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Immunology 3 > #9 HIV CLinical case > Flashcards

#9 HIV CLinical case Flashcards

1
Q

Guidelines for monitoring AIDS

A

Screen any pts, aged 13-64 once at any healtcare setting
Any pregant person at initial visit and in the 3rd treimester
Annually if : IVDU, commercial sex, more then one sex partner since last HIV test

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2
Q

Statistics show: testing reduces transmission:

A

54% of infections are caused by 25% of people unaware they are infected vs… 75% are aware of infection and cause only 46% of transmission

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3
Q

What are the Benefits of Testing

A
  1. diagnosis allows indi to get antiretroviral tx = decreased mortality
  2. 32% of new HIV cases also diagnosed w/in 1 year
  3. missed opportuniteis is don’t test in clinic~~~ most HIV+ have had previous visits to clinic
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4
Q

Acute retroviral syndrome

______wks post infection see primary response to infection

A

2-6

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5
Q
  1. Symptoms seen in 80% for acute retroviral syndrome:
A

a. fever (80%)
b. Arthralgia/myalgia (54%)
c. anorexia/weight loss (54%)
d. rash and lympadenopathy
e. fatigue and malaise
f. pharygitis and oral ulcers

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6
Q

1% of ind tested for infectious mono were + for acute HIV!!! Not mono (did a test of blood samples)

A

when we did a blood test for mono

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7
Q

Comon symptoms of acute retroviral syndrome

A

anrthalgia/anorexia/rash

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8
Q

During acute retroviral syndrome we see: High levels of _______

A

viremia

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9
Q

During viremia of acute retroviral syndrome we see what in regard to viral load and infectious aspect?

A

widespread seeding of other lymph tissues w/ high viral lode and really infectious
22xs more infectious to others than in chronic HIV phase

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10
Q

What do we see happen to CD4 cells or HIV CD8-T cells?

A

Decreased CD4 cells circulating
HIV specific CD8-T cell reponse contains infection
~~during acute retroviral syndrome

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11
Q

The Antibody test shows up:

A

negative until 4-6 wks post infection

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12
Q

For the AntiB test we use ELISA, its affordable and fast and we can detect IgM in the blood from

A

(detect IgM for HIV from week 3 until 24 weeks)

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13
Q

If an ELISA comes back +… what do we do

A

follow up with Western Blot

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14
Q

Benefits of antigent test:

A

Antigen test: detect infection after 10-14 days but very expensive

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15
Q

What are we ‘looking for’ in the antigen test

the specific antiG and timeframe

A

looks for HIV viral load/RNA

p24 antigen detection (only detected week 2-4)

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16
Q

Whats a fast and cheap way to do HIV RNA testing?

A

Pooled HIV RNA testing: samples of 20-90 pts: cheaper and faster and increases yield of HIV testing by 10% compared to antiB testing alone

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17
Q

Resistance of HIV prior to tx:

A

d/t inhereted strain mutation from person you got it from

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18
Q

Goals of HIV tx

A

a. undetectable viral lode (less then 20 copies/uL)
Increase CD4T cells
eliminate HIV-related symptoms

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19
Q

HIV tx follow Tcell counts every ___ months

Current consensus: start tx if CD4 is below ______ cells/mm3 or you can offer tx at any CD4 level

A

3 months

500 cells/mm3

20
Q

Antiretroviral tx recommendation

A
  1. 3 meds and 2 classes of drugs
    1. Classes
      a. Nucleoside reverse transctiptase inhibitors (NRTIs)~~ most commonly chosen
      b. Nonnucleoside reverse transcriptase inhibitor (NNRTI)
      c. Protease inhibitor (PI)
      d. Integrase inhibitor or fusion inhibitor or CCR5 R antagonist
21
Q

Integrase inhibitor or fusion inhibitor or ______R antagonist

A

CCR5

22
Q

Preferred guidelines: use 2 NRTI’s and then another based on

A

genetics of virus and pt response

23
Q

We didn’t see a decline in death age d/t HIV until we had

A

the 3 drug tx regimen in 1996

24
Q

Perinatal transmission

1. HIV infected pregnant woman: has \_\_\_\_\_chance she would infect her baby
2. Mom on AZT orally, IV during labor and the baby receiving it orally—\_\_\_\_\_ chance
A

