EXAM 4: HIV & Transplant

Question 1

What has HIV infection been, since 1984, known to be derived from?

Answer 1

zoonotic origin

Question 2

What many are diagnosed with HIV worldwide? in the US?

Answer 2

37 mil and 1.2 mil

Question 3

How many are believed to be undiagnosed/unaware?

Answer 3

162,500 HIV positive in US are unaware of status

Question 4

What are CDCs three goals for HIV?

Answer 4

1) prevention 2) early detection, staging, surveillance, 3) treatment!

Question 5

HIV is a retrOvirus - what is the virus component mean?

Answer 5

an onbligate intracellular parasite

Question 6

HIV is a retrOvirus - what is the retro component mean?

Answer 6

only had RNA instead of DNA

Question 7

We know that HIV invades T lymphocyte cells (CD4), macrophages, and some CNS cells - what is the implication?

Answer 7

detroys effective immune functioning against infections and cancer

Question 8

When a resting infecting CD4 becomes activated against HIV or other pathogens - what two things happen?

Answer 8

1) begins to produce new copies of both viral RNA and viral proteins 2) which leads to destruction of host CD4 & spread of infection

Question 9

What stage is AIDS in HIV infection?

Answer 9

Stage 3, severly immunocompromised

Question 10

What is goal in suppressing HIV replication?

Answer 10

get to a level below which drug-resistant mutations do not emerge

Question 11

In reducing HIV-assoc. morbidity/mortality - what is the goal?

Answer 11

prolong LIFE and improve quality of life

Question 12

In suppressing HIV to restore and preserve immmunoligic function - what should CD4 count range be?

Answer 12

500-1500 / mm^3

Question 13

When suppressing HIV viral load, where shoudl the viral load count be in order to be “undetectable”

Answer 13

less than 20-75/ml

Question 14

For HIV medications, what does ART stand for?

Answer 14

Anti-retrovirus therapy - least aggressive form

Question 15

For HIV medications, what does cART stand for?

Answer 15

Combination Anti-retroviral therapy - combo therapy to reduce resistance - more aggressive than ART

Question 16

For HIV medications, what does HAART stand for?

Answer 16

Highly Active Anti-retroviral therapy - the most aggressive combo of ART plus treatment/prevention of secondary infections

Question 17

4 indications for ART?

Answer 17

1) HIV-infected 2) HIV-infected pregnancy 3) History of AIDS-defining illness 4) serodiscordant couples

Question 18

List the 6 AntiRetroviral Therapy drugs

Answer 18

1) enfuVIRtide 2) maraVIRoc 3) zidovudine 4) delaVIRdine 5) raltegraVIR 6) ritonaVIR

Question 19

What are 6 common adverse effects of ART?

Answer 19

1) hepatoxicity 2) nephrotoxicity 3) osteopenia 4) dyslipidemia (early onset coronary diease) 5) fat redistribution syndrome (lipodystrophy) 6) insulin resistance = (DM)

Question 20

When not adhering to the treatment plan, HIV patients can have: 1) viral ________ 2) immune _________ 3) clinical ___________

Answer 20

1) rebound 2) decompensation 3) deterioration

Question 21

What percent of patients infected with HIV have suppressed viral load?

Answer 21

76%

Question 22

Non-adherence is associated with cognitive/psychosocial barriers. Nmae up to 6.

Answer 22

1) neurocognitive impairment 2) depression, denial 3) nondisclosure of HIV serostatus, stigma 4) low health literacy, social support, and stressful life 5) homeless, poverty, access to care 6) substance abuse disorder

Question 23

What causes the main problem of rejection in a organ transplant?

Answer 23

immune system reaction to the organ

Question 24

What is the induction therapy drug that produces an intense immunosuppression during the initial transplant period?

Answer 24

basiliximab

Question 25

What are the two main maintenance drugs after an organ transplant?

Answer 25

tacrolimus and cyclosporine (other: azathioprine and mycophenolate and mofetil)

Question 26

What is the acute rejection drug for an organ transplant?

Answer 26

corticosteriods IV

Question 27

What are the two main difficulties with transplant drugs?

Answer 27

1) costly, many toxic side effects 2) life-long treatment, even with good adherence, is not always effective

Question 28

Transplant maintenance drugs are highly protein bound, therefore, what two key thigns should be of concern when administering?

Answer 28

1) many drug-drug interactions 2) toxicity with malnutrition

Question 29

What are the two main side effects of transplant maintenance drugs?

Answer 29

1) hirsutism (reversible) 2) gingival hyperplasia (need good dental hygeine and check-ups)

Question 30

Contraindication for transplant maintenance drugs?

Answer 30

pregnancy & breast-feeding

Question 31

What are the main 4 adverse reactions to maintenance translplant drugs?

Answer 31

1) photosensitivity 2) RF/hepatoxicity/dysrhythmia/HTN 3) blood dyscrasia 4) lymphoma and other cancer

Question 32

What are the main signs to monitor for that indicate organ transplant rejection?

Answer 32

malaise, fever, pain, organ dysfunction!! family should know these, call provider, and very strict adherence to drug regimen!!