Exam 2: HIV (Obrien) Flashcards
1 in _____ are unaware that they are infected with HIV
7 (about 15%)
There are 2 main types of HIV.
HIV 1:_____
HIV 2:________ (2)
HIV 1: most widespread
HIV 2: less prevalent; found mainly in western africa
T/F The rates of HIV and AIDS diagnoses are LOWER in the South
FALSE; HIGHER
Overall, who is at the highest risk of acquiring HIV? (2)
- African Americans (MSM)
- Hispanics
In order for HIV transmission to happen, what 4 conditions need to be present?
- presence
- quality
- route
- susceptibility
What 5 fluids have the HIGHEST amount of HIV which allows it to be easily transmitted?
- blood
- semen
- vaginal secretions
- rectal secretions
- breast milk
What is the MOST common mode of transmission of HIV?
sexual, specifically receptive anal intercourse
The highest cause of pediatric HIV is due to PERINATAL transmission. How can this occur? (3)
- during pregnancy (cross the placenta)
- during birth
- breast feeding
T/F Despite ART being highly effective at preventing transmission, fewer than 1/3 of HIV infected individuals have suppressed viral loads
TRUE
-due to undiagnosed HIV infection and failure to link or retain pts care
What is the first step in REDUCING the spread of HIV?
testing
The CDC advises routine HIV screening of (3)…. in the health care setting in the US
adults, adolescents, pregnant women
EVERYONE 13-64 y/o should be tested at least ONCE
How often should someone with risk factors be tested for HIV?
annually
HIV tests for Screening and diagnosis
-detect the PRESENCE OF ANTIBODIES that a person’s body makes AGAINST HIV
antibody test
home test and rapid test
HIV tests for Screening and diagnosis
- detect both HIV antibodies AND antigen (p24)
- recommended for initial testing
combination OR fourth generation tests
HIV tests for Screening and diagnosis
- detects HIV the FASTEST by looking for HIV in the blood
- NOT routinely used for HIV screening
NAT (nucleic acid test)
What are the 4 phases of HIV development?
1 eclipse period
2 seroconversion
3 acute infection
4 established HIV infection
What phase of HIV?
- there are no detectable markers
- time between infection and first detection of HIV
eclipse period
What phase of HIV?
-time between when the pt is infected w/ HIV and when ANTIBODIES DEVELOP
seroconversion
What phase of HIV?
- when RNA plasma is present in the body
- antibodies start developing
acute infection
What phase of HIV?
-when pt starts to develop IgG antibodies
established HIV infection
______ is detectable by 3rd generation test
IgM
Phases of HIV antibodies and antigens (4)
HIV RNA—> p 24 antigen–> IgM —> IgG
How many tests are needed to confirm that a pt has HIV?
2
the second test is typically what differentiates between HIV-1 and HIV-2
HIV Home test?
-involves pricking finger to collect blood sample
home access HIV-1 test system
HIV Home test?
- involves swabbing your mouth for oral fluids
- up to 1 in 12 infected ppl may have false- negative test
OraQuick In-Home HIV test
T/F Rate of sexual transmission during acute infection is 26 times as high as that during established HIV infection
TRUE
CD4 count vs. CD4 %
- CD4 Count: is the absolute number of CD4 cells
- CD4%: percentage of lymphocytes that are CD4
Stage 1 of HIV infection
greater than or equal to 500 CD4 cells
Stage 2 of HIV infection
200-499 CD4 cells
Stage 3 of HIV (3)
also known as AIDS
- less than 200 CD4 cells
- OR documentation of AIDs defining conditions
Although the clinical presentation of HIV varies and is nonspecific, most patient present with…..
mononucleosis-like illness for about 2 weeks
fever, HA, sore throat, fatigue, GI upset, weight loss, myalgia, rash, night sweats
What are the 2 Main laboratory markers of HIV?
- high viral load
- persistent DECREASE in CD4 lymphocytes
Describe the POST ACUTE PHASE of HIV latency
CD4 count ________
HIV RNA plasma _____
CD4 increases in the blood again
HIV RNA declines
What is the best marker of immune fxn in pts w/ HIV?
CD4 count
How often is CD4 count obtained?
every 3-6 months
How often is the HIV viral load obtained? (2)
every 3-6 months OR
2-8 weeks after initiation or change in ART
Genotype vs. Phenotype
GENOtype: genes known to be specific mutations within the virus (USED AT BASELINE)
PHENOtype: how the drug affects the PATIENTS virus
-can asses interactions between mutations
(QUALITATIVE MEASURES)
T/F HIV is most powerful co-factor for development of active TB
TRUE
Besides TB, what other opportunistic infections are screened for in pts with HIV? (4)
- toxoplasmosis (IgG)
- syphilis (RPR)
- varicella (IgG)
- STDs
What screening is recommended?
Recommended before starting patients on ABACAVIR-containing regimens to REDUCE the risk of hypersensitivity reaction (HSR)
HLA-B* 5701
usually done at baseline
if patient is POSITIVE, then they should not be prescribed abacavir
What screening is recommended?
Identifies pts at risk for DAPSONE or PRIMAQUINE associated hemolysis
G6PD
usually done at baseline
A patient SHOULD NOT receive a LIVE virus if CD4 count is
less than or equal to 200/mm
What immunizations do pts with HIV need? (5)
- influenza (annually)
- pneumococcal vaccine
- tetanus and diphtheria
- Hep A and Hep B
A patient’s HIV is considered UNDETECTABLE when …..
the viral load is below 50 copies/mL
How do we achieve the goals associated with ART?
combo of THREE active antiretroviral agents from TWO different classes
When should ART be started for HIV patients?deferred?
immediately to reduce morbidity and mortality AND prevent HIV transmission
UNLESS pts has clinical and/or psychosocial factors that show pt will be non-adherent (tx needs to be deferred)
What 2 studies showed that immediate start of ARTs resulted in a 50% reduction in morbidity and mortality?
- START
- TEMPRANO
regardless of CD4 count–> start immediately
If you are switching PK booster (Ritonavir to Cobistat OR vice versa) what do you need to consider?
drug interactions b/c both inhibit CYP 3A4
What is the backbone of tx for naive patients w/ HIV?
2 NRTIs PLUS
- PK-enhanced PI
- NNRTI
- INSTI
Initial regimens for MOST ppl with HIV are usually _____ based
INSTI (gravir)
How are the NRTIs usually paired?
abacavir + lamivudine OR
tenofivir (TDF or TAF) + emtricitabine
Virologic Def:
HIV RNA level below the level of detection
virologic SUPPRESSION
Virologic Def:
inability to achieve or maintain suppression of virologic replication to an HIV RNA level <200 copies/mL
virologic FAILURE
Virologic Def:
TWO consecutive HIV RNA levels ≥200 copies/mL after 24 weeks on an ARV regimen in a patient who has not yet documented virologic suppression
incomplete virologic response
GENOTYPE resistance pattern:
M184V (3)
- emtricitabine
- lamivudine
- PLUS/MINUS abacavir
GENOTYPE resistance pattern:
K65R
- tenofovir
- abacavir
GENOTYPE resistance pattern:
K103N
Efavirenz
Sometimes, we keep pts on Emtricitabine or Lamivudine even though they are resistant , why?
b/c it makes the virus LESS virulent
both drugs have less SE
What drug is used for PREP?
Truvada
