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Infectious Disease II (P3 Spring) > Exam 2: HIV (Obrien) > Flashcards

Exam 2: HIV (Obrien) Flashcards

1
Q

1 in _____ are unaware that they are infected with HIV

A

7 (about 15%)

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2
Q

There are 2 main types of HIV.
HIV 1:_____
HIV 2:________ (2)

A

HIV 1: most widespread

HIV 2: less prevalent; found mainly in western africa

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3
Q

T/F The rates of HIV and AIDS diagnoses are LOWER in the South

A

FALSE; HIGHER

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4
Q

Overall, who is at the highest risk of acquiring HIV? (2)

A
  • African Americans (MSM)

- Hispanics

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5
Q

In order for HIV transmission to happen, what 4 conditions need to be present?

A
  • presence
  • quality
  • route
  • susceptibility
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6
Q

What 5 fluids have the HIGHEST amount of HIV which allows it to be easily transmitted?

A
  • blood
  • semen
  • vaginal secretions
  • rectal secretions
  • breast milk
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7
Q

What is the MOST common mode of transmission of HIV?

A

sexual, specifically receptive anal intercourse

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8
Q

The highest cause of pediatric HIV is due to PERINATAL transmission. How can this occur? (3)

A
  • during pregnancy (cross the placenta)
  • during birth
  • breast feeding
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9
Q

T/F Despite ART being highly effective at preventing transmission, fewer than 1/3 of HIV infected individuals have suppressed viral loads

A

TRUE

-due to undiagnosed HIV infection and failure to link or retain pts care

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10
Q

What is the first step in REDUCING the spread of HIV?

A

testing

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11
Q

The CDC advises routine HIV screening of (3)…. in the health care setting in the US

A

adults, adolescents, pregnant women

EVERYONE 13-64 y/o should be tested at least ONCE

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12
Q

How often should someone with risk factors be tested for HIV?

A

annually

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13
Q

HIV tests for Screening and diagnosis

-detect the PRESENCE OF ANTIBODIES that a person’s body makes AGAINST HIV

A

antibody test

home test and rapid test

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14
Q

HIV tests for Screening and diagnosis

  • detect both HIV antibodies AND antigen (p24)
  • recommended for initial testing
A

combination OR fourth generation tests

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15
Q

HIV tests for Screening and diagnosis

  • detects HIV the FASTEST by looking for HIV in the blood
  • NOT routinely used for HIV screening
A

NAT (nucleic acid test)

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16
Q

What are the 4 phases of HIV development?

A

1 eclipse period
2 seroconversion
3 acute infection
4 established HIV infection

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17
Q

What phase of HIV?

  • there are no detectable markers
  • time between infection and first detection of HIV
A

eclipse period

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18
Q

What phase of HIV?

-time between when the pt is infected w/ HIV and when ANTIBODIES DEVELOP

A

seroconversion

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19
Q

What phase of HIV?

  • when RNA plasma is present in the body
  • antibodies start developing
A

acute infection

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20
Q

What phase of HIV?

-when pt starts to develop IgG antibodies

A

established HIV infection

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21
Q

______ is detectable by 3rd generation test

A

IgM

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22
Q

Phases of HIV antibodies and antigens (4)

A

HIV RNA—> p 24 antigen–> IgM —> IgG

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23
Q

How many tests are needed to confirm that a pt has HIV?

A

2

the second test is typically what differentiates between HIV-1 and HIV-2

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24
Q

HIV Home test?

-involves pricking finger to collect blood sample

A

home access HIV-1 test system

25
Q

HIV Home test?

  • involves swabbing your mouth for oral fluids
  • up to 1 in 12 infected ppl may have false- negative test
A

OraQuick In-Home HIV test

26
Q

T/F Rate of sexual transmission during acute infection is 26 times as high as that during established HIV infection

A

TRUE

27
Q

CD4 count vs. CD4 %

A
  • CD4 Count: is the absolute number of CD4 cells

- CD4%: percentage of lymphocytes that are CD4

28
Q

Stage 1 of HIV infection

A

greater than or equal to 500 CD4 cells

29
Q

Stage 2 of HIV infection

A

200-499 CD4 cells

30
Q

Stage 3 of HIV (3)

A

also known as AIDS

  • less than 200 CD4 cells
  • OR documentation of AIDs defining conditions
31
Q

Although the clinical presentation of HIV varies and is nonspecific, most patient present with…..

