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2.1) My Cards > 8. MTB Step 3 - HIV/AIDS > Flashcards

8. MTB Step 3 - HIV/AIDS Flashcards

1
Q

HIV/AIDS

What are (3) “MUST KNOW” Facts about HIV/AIDS?

A
  1. Adverse Effects of Medications
  2. Needle-stick Injury Management
  3. Pregnancy / Perinatal HIV Management
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2
Q

HIV/AIDS

Under which (5) Conditions should you Start Therapy for HIV/AIDS?

A
  1. CD4 Count < 500 (WITHOUT EXCEPTION),
  2. Symptomatic Patient with ANY CD4 Count
  3. Pregnant Women (ALL of them, ANY state of pregnancy, ANY CD4 Count)
  4. Needle-stick Scenario (where the patient is KNOWN to be HIV+)
  5. Strongly encouraged even > 500 CD4 Count if Viral Load detected
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3
Q

HIV/AIDS

What are (3) Combination Antiretroviral Therapies (HAART) for patients with HIV/AIDS?

A

2 NRTI’s (Tenofovir, Emtricitabine) + Integrase Inhibitor (RED-gravir)

  • Tenofovir + Emtricitabine + RED-gravir = Single Pill Combo
    • ​​Raltegravir,Elvitegravir,Dolutegravir
  • Lamivudine + Abacavir + RED-gravir
    • ​​Raltegravir,Elvitegravir,Dolutegravir

2 NRTI’S + Protease Inhibitor (-navir)

  • Tenofovir + Emtricitabine + Atazanavir (or Darunavir)
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4
Q

HIV/AIDS

When a Protease Inhibitor (-navir) is used in combination with Tenofovir + Emtricitabine which medication should be added to this combination, and why?

i.e., Protease Inhibitors: Atazanavir or Darunavir

A

Add:Ritonavir (small amount)

Why:Boosts the level of the other Protease Inhibitor (either Atazanavir or Darunavir)

How:Inhibits p450 systems (the route through which Protease Inhibitors are metabolized). A small amount of Ritonavir blocks metabolism of the other protease inhibitors, allowing higher blood levels with less frequent dosing.

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5
Q

HIV/AIDS

Which one of the NNRTI’s is More Prone to Drug Resistance, Avoided in Pregnancy, and Avoided with Mental Health issues?

A

Efavirenz

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6
Q

HIV/AIDS

Which one of the NRTIs should be Avoided in those who are Positive for the HLA-B*5701 mutation?

A

Abacavir

Causes Rash in those who are Positive for the HLA-B*5701 mutation.

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7
Q

HIV/AIDS

What is (1) Adverse Effect of the NRTI class of medications?

A

Lactic Acidosis

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8
Q

HIV/AIDS

What are (2) Adverse Effects of the Protease Inhibitors class of medications (eg, -navir)?

A
  1. Hyperglycemia
  2. Hyperlipidemia
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9
Q

HIV/AIDS

What is (1) Adverse Effects of the NNRTI class of medications (eg, Rilpivirine, Efavirenz, Nevirapine, Etravirine)?

A
  1. Drowsiness
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10
Q

HIV/AIDS

What is (1) Adverse Effect of the NRTI medication Zidovudine?

A

Anemia

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11
Q

HIV/AIDS

What are (2) Adverse Effects of the NRTI medications Didanosine & Stavudine?

A
  1. Pancreatitis
  2. Peripheral Neuropathy
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12
Q

HIV/AIDS

What is (1) Adverse Effect of the Protease Inhibitor medication Indinavir?

A

Kidney Stones / Nephrolithiasis

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13
Q

HIV/AIDS

What is the Mechanism of Action of Integrase Inhibitors (RED-gravir)

A
  • Prevents the Integration of the genetic material of the HIV Virus from being integrated into the CD4 cell chromosome.
  • HIV is an RNA Virus.
  • Reverse Transcriptase turns it into DNA, and this Viral DNA must be integrated into human DNA in order to be reproduced.
  • This is the step blocked by the integrase inhibitors.
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14
Q

HIV/AIDS

What is Chemokine Receptor 5 (CCR5)?

