Guest Speakers

Question 1

When is viral load high/low?

Answer 1

high: >100,000
low:

Question 2

When should we screen for HIV?

Answer 2

-all patients ages 13-64

Question 3

Tx of Cryptococcal Meningitis?

Answer 3

Amphotericin B & Flucytosine

Question 4

Tx Toxoplasmosis

Answer 4

-already on bactrim for low CD4 count, so continute tx w/ pyrimethamine, sulfadiazine, leucovorin

Question 5

Tx for PCP?

• mild/moderate
• severe

Answer 5

• mild: oral Bactrim

- severe: IV bactrim

Question 6

Tx of Thrush?

Answer 6

-Fluconazole

Question 7

What is IRIS? why does it happen?

Answer 7

• immune reconstitution inflamm syndrome.

- this happens when you were sick and your system is back and participating and making you sick.

Question 8

What are the four indications for initiating antiretroviral therapy regardless of CD4 cell count?

Answer 8

• AIDS, prenancy, Chronic HBV, HIVAN (HIV assocaited nephropathy)
• actually…with 2015 guidlines we treat everyone always.

Question 9

Why is early therapy preferred?

Answer 9

Although early therapy seems to have little proven effects short term, early treatment has proven to be overwhelming positive in long term results and quality of life.

Question 10

Recommended Retro-Antiviral regimen?

Answer 10

-treat with atleast 3 drugs.
“2 Nukes” (backbone) truvada (emtricitabine/ tenofovir) & epzicom (abacavir/lamivudine)

and the third is dolutegravir

*be careful with abacavir, you need to do genetic testing, may cause life threatening hypersensitivity if they have HLA-B5701

Question 11

What is Rotonavir used for>

Answer 11

-not used for treatment but to BOOST other drugs.

Question 12

What is PEP? PREP?

Answer 12

post-exposure prophylaxis, its a hotline you may call when exposed.

-Pre-exposure prophylaxis

Question 13

What is the likely diagnosis if you see bat wings on CXR? Treat it with?

Answer 13

• Pneumocystis Carinii Pneumonia

- treat w/ bactrim

Question 14

When might you get wasting syndrome? tx

Answer 14

• un-treated AIDS

- Tx: antiretroviral therapy and protein

Question 15

What is a clinical finding on MAC gram stain?

Answer 15

-“red snappers”

Question 16

What is acute seroconversion?

Answer 16

-this is the acute illness stage when the pt has flu-like illness.

Question 17

at what CD4 count does HIV progress to AIDS?

Answer 17

-CD4

Question 18

WHat tests do we order to dx HIV/AIDS?

Answer 18

• Aby Testing
• -Elisa: always confirmed with westernblot if positive.
• -Rapid test: blood/saliva
• HIV Viral RNA Load:
• -may be positive in the window period. Also used to monitor infectivity and treatment effectiveness in pts.

Question 19

What disease may be present at each of the follow CD4 counts:
-1500-700
->500
-500-200
-

Answer 19

• 1500-700: normal
• > 500: lymphadenopathy
• 500-200: TB, Kaposi Sarcoma, thrush, lymphoma, Zoster

-

Question 20

Tx for the following

• TB
• PCP
• Histoplasmosis
• Toxoplasmosis
• Cryptococcus
• MAC
• CMV Retinitis

Answer 20

• TB: INH (isonzid)
• PCP: Bactrim
• Histoplasmosis: Itraconazole
• Toxoplasmosis: Bactrim
• Cryptococcus: Fluconazole
• MAC: azithromycin/clarithromycin
• CMV Retinitis: Ganciclovir