A

mononucleosis-like illness for about 2 weeks

fever, HA, sore throat, fatigue, GI upset, weight loss, myalgia, rash, night sweats

32
Q

What are the 2 Main laboratory markers of HIV?

A
  • high viral load

- persistent DECREASE in CD4 lymphocytes

33
Q

Describe the POST ACUTE PHASE of HIV latency
CD4 count ________
HIV RNA plasma _____

A

CD4 increases in the blood again

HIV RNA declines

34
Q

What is the best marker of immune fxn in pts w/ HIV?

A

CD4 count

35
Q

How often is CD4 count obtained?

A

every 3-6 months

36
Q

How often is the HIV viral load obtained? (2)

A

every 3-6 months OR

2-8 weeks after initiation or change in ART

37
Q

Genotype vs. Phenotype

A

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)

38
Q

T/F HIV is most powerful co-factor for development of active TB

A

TRUE

39
Q

Besides TB, what other opportunistic infections are screened for in pts with HIV? (4)

A
  • toxoplasmosis (IgG)
  • syphilis (RPR)
  • varicella (IgG)
  • STDs
40
Q

What screening is recommended?
Recommended before starting patients on ABACAVIR-containing regimens to REDUCE the risk of hypersensitivity reaction (HSR)

A

HLA-B* 5701

usually done at baseline

if patient is POSITIVE, then they should not be prescribed abacavir

41
Q

What screening is recommended?

Identifies pts at risk for DAPSONE or PRIMAQUINE associated hemolysis

A

G6PD

usually done at baseline

42
Q

A patient SHOULD NOT receive a LIVE virus if CD4 count is

A

less than or equal to 200/mm

43
Q

What immunizations do pts with HIV need? (5)

A
  • influenza (annually)
  • pneumococcal vaccine
  • tetanus and diphtheria
  • Hep A and Hep B
44
Q

A patient’s HIV is considered UNDETECTABLE when …..

A

the viral load is below 50 copies/mL

45
Q

How do we achieve the goals associated with ART?

A

combo of THREE active antiretroviral agents from TWO different classes

46
Q

When should ART be started for HIV patients?deferred?

A

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)

47
Q

What 2 studies showed that immediate start of ARTs resulted in a 50% reduction in morbidity and mortality?

A
  • START
  • TEMPRANO

regardless of CD4 count–> start immediately

48
Q

If you are switching PK booster (Ritonavir to Cobistat OR vice versa) what do you need to consider?

A

drug interactions b/c both inhibit CYP 3A4

49
Q

What is the backbone of tx for naive patients w/ HIV?

A

2 NRTIs PLUS

  • PK-enhanced PI
  • NNRTI
  • INSTI
50
Q

Initial regimens for MOST ppl with HIV are usually _____ based

A

INSTI (gravir)

51
Q

How are the NRTIs usually paired?

A

abacavir + lamivudine OR

tenofivir (TDF or TAF) + emtricitabine

52
Q

Virologic Def:

HIV RNA level below the level of detection

A

virologic SUPPRESSION

53
Q

Virologic Def:

inability to achieve or maintain suppression of virologic replication to an HIV RNA level <200 copies/mL

A

virologic FAILURE

54
Q

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

A

incomplete virologic response

55
Q

GENOTYPE resistance pattern:

M184V (3)

A
  • emtricitabine
  • lamivudine
  • PLUS/MINUS abacavir
56
Q

GENOTYPE resistance pattern:

K65R

A
  • tenofovir

- abacavir

57
Q

GENOTYPE resistance pattern:

K103N

A

Efavirenz

58
Q

Sometimes, we keep pts on Emtricitabine or Lamivudine even though they are resistant , why?

A

b/c it makes the virus LESS virulent

both drugs have less SE

59
Q

What drug is used for PREP?

A

Truvada

Infectious Disease II (P3 Spring) (13 decks)

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