Indiana University Infectious Diseases Fellowship
1 Feb,
8 tweets, 6 min read
#idboardreview 20 M PLWH CD4 30 VL 500k w/ pulmonary TB at time of HIV diagnosis. Started on RIPE immediately, ART started 2 wks later. 4 wks post ART: headache & weakness. Diagnosis? #meded #idmedEd #idtwitter 
CNS TB #IRIS Immune reconstitution syndrome: Continue ART and RIPE; NSAIDs if mild, steroids if more severe/refractory prednisone 1.5mg/kg/d x2wk f/u 0.75mg/kg/d x2wks
PLWH #HIV + active #TB #idboardreview #idmedEd #hivmedEd #IRIS
-if CD4 <50: can start ART within 2 wks of starting RIPE
-if CD4 >50: start ART within 8 weeks of starting RIPE
-pregnant+HIV+TB: start ART ASAP for maternal health
-if TB meningitis+HIV: wait 8 wks to start ART
-if CD4 <50: can start ART within 2 wks of starting RIPE
-if CD4 >50: start ART within 8 weeks of starting RIPE
-pregnant+HIV+TB: start ART ASAP for maternal health
-if TB meningitis+HIV: wait 8 wks to start ART
#TB CNS #IRIS two presentations:
(1) Paradoxical worsening of TB when ART is started after RIPE or
(2) unmasking TB when ART started in setting of non-recognized TB
(1) Paradoxical worsening of TB when ART is started after RIPE or
(2) unmasking TB when ART started in setting of non-recognized TB
Typically 2wks to 3 months post ART
-Risk factors #CNS #TB #IRIS
CD4 <50, high pre-ART VL, severe TB, short interval b/w intiation of RIPE & ART
-Protean manifestations: Fever, new lesions, extension of prior lesions
-Risk factors #CNS #TB #IRIS
CD4 <50, high pre-ART VL, severe TB, short interval b/w intiation of RIPE & ART
-Protean manifestations: Fever, new lesions, extension of prior lesions
CNS #TB #IRIS w/ new or worsening meningitis and/or features of raised ICP, due to enlarging cerebral tuberculomas or intracranial abscesses; mortality is high 12%-25%. It may also present with spondylitis, epidural abscesses, and radiculomyelopathy
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