Herpes Treatment in HIV+ Patients
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Questions and Answers

What is the duration of treatment for a patient with HIV+ who is prescribed acyclovir for herpes infection?

  • 10-14 days
  • 5-10 days (correct)
  • 3-7 days
  • 7-14 days

    • For daily suppressive therapy in HIV+ patients, which of the following dosages is NOT appropriate for acyclovir?

  • 600 mg po tid (correct)
  • 800 mg po bid
  • 400 mg po bid
  • 400 mg po tid

    • In the treatment of neonatal herpes with disseminated/CNS infection, which of the following dosing regimens is correct?

  • 30 mg/kg IV q12h for 14 days
  • 10 mg/kg IV q8h for 14 days
  • 15 mg/kg IV q6h for 21 days
  • 20-60 mg/kg IV q8h for 21 days (correct)

    • What is the recommended treatment for suspected acyclovir resistance in herpes infections?

    <p>Topical Cidofovir 1% gel applied to lesions qd x 5 days</p> Signup and view all the answers

    Which statement about herpes encephalitis caused by HSV is accurate?

    <p>Empirical treatment should start immediately.</p> Signup and view all the answers

    What is a common complication of chickenpox that requires attention?

    <p>Bacterial infection of blisters</p> Signup and view all the answers

    What is the recommended dose for children aged 12 months to 12 years receiving the Varicella vaccine?

    <p>0.5 mL subcutaneously</p> Signup and view all the answers

    What occurs as a result of the reactivation of the Varicella Zoster Virus (VZV)?

    <p>Herpes Zoster</p> Signup and view all the answers

    Which medication is proven effective for treating localized and disseminated VZV?

    <p>Acyclovir</p> Signup and view all the answers

    Which of the following is NOT FDA-approved for treating post-herpetic neuralgia (PHN)?

    <p>Acetaminophen</p> Signup and view all the answers

    What vaccine is currently recommended in the U.S. as the preferred shingles vaccine?

    <p>Recombinant zoster vaccine (RZV, Shingrix)</p> Signup and view all the answers

    What is the dose of Acyclovir for treating disseminated VZV?

    <p>800 mg po 5 times a day for 7-10 days</p> Signup and view all the answers

    What role does Varizig® play in the management of Varicella Zoster Virus exposure?

    <p>Reduces incidence or severity of disease</p> Signup and view all the answers

    Which virus is included in the egg-based flu vaccine recommendations for the year 2021?

    <p>A/Darwin/9/2021 (H3N2)-like virus</p> Signup and view all the answers

    What is the primary mode of transmission for hantavirus infection based on the content provided?

    <p>Inhalation of aerosolized particles from rodent droppings</p> Signup and view all the answers

    Which of the following is a characteristic symptom of Hantavirus Pulmonary Syndrome (HPS)?

    <p>Fever and myalgia with rapid progression to ARDS</p> Signup and view all the answers

    What is the current treatment approach for Hantavirus infections mentioned in the content?

    <p>Supportive care with no FDA-approved drugs</p> Signup and view all the answers

    Which virus is identified as a vector-borne disease transmitted by mosquitoes?

    <p>West Nile Virus</p> Signup and view all the answers

    What is the recommended supportive treatment for West Nile Virus according to the content?

    <p>Supportive care as current antivirals are ineffective</p> Signup and view all the answers

    What symptom is commonly associated with severe cases of West Nile Virus?

    <p>Encephalitis</p> Signup and view all the answers

    Which of the following viruses has no approved protocols for treatment according to the provided content?

    <p>Hantavirus</p> Signup and view all the answers

    What is the primary mode of COVID-19 transmission?

    <p>From person to person via respiratory droplets</p> Signup and view all the answers

    Which vaccine is primarily used against mpox during the current outbreak in the United States?

    <p>JYNNEOS</p> Signup and view all the answers

    What is a common characteristic of the spread of COVID-19?