A

The mechanism whereby the HIV Virus enters the CD4 cell.

CCR5 is the attachment point of the GP120 on the surface of the HIV virus whereby it finds its way into human cells.

Maraviroc is an Entry Inhibitor: it Blocks the CCR5 receptor.

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15
Q

HIV/AIDS

What is the medication Cobicistat used for, and what is an Adverse Effect of the drug?

A

Cobicistat is added to Boost drug levels.

It can Falsely elevate creatinine levels

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16
Q

HIV/AIDS

What is meant by “Preexposure Prophylaxis (PrEP)?

A

The use of ART in uninfected persons before High-Risk events, such as Needle-sharing or Sexual contact, occur.

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17
Q

HIV/AIDS

What is the PrEP Treatment for the HIV Uninfected person before high-risk events?

A

2-Drug Combination

  • Tenofovir + Emtricitabine
    • Start BEFORE the First Exposure
    • Continued DAILY for 1-Month AFTER the Last Exposure
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18
Q

HIV/AIDS

What other Infectious Disease does the NRTI Medication Tenofovir treat and, therefore, should be tested for BEFORE starting therapy?

A

Hepatitis B

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19
Q

HIV/AIDS

What are (3) Adverse Effects of the older, Disoproxil, form of the NRTI drug Tenofovir?

A
  1. Renal Toxicity / RTA
  2. Bone Demineralization
  3. Fanconi Syndrome

Newer, Alafenamide, form of Tenofovir = LESS TOXIC

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20
Q

HIV/AIDS

What is the Postexposure Prophylaxis (PoEP) for ANY significant exposure to HIV-Positive Blood via a Needle-stick, Scalpel, Penetrating Injury, Mucosal Surfaces, or Unprotected Sex w/ HIV+ person?

A

Antiretroviral Therapy (ART) for 1-Month:

  • 2 NRTI’s + 1 Integrase Inhibitor (RED-gravir)

Start within 72-hours of exposure

Do NOT use Abacavir since you need to start therapy immediately and you do not have HLA-B*5701 testing available.

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21
Q

HIV/AIDS

What is the Risk Percentage of Mother-to-Child transmission of HIV/AIDS if the Mother is on fully suppressive Anti-Retroviral Therapy?

A

< 1%

Give 2 NRTIs + 1 Protease Inhibitor

22
Q

HIV/AIDS

At what CD4 Count would you Start Prophylaxis for Pneumocystis Jiroveci Pneumonia (PCP) in a patient with HIV/AIDS?

A

CD4 < 200 cells

23
Q

HIV/AIDS

Which Antibiotic is the Best Prophylaxis for Pneumocystis Jiroveci Pneumonia (PCP) by far?

A

TMP/SMX (Bactrim)

24
Q

HIV/AIDS

If the Best Prophylaxis for Pneumocystis Jiroveci Pneumonia (PCP) causes a Rash, which (2) medications should you switch to?

A
  1. Atovaquone, or
  2. Dapsone (cannot use in a patient with G6PD Deficiency)
25
Q

HIV/AIDS

OPPORTUNISTIC INFECTION PROPHYLAXIS

At what CD4 Count would you Start Prophylaxis for Mycobacterium Avium-Intracellulare (MAI) in a patient with HIV/AIDS?

A

CD4 < 50 cells

26
Q

HIV/AIDS

OPPORTUNISTIC INFECTION PROPHYLAXIS

Which Antibiotic is used for the Prophylaxis of Mycobacterium Avium-Intracellulare (MAI) in a patient with HIV/AIDS?