25%

8%

25
Q

Standard of care for pregnant women: HAART to mother –_______ + IV AZT at labor and AZT to baby X6 wks and formula feed~~~ see 0-1%

A

2nd trimester

26
Q

HIV viral loads

Determines liki-hood of transmission:

A

as viral load increases, so does the likilhood of transmission: especially male to female

27
Q

When people go off meds……

A

their viral loads increase as does their chance for transmitting the virus

28
Q

Saw NO transmission when viral load is less then _______

A

1500

29
Q

Test and tx strategy:
1. Universal HIV testing and immediate ARVs
Expected results:

A

see 1/1000 in in 10 yrs with a prevalance of under 1% in under 50 yrs → goal is put on immediate HAART once HIV +
→ this would reduce 8 million deaths d/t AIDS

30
Q

HIV exposure

Main modes Transmission

A

Needle sharing (67%),
receptive anal sex,
percutaneous needle stick,
receptive penile vaginal intercourse, insertive anal intercourse,
instertive penile-vaginal intercourse (6.5%), receptive oral an instertive oral

31
Q

Largest cause of HIV transmission

A

needle sharing
receptive anal sex
percutaneous needle stick

32
Q

rule of 3’s

A

Hep B = 30% Hep C = 3% HIV = .3%

for transmission per 1 exposure

33
Q

Pecuratnous injury (needlestick or cut) OR contact of mucous membrane or non-intact skin WITH

A

a. blood and tissue (other potentially fluids—CSF, synovial, vaginal, pericardial, amnionic, semen or vag)

34
Q

What will NOT cause transmission

A

NOT infectious for HIV unless bloody: feces, nasal secreations, urine, sweat, tears, vomit, saliva

35
Q

factors associated with injury more likely to cause transmission:

A

deep injury, visible blood on device, intravascular devic,e terminally ill

36
Q

ARBs for post-exposure prophylaxsis (PEP)

1. started in health care settins d/t 400,000 needlesticks/yr

A
  • -started in healthcare setting
  • -initiate 2-3 drug therapy within 72 hours
  • -saw that HIV seroconverters were 80% less likely to have taken PEP
37
Q

Post-exposure prophy in non health-care related is applicable for:

A

for sexual exposure to HIV (nonoccupational, nPEP)

~~feasible, especially dedicated prograoma and its timely ARVs and expensive

38
Q

Pre-exposure prophylaxsis (PrEP):

A
  1. an HIV uninfected ind uses antiretroviral meds ahead of HIV exposure
  2. presence of HIV antiretrovirals in blood/tissue, makes difficult for HIV to establish infection
39
Q
  1. an HIV uninfected ind uses antiretroviral meds ahead of HIV exposure
    1. presence of HIV antiretrovirals in blood/tissue, makes difficult for HIV to establish infection
A

use PrEP

40
Q

Prescribing PrEP

a. Before:

A

assess sexual risk/ Screen for HIV and STIs

41
Q

Inination or PrEP:

A

reinforce adherence, discuss additional risk reduction methods

42
Q

On PrEP how do we monitor our patients

A

Every 3 months: HIV testing and STI testing and assess medication adherence
every 6 moths: monitor kidney fnx and assess sexual risk

43
Q

Every 3 months:

every 6 moths:

A
  • HIV testing and STI testing and assess medication adherence
  • monitor kidney fnx and assess sexual risk
44
Q

3 RCTs of PEP

A

a. iPrEx in men-men saw 44% protection with iPrEx
b. Partners that PrEP in hetorsexual couples saw 75% HIV protection
c. TDF2 in male and femal saw 56% HIV protection

45
Q

Adherence and efficacy in PrEP trials

A

a. saw a clear dose response between evidence of PrEP use and efficacy
b. higher the tenofovir levels, the lower the incidence of spread
c. if you take tenofovir you see 90% reduction in transmission

Immunology 3 (20 decks)

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