    <p>Transmission can occur from asymptomatic individuals</p> Signup and view all the answers

    Which treatment is NOT listed for managing mpox disease?

    <p>Remdesivir</p> Signup and view all the answers

    What additional route of COVID-19 transmission is indicated aside from person-to-person spread?

    <p>Transmission via contaminated objects and surfaces</p> Signup and view all the answers

    Which of the following vaccines is used under an Expanded Access Investigational New Drug protocol for mpox?

    <p>ACAM2000</p> Signup and view all the answers

    What type of droplets are responsible for the spread of COVID-19?

    <p>Respiratory droplets released when talking, sneezing, or coughing</p> Signup and view all the answers

    Which of the following statements about the COVID-19 pandemic is true?

    <p>Travel-related exportation of COVID-19 cases has been reported</p> Signup and view all the answers

    What is the primary mechanism by which ganciclovir and valganciclovir exert their effect?

    <p>Inhibits viral DNA synthesis</p> Signup and view all the answers

    Which adverse effect is common with the use of foscarnet?

    <p>Renal impairment</p> Signup and view all the answers

    What percentage of Americans over the age of 35 are CMV positive?

    <p>81%</p> Signup and view all the answers

    Which treatment is specifically indicated for the prevention of CMV infection in allogeneic stem cell transplant patients?

    <p>Letermovir</p> Signup and view all the answers

    What is the likely onset of symptoms for influenza compared to a common cold?

    <p>Sudden for influenza, gradual for cold</p> Signup and view all the answers

    What differentiates Type A influenza from Type B regarding the evolution of the virus?

    <p>Type A causes pandemics due to antigenic shift</p> Signup and view all the answers

    Which gastrointestinal condition is commonly associated with CMV in immunocompromised patients?

    <p>Esophagitis</p> Signup and view all the answers

    What is a common lab diagnostic method to identify CMV infection?

    <p>Tissue culture</p> Signup and view all the answers

    Which antiviral agent needs to be administered with caution due to its potential for renal toxicity?

    <p>Foscarnet</p> Signup and view all the answers

    How is cytomegalovirus typically transmitted?

    <p>Congenital and through contaminated blood products</p> Signup and view all the answers

    In terms of drug interactions, what is a major consideration when using cidofovir?

    <p>Needs hydration and probenecid co-administration</p> Signup and view all the answers

    Which of the following adverse effects is less commonly associated with ganciclovir treatment?

    <p>Fatigue and lethargy</p> Signup and view all the answers

    In patients with AIDS, which condition is the most common manifestation of CMV?

    <p>Chorioretinitis</p> Signup and view all the answers

    What should be done if a patient's CD4 count exceeds 100 for three to six months regarding secondary prophylaxis for CMV?

    <p>Discontinue prophylaxis</p> Signup and view all the answers

    Study Notes

    Herpes Treatment in HIV+ Patients

    • Acyclovir dosing for infections: 400 mg PO tid for 5-10 days, or 200 mg PO five times daily, or Famciclovir 500 mg PO bid, or Valacyclovir 1 g PO bid for the same duration.
    • Daily suppressive therapy options include Acyclovir 400-800 mg PO bid-tid, Famciclovir 500 mg PO bid, or Valacyclovir 500 mg PO bid.
    • If resistance is suspected, options include Foscarnet 40 mg/kg IV every 8 hours until clinical resolution or topical Cidofovir 1% gel daily for 5 days.

    Herpes Encephalitis

    • Associated with both HSV-1 (in adults) and HSV-2 (in newborns).
    • Diagnosis via cultures for HSV-2 in CSF, PCR preferred for rapid results.
    • Mortality ranges from 50-85%; early diagnosis is crucial.
    • Empirical treatment: Acyclovir 5-10 mg/kg every 8 hours for 2-3 weeks; Foscarnet indicated for resistant cases.

    Neonatal Herpes

    • Transmission occurs during pregnancy, leading to significant morbidity and mortality.
    • Acyclovir 20-60 mg/kg IV every 8 hours for 21 days for disseminated/CNS infections, or 14 days for limited skin/mucous membrane infections.

