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Simmons NURP 503 Exam 4 > 11: HIV > Flashcards

11: HIV Flashcards

1
Q

What are the 2 prophylaxis regimens for ART?

A
  1. Postexposure - Use of ART recommended for a few days.

2. Preexposure - People who exhibit or plan to exhibit risky behavior.

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2
Q

What is the first symptom of HIV in infants?

A

Usually lymphadenopathy, followed by enlarged liver and spleen, then FTT, encephalopathy and low birth weight. Over time, diarrhea, pneumonia, thrush, and opportunistic infx. Prior to these symptoms, may see recurrent bacterial infx.

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3
Q

What is the best HIV test for a baby and why?

A

HIV DNA PCR b/c they retain their mother’s antibodies until 12-18 months of age. Antibody testing can be done after 18 months of age.

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4
Q

Symptoms develop within _____ weeks of infection.

A

4-6 weeks

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5
Q

Risk factors for HIV (5)?

A
  1. IV drug users/partners
  2. Sex workers
  3. Partners of HIV+
  4. Women with male partners who have sex with men
  5. More than 1 sex partner since last HIV test
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6
Q

With suspected acute HIV infx, what should you order (3)?

A
  1. Order HIV RNA
  2. Order HIV antibody (r/o previous infx)
  3. HIV p24 antigen test is available
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7
Q

What are early signs of HIV in adults?

A
  1. Generalized lymphadenopathy, unexplained weight loss, recurrent respiratory infections
  2. Shingles, oral sores, angular cheilitis
  3. Rashes such as pruritic papules, seborrhea, fungal nail infections
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8
Q

Which ethnicity is most affected by HIV in the US?

A

Black

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9
Q

What are signs of AIDS vs just HIV (5)?

A
  1. Opportunistic infx (Kaposi’s sarcoma)
  2. HIV encephalopathy
  3. Lymphoma
  4. Invasive cervical carcinoma
  5. Nephropathy and cardiomyopathy
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10
Q

What is the role of the NP in HIV (3)?

A
  1. Practice primary prevention.
  2. Respond quickly to acute infection.
  3. Comanage chronic infections with infectious disease.
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11
Q

80% of HIV+ infants will have symptoms by age _____ months.

A

12 months

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12
Q

What is the current recommendation of who receives ART?

A

All receive it. There are no exact CD4 counts that indicate initiation of therapy. Initiate to reduce risk of disease progression and prevention of transmission.

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13
Q

Which pregnant women should receive repeat HIV testing?

A

Those at high-risk who tested negative.

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14
Q

Where is HIV-2 most common?

A

Africa

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15
Q

ART is administered based on _____ and clinical manifestation.

A

CD4 count

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16
Q

What is the confirmation test for ELISA?

A

Western Blot

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17
Q

What test should be used intrapartum so that antiretrovirals can be given?

A

Rapid HIV test

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18
Q

What are the meds for exposed infants of untreated HIV+ mothers?

A

Zidovudine + Nevirapine

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19
Q

What is the landmark study on HIV+ mothers and infants?

A

ACTG 076 Study

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20
Q

How often is CD4 percentage monitored?

A

Q 3-4 months

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21
Q

What are long-term effects seen in babies with HIV (3)?

A
  1. Cardiac hypertrophy/CHF
  2. Anemia
  3. Malignancies
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22
Q

What do you test prior to treatment?

A

Genotypic testing and drug resistance testing

23
Q

What is the risk of vertical transmission with HIV+ mothers?

A
  1. Untreated = 25.5%
  2. Treated = 8.3%
  3. Multiple medication therapy has reduced rate to <2%.
24
Q

What is the confirmation test for babies who get HIV DNA PCR?

A

HIV RNA Assay (viral load)

25
Q

What are benefits of early ART intervention (2)?

A
  1. Prevent HIV-related end-organ damage.

2. Decrease risk of complications.

26
Q

What are 4 considerations for deferral of ART?