A

Azithromycin - Once a week orally

27
Q

HIV/AIDS

OPPORTUNISTIC INFECTIONS

What are (4) Clinical Presentation Findings in a patient with Pneumocystis Jiroveci Pneumonia (PCP)?

A
  1. Shortness of Breath (SOB)
  2. Dry Cough
  3. Hypoxia
  4. Increased LDH
28
Q

HIV/AIDS

OPPORTUNISTIC INFECTIONS

  1. What is the Best INITIAL Test for Pneumocystis Jiroveci Pneumonia (PCP)?
  2. What is the Most ACCURATE Test for Pneumocystis Jiroveci Pneumonia (PCP)
A
  1. Best INITIAL Test = CXR (increased interstitial markings bilaterally)
  2. Most ACCURATE Test = Bronchoalveolar Lavage (BAL)
29
Q

HIV/AIDS

OPPORTUNISTIC INFECTIONS

What is the Best INITIAL Treatment for Pneumocystis Jiroveci Pneumonia (PCP)?

A

TMP/SMP (IV)

30
Q

HIV/AIDS

OPPORTUNISTIC INFECTIONS

What are (2) Alternative Treatments for Pneumocystis Jiroveci Pneumonia (PCP) if the best initial treatment causes a Rash?

A
  1. Pentamidine (IV)
  2. Clindamycin + Primaquine
31
Q

HIV/AIDS

OPPORTUNISTIC INFECTIONS

What is (1) Treatment Option for MILD Pneumocystis Jiroveci Pneumonia (PCP)?

A

Atovaquone

Dapsone does NOT come in IV form and, therefore, canNOT be used to Treat PCP. It can ONLY be used for PCP Prophylaxis

32
Q

HIV/AIDS

OPPORTUNISTIC INFECTIONS

When would you give Steriods in the Treatment of Pneumocystis Jiroveci Pneumonia (PCP) and which (2) Diagnostic Findings would you use to decide?

A

SEVERE Pneumocystis Jiroveci Pneumonia (PCP):

Criteria

  1. pO2 < 70 or
  2. A - a gradient > 35
33
Q

HIV/AIDS

OPPORTUNISTIC INFECTIONS

What are (3) Signs/Symptoms to look for in a patient with Toxoplasmosis?

A
  1. Headache
  2. Nausea/Vomiting
  3. Focal Neurologic findings
34
Q

HIV/AIDS

OPPORTUNISTIC INFECTIONS

What is the Best INITIAL Test for Toxoplasmosis and what does it show?

A

Head CT w/ Contrast = “Ring”/Contrast-enhanced lesions

35
Q

HIV/AIDS

OPPORTUNISTIC INFECTIONS

What is the 2-Drug Treatment for Toxoplasmosis and what is the Duration of Treatment?

A

Pyrimethamine and Sulfadiazine x 2 weeks

36
Q

HIV/AIDS

OPPORTUNISTIC INFECTIONS

What is the Follow-up Management for a patient with Toxoplasmosis AFTER starting Initial Treatment?

A

Repeat Head CT following initial treatment with Pyrimethamine + Sulfadiazine x 2 weeks:

If the Lesions are Smaller = Confirmation of Toxoplasmosis

If the Lesions are Unchanged in Size ⇒ Perform a Brain Biopsy (most likely Lymphoma)

37
Q

HIV/AIDS

OPPORTUNISTIC INFECTIONS

What Medication can be used in the treatment of Toxoplasmosis as a substitute for Pyrimethamine??

A

Atovaquone

38
Q

HIV/AIDS

OPPORTUNISTIC INFECTIONS

What are (2) Common Findings in a patient with Cytomegalovirus (CMV) infection?

A
  1. < 50 CD4 cells
  2. Blurry Vision
39
Q

HIV/AIDS

OPPORTUNISTIC INFECTIONS

What is the ONLY method for diagnosing CMV?