    Oral-Facial Herpes

    • Treatment varies based on immune status; common complication post-chickenpox is bacterial infection of blisters.

    Chicken Pox Management

    • Supportive care: cool baths, calamine lotion, topical antipruritic; aspirin is contraindicated.

    Varicella Zoster Virus (VZV)

    • Reactivation of latent virus causes Herpes-Zoster; affects ~67% of individuals over 40.
    • Symptoms include erythematous macules and grouped vesicles; resolves in 2-4 weeks.
    • Common treatment includes Acyclovir, Famciclovir, and Valacyclovir; corticosteroids use is controversial.

    Drug Dosing for Herpes-Zoster

    • Acyclovir: 800 mg PO five times daily for 7-10 days.
    • Famciclovir: 500 mg PO three times daily for 7 days.
    • Valacyclovir: 1 g PO three times daily for 7 days.

    Post-Herpetic Neuralgia (PHN)

    • Lasts over 30 days post-rash onset; FDA-approved treatments include topical capsaicin, lidocaine patches, gabapentin, and pregabalin.
    • Recombinant zoster vaccine (Shingrix) recommended for shingles prevention.

    Cytomegalovirus (CMV) Infections

    • High prevalence: 53% in 18-25 age group, 81% in >35, with >90% in MSM.
    • Transmitted through congenital routes, sexual contact, and blood products; often remains asymptomatic until immunosuppression.
    • Common manifestations include chorioretinitis, GI infections, pneumonia, CNS infections, and retinitis.

    Treatment for CMV

    • Primary agents: Ganciclovir, Valganciclovir, Foscarnet, Cidofovir.
    • Ganciclovir: Induction with 900 mg BID for 14-21 days, maintenance with 900 mg daily.
    • Foscarnet: Reserved for resistant strains; can cause renal impairment.

    Prophylaxis for CMV

    • Secondary prophylaxis recommended; may discontinue if CD4 count >100 for 3-6 months. Primary prophylaxis is not recommended.

    Influenza Overview

    • Seasonal virus (peak in winter); mortality highest in individuals over 65, particularly those with comorbidities.
    • Transmission primarily via respiratory droplets; incubation averages 2 days.

    Types of Influenza

    • Type A: Defined by hemagglutinin/neuraminidase variations (e.g., H1N1, H3N2); pandemics result from antigenic shifts.
    • Type B: Prone to mutations; epidemics occur every 5 years.

    Influenza Treatment

    • Antivirals (Amantadine, Rimantadine) not recommended according to current guidelines.
    • Vaccination key; includes egg-based and cell-based composition tailored to circulating strains.

    Hantavirus Infections

    • Primarily rodent-borne; manifests as Hemorrhagic Fever, Nephropathia Epidemica, or Hantavirus Pulmonary Syndrome (HPS).
    • Supportive treatment; no FDA-approved drugs; IV ribavirin under study.

    West Nile Virus

    • Transmitted by mosquitoes; symptoms range from mild febrile illness to severe encephalitis.
    • Treatment is largely supportive; no effective antivirals available.

    COVID-19 Transmission and Prevention

    • Primarily person-to-person via respiratory droplets; also possible via contaminated surfaces.
    • Vaccines available: Moderna, Pfizer, J&J, Novavax, contributing to preventive strategies against the disease.

    Monkey Pox Virus

    • Outbreak caused by Clade IIb; treatment options include Tecovirimat, Brincidofovir, and Vaccinia Immune Globulin.
    • JYNNEOS vaccine is commonly used for prevention during outbreaks.

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    Viral Infections Management & Treatment - IT3 PDF

    Description

    This quiz covers the treatment options for herpes in HIV-positive individuals, including acute and suppressive therapies. It outlines dosages for medications such as Acyclovir, Famciclovir, and Valacyclovir. Additionally, the quiz discusses treatment options in cases of resistance.

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