A
  1. With low CD4 count, deferral considered only in unusual situations and with close follow-up.
  2. With significant barriers to adherence.
  3. With comorbidities that complicate or prohibit ART.
  4. With subgroup of long-term nonprogressors.
27
Q

T/F Teens prefer to receive sexual education from their PCP.

A

True

28
Q

T/F If side effects to ART are problematic, reducing drug dose helps.

A

False. Do NOT reduce drug doses as there is increased risk of drug resistance.

29
Q

_____ and _____ common in HIV+ infants.

A

FTT and irritability

30
Q

What vaccines should HIV+ children receive?

A

Flu annually. Live vaccines are risky. Decided on case-by-case basis.

31
Q

What is the medication and dose for infants exposed to HIV if their mothers were on therapy?

A

Zidovudine 2 mg/kg/dose 4x/day within 8-12 hours after birth. Continue for 6 weeks.

32
Q

What are common side effects of ART (4)?

A
  1. Hematologic: drug-induced bone marrow suppression
  2. Mitochondrial dysfunction: lactic acidosis, hepatic toxicity, pancreatitis
  3. Lipodystrophy and metabolic abnormalities
  4. Allergic reactions: skin rashes, hypersensitivity
33
Q

All infants born to HIV+ moms should start on PCP prophylaxis at _____ weeks of age and stay on until HIV is ruled out completely.

A

6 weeks. If HIV infx is confirmed in infant, continue therapy until 1 year, or based on CD4 count.

34
Q

Which type of HIV is more easily transmitted from mother to child?

A

HIV-1

35
Q

Who gets HIV the most in the US?

A

White MSM, followed by black MSM.

36
Q

What lab test is used for children under 5 to monitor HIV?

A

CD4 percentage. HIV RNA (viral load) is also monitored in all ages.

37
Q

Are adults or children the largest population with HIV?

A

Adults

38
Q

Why is number of those infected with HIV increasing if the rate of new infections is stable at ~50,000/year?

A

Longer life expectancy after diagnosis.

39
Q

15-20% of untreated HIV+ infants will die by age _____.

A

4

40
Q

Most common type of HIV in the US?

A

HIV-1 Subtype B

41
Q

Who should be tested and when (5)?

A
  1. Everyone (13-64) tested at least 1x in lifetime.
  2. High-risk tested annually.
  3. Pregnant women tested with each pregnancy.
  4. STI complaints
  5. TB treatment
    Opt-out screening should be utilized.
42
Q

Pediatric HIV infection is asymptomatic within the first _____ weeks of life.

A

6 weeks

43
Q

Why must you maximize treatment adherence?

A

To prevent resistance.

44
Q

What has a high mortality rate in HIV+ infants?

A

PCP pneumonia

45
Q

Who is most likely to be diagnosed with HIV late (3)?

A
  1. Blacks
  2. Hispanics
  3. Heterosexuals
46
Q

What are the guidelines for deciding on ART?

A

Use combination agents of at least 3 drugs from at least 2 categories. Base it on HIV type, future treatment options. Drug resistance and cross-resistance is a MAJOR factor in choice of agent.

47
Q

What is the most common HIV test?

A

Antibody ELISA confirmed by Western Blot

48
Q

T/F If the patient refuses to completely comply with treatment, they should not be treated.

A

True. If patient will not or cannot comply completely, do not treat due to threat of resistance.

49
Q

T/F At 4-6 weeks post exposure to HIV, HIV antibody is negative but the person is highly contagious.

A

True. There is a burst of viremia. Duration is 2-3 weeks and resolves spontaneously, leading to misdiagnosis.

50
Q

What is a concern with adolescents with HIV?

A

ART may interact with contraception.

51
Q

T/F C-section should be considered to decrease risk of HIV transmission to fetus.

A

True

52
Q

How does age affect the HIV prognosis?

A

Children under 1 year have highest risk of progression. Children over 5 are comparable to adults.

53
Q

How often is HIV RNA (viral load) monitored?

A

Q 3-4 months

54
Q

What are crucial markers in acute HIV infx?

A

Presence of rash and/or oral ulcers.

Simmons NURP 503 Exam 4 (17 decks)

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