Teaching Points:

• Standard HAART Therapy
  • 2NRTIs + either of the following:
    • protease inhibitor
    • NNRTI
    • Integrase inhibitor
    • TeachingTeadfsTeadsfsadfds
• Etiologies of CNS involvement in a patient with HIV
  • Toxoplasmosis
  • CNS primary lymphoma
  • HSV infection
  • Cryptococcus
  • TB
  • Coccidiomycosis
• CSF Fluid Analysis
  • Bacterial
    • WBC 800-20k
    • Protein 100-500
    • Glucose <40
  • Viral
    • WBC 5-500
    • Protein 30-150
    • Glucose 30-70
  • Fungal
    • WBC 20-2k
    • Protein 30-150
    • Glucose 30-70
  • TB
    • WBC 5-2000
    • Protein 750
  • Normal
    • WBC 0-5
    • Protein 15-50
    • Glucose 45-100
• Cryptococcal infection can cause increase in opening pressure due to clogging of the arachnoid villi. This stresses importance of repeat LP until opening pressure goes back to normal.
• Crypto infections can also cause mass-like and cavitary pulmonary lesions. May disseminate to prostate, bone, GU, and skin, causing a molluscum-like skin rash
• Treatment
  • Amphoterecin + flucytosine x 2 weeks followed by fluconazole
  • Repeat LP until opening pressure normal.