A

Dilated Ophthalmologic examination

CMV is diagnosed by the Appearance of the Lesions on examination

40
Q

HIV/AIDS

OPPORTUNISTIC INFECTIONS

What (2) Medications can be used in the treatment of Cytomegalovirus (CMV)?

A
  1. Ganciclovir, or
  2. Foscarnet

Give the medication IV if the infection is immediately sight-threatening

41
Q

OPPORTUNISTIC INFECTIONS

What is the Maintenance Therapy for Cytomegalovirus (CMV)?

A

Valganciclovir lifelong (PO) unless the CD4 goes up with HAART.

If the CD4 rises, you can stop the CMV medications.

42
Q

OPPORTUNISTIC INFECTIONS

What are (3) Clinical Manifestations of Cryptococcus infection?

A
  1. < 50 CD4 cells
  2. Fever
  3. Headache

+/- Neck Stiffness and Photophobia (not always present)

43
Q

OPPORTUNISTIC INFECTIONS

  1. What is the Best INITIAL Test for Cryptococcus infection?
  2. What is the Next BEST Test for Cryptococcus infection?
  3. What is the Most ACCURATE Test for Cryptococcus infection?
A
  1. India Ink stain (only 60% sensitivity)
  2. Lumbar Puncture (LP) = Increase in Lymphocyte level in CSF
  3. Cryptococcal Antigen test ( > 95% Sensitive and Specific)
44
Q

OPPORTUNISTIC INFECTIONS

What are the (2) Medications given as Initial Treatment for Cryptococcus infection?

What Medication is given following the Initial Treatment for Cryptococcus infection?

A
  1. Amphotericin + 5-FC
  2. Fluconazole (continued Lifelong unless CD4 count Rises)
45
Q

OPPORTUNISTIC INFECTIONS

What are (2) Clinical Manifestations of Progressive Multifocal Leukoencephalopathy (PML)

A
  1. < 50 CD4 cells
  2. Focal Neurologic abnormalities
46
Q

OPPORTUNISTIC INFECTIONS

Which (2) Diagnostic Tests are considered equivalent as the Best INITIAL Test for Progressive Multifocal Leukoencephalopathy (PML)?

A
  1. Head CT = NO ring-enhancing lesions
  2. MRI Head = NO mass effect
47
Q

OPPORTUNISTIC INFECTIONS

What is the Most ACCURATE Test for Progressive Multifocal Leukoencephalopathy (PML)?

A

PCR of CSF for JC Virus

48
Q

OPPORTUNISTIC INFECTIONS

What is the Treatment for Progressive Multifocal Leukoencephalopathy (PML)?

A

Simply treat with HAART.

  • There is NO specific therapy available for PML.*
  • When the CD4 cell count rises on HAART, PML will resolve*
49
Q

OPPORTUNISTIC INFECTIONS

What are (6) the Clinical Manifestations of Mycobacterium Avium-Intracellulare (MAI) infection?

A
  1. HIV and < 50 CD4 cells
  2. Wasting w/ Weight Loss
  3. Fever
  4. Fatigue
  5. Anemia
  6. Increased Alkaline Phosphate & GGTP with a Normal Bilirubin is characteristic of Hepatic Involvement.
50
Q

OPPORTUNISTIC INFECTIONS

Which Test is MORE Sensitive than initial labs for Mycobacterium Avium-Intracellulare (MAI)?

A

Bone Marrow biopsy

51
Q

OPPORTUNISTIC INFECTIONS

What is the Most SENSITIVE Test for Mycobacterium Avium-Intracellulare (MAI)?

A

Liver biopsy

52
Q

OPPORTUNISTIC INFECTIONS

What are the (3) Medications given to treat Mycobacteria Avium-Intracellulare (MAI)?

A
  1. Azithromycin or Clarithromycin,
  2. Rifampin, and
  3. Ethambutol
  • Prophylaxis with Azithromycin*
  • Rifabutin is sometimes added to therapy.*

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