User:Gmoren5/Opportunistic infections: Difference between revisions

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Article Draft

Talk:

Hello, I am a fourth-year medical student participating in the WikiMed course at my university. I’m excited to be able to participate in this article and would welcome any suggestions or advice for my following edits. I am mainly focused on the prophylactic medication section. I want to add other infections we should be aware of when starting prophylactic medications. I also want to add more information on the indication sections, as CD4 count is not the only indication to start prophylactic medication. I want to add a new section discussing when it is appropriate to discontinue the medication. And finally, I want to update and add alternative medications when suggesting the agent.

Below is the bibliography, where I will be referring to the information. Thank you in advance for your suggestions and advice.

https://www.eacsociety.org/media/final2021eacsguidelinesv11.0_oct2021.pdf --> EU society guidelines for opportunistic infections, last updated in 2021

https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-oi/guidelines-adult-adolescent-oi.pdf --> CDC and NIH guidelines for opportunistic infections, updated regularly

https://www.ncbi.nlm.nih.gov/books/NBK567851/pdf/Bookshelf_NBK567851.pdf --> New York clinical guideline for HIV care, updated in 2021

Lead

Prophylactic medications

Individuals at higher risk are often prescribed prophylactic medication to prevent an infection from occurring. A patient's risk level for developing an opportunistic infection is approximated using the person's CD4 T-cell count and other indications. The table below provides information regarding common opportunistic infections and their treatment management.

Article body


Opportunistic infections	Indication(s) for prophylactic medications	Preferred agent(s)	When to discontinue agent(s)	Secondary prophylactic/maintenance agent(s)
Mycobacterium tuberculosis	Upon diagnosis of HIV, any positive screening test, or prior medical history of Mycobacterium tuberculosis.	Rifampicin Isoniazid Pyridoxine Pyrazinamide Ethambutol	These agents will discontinue after two months. Depending on clinical presentation, maintenance agents will continue for at least four more months.	Rifampicin, isoniazid, and pyridoxine
Pneumocystis jiroveci	CD4 count is less than 200 cells/mm³ or less than 14%. The person has documented medical history of recurrent oropharyngeal candidiasis.	Trimethoprim-sulfamethoxazole	These agent(s) will discontinue after 21 days. Secondary prophylactic agents will continue until the CD4 count is above 200 cells/mm³ and HIV viral load is undetectable for at least three months while taking antiretroviral therapy.	Trimethoprim-sulfamethoxazole
Toxoplasma gondii	CD4 count is less than 100 cells/mm³ or less than 14%, and the person has a positive serology for Toxoplasma gondii.	Trimethoprim-sulfamethoxazole	These agent(s) will discontinue after six weeks. Secondary prophylactic medications will continue until the CD4 count is above 200 cells/mm³ and HIV viral load is undetectable for at least six months while taking antiretroviral therapy.	Sulfadiazine, pyrimethamine, and folinic acid
Mycobacterium avium complex disease	CD4 count is less than 50 cells/mm³ and has a detectable viral load while taking antiretroviral therapy.	Clarithromycin and ethambutol Rifabutin may be added depending on clinical presentation.	These agent(s) will discontinue after 12 months only if the person does not have any symptoms that will be concerning for persistent Mycobacterium avium complex disease and their CD4 count is above 100 cells/mm³, and while their HIV viral load is undetectable for at least six months while taking antiretroviral therapy.	N/A

Alternative agents can be used instead of the preferred agents. These alternative agents may be used due to allergies, availability, or clinical presentation. The alternative agents are listed in the table below.


Opportunistic infections	Alternative agent(s)
Mycobacterium tuberculosis	Rifabutin
Pneumocystis jiroveci	Dapsone Atovaquone Pentamidine
Toxoplasma gondii	Dapsone, pyrimethamine, and folinic acid Atovaquone, pyrimethamine, and folinic acid
Mycobacterium avium complex disease	Azithromycin and ethambutol

References

https://www.eacsociety.org/media/final2021eacsguidelinesv11.0_oct2021.pdf --> EU society guidelines for opportunistic infections, last updated in 2021

https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-oi/guidelines-adult-adolescent-oi.pdf --> CDC and NIH guidelines for opportunistic infections, updated regularly

https://www.ncbi.nlm.nih.gov/books/NBK567851/pdf/Bookshelf_NBK567851.pdf --> New York clinical guideline for HIV care, updated in 2021

@@ Line 17: / Line 17: @@
 === Lead ===
 Prophylactic medications
+Individuals at higher risk are often prescribed prophylactic medication to prevent an infection from occurring. A patient's risk level for developing an opportunistic infection is approximated using the person's [[CD4|CD4 T-cell count]] and other indications. The table below provides information regarding common opportunistic infections and their treatment management.
 === Article body ===
@@ Line 23: / Line 25: @@
 !Opportunistic infections
 !Indication(s) for prophylactic medications
-!Preferred agent(s) or (''alternative agent'')
+!Preferred agent(s)
 !When to discontinue agent(s)
 !Secondary prophylactic/maintenance agent(s)
@@ Line 43: / Line 45: @@
 |
 * [[Trimethoprim/sulfamethoxazole|Trimethoprim-sulfamethoxazole]]
-|These agent(s) will discontinue after 21 days. Secondary prophylactic agents will continue until the CD4 count is above 200 cells/mm<sup>3</sup> and HIV viral load is undetectable for at least three months while taking antiretroviral therapy.
+|These agent(s) will discontinue after 21 days. Secondary prophylactic agents will continue until the CD4 count is above 200 cells/mm<sup>3</sup> and HIV viral load is undetectable for at least three months while taking [[antiretroviral therapy]].
 |
 * Trimethoprim-sulfamethoxazole
@@ Line 54: / Line 56: @@
 |These agent(s) will discontinue after six weeks. Secondary prophylactic medications will continue until the CD4 count is above 200 cells/mm<sup>3</sup> and HIV viral load is undetectable for at least six months while taking antiretroviral therapy.
 |
-* [[Sulfadiazine]], pyrimethamine, and folinic acid
+* [[Sulfadiazine]], [[pyrimethamine]], and [[folinic acid]]
 |-
 |[[Mycobacterium avium-intracellulare infection|Mycobacterium avium complex disease]]
-|CD4 count is less than 50 cells/mm<sup>3</sup> and has a detectable viral load while taking [[Management of HIV/AIDS|antiretroviral therapy]].
+|CD4 count is less than 50 cells/mm<sup>3</sup> and has a detectable viral load while taking antiretroviral therapy.
 |
 * [[Clarithromycin]] and ethambutol
@@ Line 83: / Line 85: @@
 |[[Toxoplasma gondii]]
 |
-* Dapsone, [[pyrimethamine]], and [[folinic acid]]
+* Dapsone, pyrimethamine, and folinic acid
 * Atovaquone, pyrimethamine, and folinic acid
 |-