HIV Flashcards
HIV
Retrovirus
- It’s an RNA virus that must reverse to the DNA before replicating/reproducing
- It is the DNA which enables the virus to replicate
HIV invades mainly the helper T cells to replicate itself. It enters the bloodstream through breaks in the skin, mucous membranes, and direct injection. Usually through exposure to infected blood, semen, vaginal secretions, or breast milk.
Currently, no cure.
How long after infection is testing negative?
Patients will test positive within 3 months of expsoure.
Symptoms of HIV
Fever, fatigue, headache, lymphadeopathy, generalized rash, myalgia, arthralgia, diarrhrea
Stage 1 HIV
Primary- short flu-like illness occurs 1-6 weeks after infection, may have no symptoms, able to infect others, usually test negative.
Stage 2 HIV
Asymptomatic- Duration is on average 10 years, usually free from symptoms, may have swollen glands, oral candidiasis, zoster infections, HIV antibodies are detectable.
Aids occurs when ___?
CD4 count falls below 200 cells per cubic MM of blood. Even if CD4 count goes up, patient still diagnosed with AIDs. High risk for opportunistic infections.
HIV Testing
Offer to everyone age 13 and up.
All newborns are tested and pregnant mothers.
Individuals at risk
Ask about sexual health and practices including types of partners, practice (anal, vaginal, oral), protection used, past STI history, prevention of pregnancy.
Testing no longer requires written consent, should document that patient agreed to testing.
HIV Tests
1st and 2nd generation tests detect IGG IGG antibody 42-60 days after infection.
3rd generation tests detect IGM & IGG antibodies 21-24 days after infection. Will detect HIV-1 and HIV-2 antibodies.
4th generation tests detect antigen & antibody 14-15 days after infection. HIV-1 P24 antigen, HIV-1 & HIV-2 antibodies- preferred test. If negative person is considered negative. If positive- needs further differentiation to determine if HIV-1 or HIV-2. Can have both. If differentiation test is negative or indeterminate check plasma HIV RNA (viral load).
A positive screening test and negative confirmation test is not likely HIV. False positives- cross reacting alloantibodies from pregnancy, autoantibodies from other diseases, receipt of experimental HIV vaccine, influenza vaccine.
Rapid testing- produces results in 20 minutes
Oral, fingerstick, or blood draw. Positives must be followed up with a confirmatory test. If negative, retest in 1-3 months depending on risk factors.
CD4 Counts
Used to evaluate immune function
Initiation of therapy in all patients should be strongly considered and individualized with recommendations for adherence.
CD4 lymphocyte & HIV RNA levels every 3-6 months.
If <100, need antibiotic prophylaxis for toxoplasmosis
If <50, need antibiotic prophylaxis for Mycobacterium avium
Viral load
Indicates progression of untreated HIV and response to therapy. Keeping viral loads as low as possible decreased complications of HIV and prolongs life. Used to monitor status of HIV, guide therapy, and predict future course of HIV.
Resistance testing is recommended prior to initiation of antiretroviral therapy. Should be repeated if viral load >750 to evaluate resistance against current meds
Genotype usually ordered, but phenosense may be better if previous exposure to multiple medications.
HIV Treatment
Decision to start treatment- evaluate HIV viral load, treatment history, resistance profiles, patient preferences
Taking 3-4 drugs is known has HAART (Highly active antiretroviral therapy).
Secceral drug classes
- Reverse transcriptase inhibitors
- Nonreverse transcriptase inhibitors
- Protease inhibitors
- Integrase inhibitors
- Entry inhibitors or fusion inhibitors
Initial HIV Workup
CBC, CD4, HIV viral load Hepatitis A, B, C T. Pallidum/RPR, Toxoplasmosis IGG Genotype CMP, Cholesterol panel PPD Give any needed immunizations- Prevnar 13, TDAP, Hepatitis, Meningitis, Gardasil
AIDS Defining Opportunistic Infections
Candidiasis of bronchi, trachea, esophagus, or Lungs
Invasive cervical cancer
Coccidioidomycosis, cryptococcosis, cryptosporidiosis, chronic intestinal
Cytomegalovirus disease
Encephalopathy
HIV-Related herpes simplex, chronic ulcers greater than 1 month duration
Lymphoma
Kaposi’s sarcoma lymphoma, multiple forms
Mycobacterium avium complex
Tuberculosis
Pnumocystitis carinii pnumonia
Septicemia
Recurrent toxoplasmosis of brain
Wasting syndrome due to HIV
Pneumocystis Jiroveci Pneumonia
Prophylaxis recommended for patients with CD4 counts less than 200
Prophylaxis consists of bactrim, dapsone or mepron may be used if intolerant to bactrim (check G6PD prior to starting Dapsone)
Preferred recommendation for PJP disease is Bactrim 15-20mg/kg/day of Trimethoprim component in 3 or 4 divided doses for 21 days (usually 2 DS tabs every 6-8 hours)
For moderate to severe disease, steroids may be beneficial. Prednisone 40mg twice daily x5 days; 40mg daily x5 days, then 20mg daily for 11 days.
Prep for HIV Prevention
Person negative for HIV who engages in high-risk behavior takes one pill daily to prevent infection with HIV.
Truvada is primarily recommended. Must have every 3 month follow ups for labs, STI & HIV testing.
Discuss willingness to take medication daily & ensure funding for medication. Educate about symptoms of acute HIV.
Educate that condoms are still needed as it does not protect against other STIs. Most insurance covers and Financial assistance is available.
