HIV

Question 1

What is duration of avoidance of Abx in people receiving TNF and Rituxamab

Answer 1

contraindicted 4 week before therapy

Question 2

What is advice to IC H regarding live vaccine?

Answer 2

Cant have Live vaccine , Esp caution regarding changing nappies of infants who has Rota virus vaccine.

Question 3

What is your advice regarding HSCT pt

Answer 3

Needs to be revaccinated

Question 4

what is issue with influenza vaccine and Check point inhibitor

Answer 4

There is massive Cytokine storm so be cautious

Question 5

what are antiviral classes of drugs?

Answer 5

Fusion inhibitor 
Integrase inhibitor
NRTIS 
NNRTIs 
Protease inhibitors

Question 6

How are NRTIS activated?

Answer 6

They are nucleoside analogue so require addition of phosphate for activation

Question 7

What is unique about Tenofovir , an NRTI?

Answer 7

it is a nucleotide analogue instead of nucleoside analogue and hence does not require activation

Question 8

What are NNRT?

Answer 8

Bind to allosteric site on reverse transcriptase and change binding site on RT

Question 9

what are side teratogenic NNRT

Answer 9

delaverdine and effavirenz

Question 10

Which NNRTis are safe in pregnancy

Answer 10

nivarapine and etravirine

Question 11

what are content of Caspid of HIV

Answer 11

Single stranded RNA
Reverse transcriptase
Integrase
Aspartate protease

Question 12

what are Side effect of Ritonavir ?

Answer 12

Liver damage
paresthesia
Strongly inhibits Cyt P450

Question 13

what are side effect of Atazanavir ?

Answer 13

paresthesia,
Inc billi,(Increased billi is marker of disease activity)
Rare renal stones

Question 14

What are class SE of Protease inhibitor ?

Answer 14

Hchol , hbsl and lipodystrophy

Question 15

what are SE of Indinavir?

Answer 15

Dec plt

Hematuria and kidney stones

Question 16

what are Immune responses to HIV infection

Answer 16

Early T lymphocyte try to eradiacted HIV (Seroconversion)

1 week Later, B cell produce Anitbodies (Seropositve)

Question 17

what is the advantge of having HLA 57.01 in HIV pt ?

Answer 17

More effective cytotoxic response against HIV

Bind a peptide from HIV core protein effectively

Question 18

what is the role of broadly neutralising antibodies in HIV?

Answer 18

Can supresses viral growth up to 21 week after HAART stopped.B10-1074 WAS LONGER LASTTING than 3 BNC117 .
relapse occur only after when only B10-1074 Remained in bLOOD and HIV was resistant to that.

Question 19

what is the evidence of starting HIV treatment Early?

Answer 19

Less transmission to Partners NJEM 2016

Question 20

what are Risk at certain CD4 count oF HIV?

Answer 20

At any count : risk of transmission to partenrs
300-500:CVD and Ca
200-300: Risk of going to
<200:OPI and DEATH

Question 21

what are Aschm Guiglines HIV combination therapy ?

Answer 21

X1 integrase inhibitor X2 NNRT or NRTI 
Current 
BIC/TAF/FTC
DTG/ABC/3TC
DTG/Tenofovir/FTC
RAL/Tenofivir /FTC

Question 22

what are alternate therpy regime ?

Answer 22

2 drug therapy

Question 23

AZT SE?

Answer 23

Lipodystrophy
GI
Metabolic SE

Question 24

What are 2 types of Tenofovir ?

Answer 24

2 tenofovir prodrugs
Tenofovirdisproxi fumarate(TDF)
Tenofovir alafenmide (TAF)

Question 25

What are SE of TDF?

Answer 25

Nephrotoxicty(Monitor creat) It is rapidly metabolisedin PLASMA RE quiring large doses Watch Po4 BMD reduction

Question 26

what is advantage of TAF?

Answer 26

less Nephrotoxic(Less metabolism into plasma and more drug reaches to HIV infected cell

Question 27

What are fusion inhib drug

Answer 27

enfuvirtide -comes in infusion

Question 28

What are SE of Raltagrevir(iNTEGRASE INHIB?

Answer 28

INC CK and rhabdo | Useful in decreasing Viral load rapidly

Question 29

what is Maraviroc

Answer 29

CCR5 inhib-requires tropism asay

Question 30

what does GEMNI 1 AND 2 prove

Answer 30

2 DRUG are as good as three drug regime Dolutagrevir+Lamuvidine Dolutagravir_Emtricitabine+TDF

Question 31

Wht is the evidence of Long acting IM Injection in HIV ?

Answer 31

Cabotegravir+Rilpivirine IM 8 weekly( LATTE 2--Lancet 2017)

Question 32

WHAT is window for PEP in HIV?

Answer 32

24-72 hours | As CD4 i nfect as early as 24 hours and circulate to whole body in 3-6 days

Question 33

what is evedence for 28 days course of PEP ?

Answer 33

In animal based studies 28 day scourse as superior to 10 days course

Question 34

what is evidenc eof PEP in HIV pt?

Answer 34

HCW -81% prevention MSM -90-99% '' Antenatal :60-70%''

Question 35

WHAT high risk of HIV acuisation?

Answer 35

Long needle with visible blood High viral load Of risky behaviors Highest with Receptive anal intercourse with ejecualtoin ``` Of source MSM 10% if PWID 30% Heterosexual male 0.12% Hetreosexual female 0.14% Blood transfusion <0.003 ```

Question 36

what is regime for HIV Risk >1/1000 and viral load of HIV infected person not known ?

Answer 36

3 drug therapy if viral load undetectable than no need PEP therapy

Question 37

what is REcommended in HCW HIV exposure

Answer 37

If sourc e not on Rx, High or unknown load 3 drugs | If undetectable ,2 drugs PEP

Question 38

what is recommendation when Unknown source?

Answer 38

Depeneding on rough ratio predicted in Chart if >1/10000 but < 1/000 --->2 drug therapy If >1/000 than 3 drug therapy

Question 39

what are PRep regime ?

Answer 39

Tenofovir /Emtricitabine 1 daily

Question 40

what are PEP regime ?

Answer 40

WITH IN 72 hours -for 28 days NRTI back bone Tenofovie with either Emtricitabine/Lamuvidine OR 3 drug therapy 2NRTI X1 Integrase Inib

Question 41

How you Monitor Prep SE?

Answer 41

ACR and eGFR +STI hep HIV syphilis

Question 42

What are Cd4 cut off and OPis?

Answer 42

350-250-->Kaposi Sa_Oral candiases 250-150--> NHL ,PJP 150-100 -->CRYPTOCOCCAL,HSV <50:CMV ,MAC

Question 43

what PJP is classified as

Answer 43

Unicellular Antifungal which does not respond to any antifungal .

Question 44

what is most prominent finding of PJP?

Answer 44

SOBE

Question 45

what isRADIO finding of PJP?

Answer 45

APICAL AND Basal sparing ,Ground glass on CT | Pneumothoacies

Question 46

PJP lab test?

Answer 46

Beta D glucan NPV | BAL 90% sensitive

Question 47

PJP prophylaxis

Answer 47

New HIV CD4 <200TMP-SMX SEcondary PEP 3rice weekly Or pentamidine nebs 3 weekly

Question 48

HOW Cryptococcu s Dx?

Answer 48

High Opening pressure on LP?VP shunt theurapetic | India iNK /or serum Crag

Question 49

How Cryptococcus is Rx

Answer 49

Amp B+Flucytocine