Dr. Graham HIV part 1 Flashcards
How long does it take for viral load to be positive on a PCR?
- 10 days the PCR will be positive for HIV RNA
Acute illness -> symptomatic disease
- often precedes positive ab test (15-25 days following the infection)
Eclipse phase of HIV infection
- time between infection and detectable HIV RNA (0-10 days following HIV transmission)
- no serological or blood test that will tell you that you have HIV
What is the window period of HIV infection?
- time b/t infection and detectable HIV abs (25 days following HIV transmission)
stage 3 HIV infection (AIDS)
- lab confirmation of HIV and CD4 count
Stage 1 HIV infection
- laboratory confirmation of HIV and CD4 count >500 cells/mm3 or CD4% >29%
Stage 2 HIV infection
- lab confirmation of HIV and CD4 count 200-499 cells/mm3 or CD4% 14-28
How many people are living with HIV in the US?
- 1.1 mill persons living with HIV in US
- 2.7-3.9 mill persons living with HCV in US
During the past 10 years, what has happened regarding the number of persons living with HIV in the U.S.?
the number has increased.
Why has the number of people living with AIDS increased in the U.S.?
- because of HAART, antiretroviral drugs that help keep the CD4 count up and extend HIV pt lifespans.
What % of HIV infected persons are unaware of their HIV status?
- 21% (1/5 people that have HIV unaware)
- this meds to an increased amount of HIV infections
What are the races/ethnicities that have the highest HIV rate in the US?
- Black and hispanics
Routine screening guidelines for HIV infection
- voluntary testing
- permission from pt required
- written consent shouldn’t be required
- prevention counseling not required in conjunction with screening
Goals of routine HIV screening?
-HIV screening -> HIV dx -> link to care -> improve survival and quality of life and prevent new HIV infections
Compare a normal molluscum contagious finding and non-normal finding?
- normal: just see a couple, common in daycare children
- not normal: way too many, growing on top of one another, or just out of control distribution
Other findings that may be normally seen in immunocompetent person but is out of control in HIV infected person?
- herpes simplex -> distal lesions -> ulcerate
- seborrheic dermatitis
- herpes zoster (shingles) -> see in a young pt or see hemorrhagic zoster, which covers 2-3 dermatomes
- kaposi’s sarcoma (really only seen in AIDS -> see all over skin, and palate
- oral hairy leukoplakia (not common in immunocompetent pts)
- out of control oral candidiasis
What is considered the cut-off for a positive tb skin test in an HIV-infected persons?
- greater than 5 mm of induration
- might be positive but doesn’t mean it is an active case of TB, could be latent
- Tx of latent TB?
- isoniazid x 9 months
- pyridoxine x 9 months
Major indication of prophylaxis tx for pneumocystis pneumonia?
CD4 less than 200 or oropharyngeal candidiasis
- tx: Bactrim
major indication of prophylaxis tx for Toxoplasma encephalitis?
- CD4 less than 100 and Toxoplasma IgG positive
- tx: bactrim
major indication of prophylaxis tx for disseminated Mycobaterium avium complex?
- CD4 less than 50 cells
tx: azithro
39 yo HIV pt presents with with 2 week hx of low grade fever, HA, and slight decline in mental status. CD4 count is 65 cells/mm3. What is this presentation consistent with?
- cryptococcal meningitis
- shows no signs of focal abnormalities or dementia (slight decline in mental status, but no dementia - pt is 39)
What will be positive in crytococcal meningitis?
- CSF cryptococcal antigen: positive in > 95% of cryptococcal meningitis cases
Preferred tx of cryptococcal meningitis?
- Amphotericin B + Fluctyosine
What is true regarding CNS toxoplasmosis?
- most patients have solitary lesion
- w/ tx >75% improve by day 14
- most have a CD4 count 200-300 cells/mm3
- Preferred therapy is Dapsone+ azithro
- w/ tx >75% improve by day 14
Preferred acute therapy for Toxoplasma encephalitis?
- Pyrimethamine + Sulfadiazine+ Leucovorin
Preferred tx of Pneumocystis Pneumonia?
- if severe Bactrim IV
- if mild-moderate oral Bactrim (100% bioavailable)
When would you give a pt with pneumocystis pneumonia corticosteroids?
if PO2 less than 70
What would you recommend as a tx for thrush?
- fluconazole
What would you do if a pt presents with IRIS after starting HIV meds?
- give steroids to decrease inflammation, don’t stop the HIV meds
What are the four indications for initiating antiretroviral therapy regardless of CD4 count?
- clinical AIDS
- pregnancy
- Chronic HBV
- HIVAN
- anyone infected with HIV should be tx with antiretroviral drugs
Should a woman with CD4 count of 470 and decreasing count and a boyfriend who is not infected with HIV start antiretroviral tx?
- yes she should, CD4 is decreasing and less chance of infecting boyfriend if viral load is low
- recommended that tx start below 500 CD4
Why do you want to start therapy earlier than later?
- more effective regimens
- more convenient regimens
- better tolerated therapy
- less long-term toxicity
- better immune recovery
- lower rates of resistance
- more tx options
- concerns for uncontrolled viremia
- decrease HIV transmission
When should you initiate ART? at what CD4 count?
- strongly recommended for all CD4 counts
What does a protease inhibitor do?
- used to boost the effectiveness of other drugs
- ritonavir
What is the backbone of ART?
- NUCs -> nucleoside reverse transcriptase inhibitor (truvada: combo of tenofovir/emtricitabine)
When should the viral load be undetectable during the ART regimen?
- within 12 -24 weeks, viral load should be undetectable
- if it is still detectable think about patient compliance or drug resistance
when does the viral load increase during the HIV infection?
- typically increases sharply after initial HIV infection, often reaching levels of 10s of millions, thereafter (4-8 weeks) the viral load typically settles into a lower level that remains relatively constant over the next several years. This level is called the baseline viral load, and it correlates with progression of disease, in general the higher the viral load, the faster CD4 cells are destroyed and the faster the patient will progress to AIDS. Also common to see baseline viral load increase to higher levels in end-stage disease
What is a signature sign of PCP?
- bat wings on CXR
What is norwegian scabies?
- plaque like lesions that will flourish in a person who is immunocompromised (HIV/AIDS)
