to dry cough, so replace the ACE if causing a dry cough
– think about the reasons for hypoxemia (see ABG lecture)
– watch out for V/Q mismatch/hypoventilation, if you see a pt with sats of 89% on room air, and corrects to 94% on 4L 02…something is not right, think of the cause
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
NRTIs force the HIV virus to use faulty versions of building blocks so infected cells can’t make more HIV.
- Abacavir, or ABC (Ziagen)
- Didanosine, or ddl (Videx)
- Emtricitabine, or FTC (Emtriva)
- Lamivudine, or 3TC (Epivir)
- Stavudine, or d4T (Zerit)
- Tenofovir, or TDF (Viread)
- Zidovudine, or AZT or ZDV (Retrovir)
Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
These are also called “non-nukes.” NNRTIs bind to a specific protein so the HIV virus can’t make copies of itself, similar to jamming a zipper.
- Delavirdine (Rescriptor)
- Efavirenz (Sustiva)
- Etravirine (Intelence)
- Nevirapine (Viramune)
- Rilpivirine (Edurant)
Protease Inhibitors (PIs)
These drugs block a protein that infected cells need to put together new copies of the HIV virus.
- Atazanavir, or ATV (Reyataz)
- Darunavir, or DRV (Prezista)
- Fosamprenavir, or FPV (Lexiva)
- Indinavir, or IDV (Crixivan)
- Lopinavir + ritonavir, or LPV/r (Kaletra)
- Nelfinavir, or NFV (Viracept)
- Ritonavir, or RTV (Norvir)
- Saquinavir, or SQV (Invirase)
- Tipranavir, or TPV (Aptivus)
Cobicistat (Tybost) is a drug that helps atazanavir and darunavir work better, but it can cause life-threatening kidney problems if you take it with certain other medicines.
- Atazanavir + cobicistat, or ATV/COBI (Evotaz)
- Darunavir + cobicistat, or DRV/COBI (Prezcobix)
Unlike NRTIs, NNRTIs, and PIs — which work on infected cells — these drugs help block HIV from getting inside healthy cells in the first place.
Maraviroc, or MVC (Selzentry), also stops HIV before it gets inside a healthy cell, but in a different way than fusion inhibitors. It blocks a specific kind of “hook” on the outside of certain cells so the virus can’t plug in.
These stop HIV from making copies of itself by blocking a key protein that allows the virus to put its DNA into the healthy cell’s DNA. They’re also called integrase strand transfer inhibitors (INSTIs).
Some drug manufacturers put together specific medicines into a single pill so they’re easier to take, including:
- Abacavir + dolutegravir + lamivudine, or ABC/DTG/3TC (Triumeq)
- Abacavir + lamivudine, or ABC/3TC (Epzicom)
- Abacavir + lamivudine + zidovudine, or ABC/3TC/ZDV (Trizivir)
- Efavirenz + emtricitabine + tenofovir, or EFV/FTC/TDF (Atripla, Tribuss)
- Elvitegravir + cobicistat + emtricitabine + tenofovir, or EVG/COBI/FTC/TAF or ECF/TAF (Genvoya)
- Elvitegravir + cobicistat + emtricitabine + tenofovir, or EVG/COBI/FTC/TDF or ECF/TDF (Stribild)
- Emtricitabine + rilpivirine + tenofovir, or FTC/RPV/TAF (Odefsey)
- Emtricitabine + rilpivirine + tenofovir, or FTC/RPV/TDF (Complera)
- Emtricitabine + tenofovir, or TAF/FTC (Descovy)
- Emtricitabine + tenofovir, or TDF/FTC (Truvada)
- Lamivudine + zidovudine, or 3TC/ZDV (Combivir)
Truvada has also been approved as a way to prevent HIV infection for people who are at high risk. Even if you take it, you have to practice safe sex, too.
HIV Diagnostic tests:
4 stages of infection
– flu-like illness (acute stage)
– feeling fine (latent stage)
– virus replicates in lymph nodes
– falling CD4 count
– final crisis
Immune reconstitution inflammatory syndrome (IRIS) (also known as immune recovery syndrome) is a condition seen in some cases of AIDS or immunosuppression, in which the immune system begins to recover, but then responds to a previously acquired opportunistic infection with an overwhelming inflammatory response that paradoxically makes the symptoms of infection worse.
2. Goodpasture Syndrome (scroll down)
|apidly progressive glomerulonephritis||
– Alpha3 chain of type 4 collagen
– HLA – DR2, youg women, old men
– plasmaporesis, cyclophosphamide, corticisteroids (e.g., prednisone)
– deposits of IgG in basement membranes of glomerulus and alveolar BM.
– HLA DR2, DR4, DR15
– hemoptysis, low-grade fever, myalgias…
– Dx, anti-GBM antibodies, ELISA
– atypical pneumnia, dark urine, could be dehydration
– NC domain, non-collagnous portion
– Type 2 antibody reaction (immune complex membrane attack)
– unmasking hidded epitopes
– DDx, IgA nephropathy, vasculitis (ANCAS)
– act fast as rapidly fatal!
Q: what organisms would you see in bacterial tracheitis?
A: Bacterial tracheitis is usually caused by Staphylococcus aureus bacteria. Other bacteria can also cause it, including:
– hemagglutinin (binds virus to cells, viral entry)
– neuroamidase (virus replication and translation)
– Drift (small change, slow) vs shift Major change (rapid, pandemic), Only influenza A can do this
– gram neg, bortatella pertussis
– 7 to 9 yrs old
– toxin causes damage, inhibits macs, polys
– affects cilliated epithelial cells
– neutrophils cause damage too
– DDx PAH for older pts.
Whooping cough has 4 stages
- incubation (7-10 days)
- no symptoms
- catarrhal (1-2 wks)
- most contagious phase
- similar to mild upper respiratory infection
- low grade fever
- paroxysmal (2-4 wks)
- characteristic bursts of nonproductive cough with “whoops”
- attacks become less frequent
- complications may develop (pneumonia, seizures, encephalopathy)
5. Croup / epiglottitis / tracheitis
– INSPIRATORY STRIDOR
– VIRAL, RSV, Influenza, admission, adenovirus, mycoplasma pneumonia
– 3rd generation cephalosporin g.neg and g.pos
– normal diameter of the throat is 6-7 cm for kids, 15 cm for adults, so lower radius leads to incre. in resistance
– kids, 3-5
- parainfluenza virus is most common cause of croup (#2 RSV) (diagnose with PCR)
Epiglottitis link (scroll down a bit)