1
Q

What type of virus is HIV

A

retrovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

HIV Patho

A

There are two types HIV-1, HIV-2
HIV-2 is only seen in migrants from a certain part of Africa or in that specific location its self
Primarily infects CD4 tHelper cells by attaching to receptors on the CD4 membrane. The virus is released into cytoplasm of CD4. RNA>DNA>into nucleus>integrated into CD4 DNA>new viral RNA is created>viral proteins created>packaged together by protease>buds off of CD4 membrane to infect a new cell. Very rapid process.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CD4 count

A

measured in cells per mm
Normal: 800-1000/mm3
Symptoms begin when CD4 is around 500
<200 is dx of AIDS- you’ll see opportunistic infx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Viral load

A

measured in copies per mL
Goal is undetectable
<20 in the most sensitive tests
as the immune system fails, levels can reach up to 10to the 7th per mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Timeline of untreated HIV

A

-First 6 weeks: viral load increases rapidly, CD4 count decreases rapidly. May have flu like symptoms
-6-12 weeks: CD4 some what normalizes, viral load decreases- detectible.
over the next 8-10 years: viral load is detectible, CD4 decreases, viral load increases. pt becomes severely immunocompromised
increased viral load is causative factor with reduced CD4 being the resulting factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When to start HIV treatment

A

Immediately once the pt is diagnosed - stronger recommendation with the lower CD4 counts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Early treatment initiation:

A
pregnancy
AIDS defining condition
CD4 <200
Rapid decline of CD4
high viral load > 100000 copies 
HIVAN
Hep B, Hep C, other coinfections
Over age 50
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ARV use pearls

A

mono therapy is harmful
HIV can mutate quickly, must sty on effective med as Rx
viral suppression requires a very high adherence of 95 percent or higher
high cost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Resistance testing

A

genotype: shows genetic sequencing- shows mutations to ARVs
Order at Dx, before ARV initiation, rebound of viral load
in all pregnant women before initiation
minimum viral load required for accurate testing is 500-1000 copies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

5 classes of ARV are

A

fusion/entry inhibitors- prevents fusion to CD4 cell

nucleoside reverse transcriptase inhibitors NRTI and
nonnucleoside reverse transcriptase inhibitors NNRTI- both prevent transcription of RNA to DNA

integrase inhibitors II- prevent insertion
Protease inhibitors PI- inhibits the protease that packages the viral DNA/protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Caveats to initial regimen

A
  • ABC should not be used in pt who test + for HLA-B 5701
  • TDF should be used with caution in renal insuffcency,-also known to decrease BMD
  • DTG may cause higher risk of NTD when taken at time of conception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

LABS

A

MET panel first 5-7 weeks

Renal Fx and urine q/6mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Biktarvy

A
ARV
3-in-1 pill
Bictegravir-TAF-emtricitabine 
preferred regimen: II and 2 NRTI
same pregnancy concerns as DTG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Biktarvy

A
ARV
3-in-1 pill, once a day 
BIC-TAF-FTC
preferred regimen: II and 2 NRTI
same pregnancy concerns as DTG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Triumeq

A
ARV
3-in-1 pill, once a day 
DTG-ABC-3TC
preferred regimen: II and 2 NRTI
needs genetic testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ongoing monitoring of ARV treatment

A
viral load checked at 2-8wk after initial admin
VL should be undetectable at 12-24wk
CD4-VL every 3-6mos, PRN
CMP, CBC, Fasting BG 3-6mo or PRN
Kidney function for all pt on TDF
17
Q

Opportunistic Infections

A

Community acquired Infx, HIV related Infx
all OI improve with reconstitution of immune system

PCP
candidiasis
KArposi Sarcoma

18
Q

PCP- pneumocystis Jiroveci PNA

A
Aids defining OI
CD4 <200
progressive, cough fever, chest pain
some pt may have a clean CXR
Rx- TMP/SMX 15-20/75-100mg/kg/d TID/QID for 14-21 days 
Taper steroids if hypoxic < 90
19
Q

OI prophylaxis for PCP

A

CD4<200
TMP/SMX DS 1 daily
Dapsone 100mg daily
my dc when CD4 >200 x 3mos

20
Q

candidiasis

A

Fluconazole 200mg PO daily x 14 days

21
Q

OI prophylaxis for MAC

A

CD4<50
azithromycin 1200mg weekly, or 250mg daily

clarithromycin 500mg BID

22
Q

Gold Standard for HIV testing

A

.

23
Q

False positives can come from

A

.

24
Q

False negatives can come from

A

.

25
Q

Reverse transcriptase

A

.

26
Q

Which HIV med is not really excreted

A

.

27
Q

4 initial regimens for HIV

A

BIC+TAF/FTC-
DTG+ABC/3TC-
DTG+TDF/FTC-
RAL+TDF/FTC-

28
Q

TDF/FTC is what

A

Truvada

29
Q

BIC+TAF/FTC- is what

A

.

30
Q

DTG+TDF/FTC- is what

A

.

31
Q

RAL+TDF/FTC- is what

A

.

32
Q

DTG+ABC/3TC- is what

A

.