ART for HIV Infected Patients Flashcards
What two lab values are used when considering start ART in an HIV patient
CD4 count: indicator of immune function and predictor of disease progression. Helps determine treatment response as well.
HIV RNA: helps monitor ART response too
What are we trying to achieve with ART, in terms of labs
CD4: 50-150cell/uL increase /year
HIV RNA: 20-75 copies/mL
Regardless of CD4 count, you start ART in these cases:
- History of AIDS defining illness
- Pregnant woman
- HIV-associated nephropathy
- HBV co-infection
- Acute opportunistic infections
- > 50 years old
When do you start ART based on CD4 counts?
–CD4 count less than 350 cells/µL (AI)
–CD4 count 350 to 500 cells/µL (AI)
–CD4 count greater than 500 cells/µL (AI) was (BIII)
When should you consider deferral of ART?
- When there are significant barriers to adherence
- If there are co-morbidities that complicate or prohibit ART
- When you have “elite controllers” and long term non-progressors (basically people who have very low viral counts and aren’t progressing in their disease)
What are the benefits to early therapy?
- Prevent AIDS or AIDS defining illness
2. Prevent HIV related end organ damage
What are the risks of early therapy?
- Drug related toxicity
- Nonadherence
- Drug resistance
- Cost
- Transmission of an ART resistant virus if incomplete virology suppression occurs.
What are some common ART combination therapies?
- 2 NRTIs + PI*
- 2 NRTIs + NNRTI*
- 2 NRTIs + ISI* (integrase strand inhibitor)
*most powerful in stopping viral replication
Remember: 2+1 (2 NRTIs+1 other drug)
Can you use mono therapy for HIV?
NO
When should a pregnant lady with HIV get a C-section
Viral load >1000
or if VL is unknown
or if no history of ART
Baby gets post-exposure prophylactic AZT for 6 months
