HIV Flashcards
What cells does HIV attack and destroy?
Infection fighting CD4 T cells
Mode of transmission of HIV?
Through specific body fluids e.g. blood, semen, genital fluids, and breast milk.
- unprotected sex with infected person
- sharing infected syringes and needles
- mother to child transmission during pregnancy, at birth or through breast feeding
- transfusion with contaminated blood and blood products
Who should get tested for HIV?
- IV drug users
- person who has unprotected sex with multiple partners
- man who have sex with man
- commercial sex workers
- persons treated for STDs -> high chance of HIV
- recipients of multiple blood transfusions
- persons who have been sexually assaulted
- pregnant women
What are the different stages of HIV?
- acute (primary) HIV infection
- asymptomatic stage
- persistent generalised lymphadenopathy
- AIDS & related conditions
What are the goals of anti retro viral therapy?
- reduce HIV associated morbidity and mortality
- prolong duration and quality of survival
- restore and preserve immunologic function
- maximally and durably suppress plasma HIV viral load
- prevent HIV transmission
What is the surrogate marker for HIV?
CD4. For healthy person, ranges from 500 to 1200.
adequate CD4 response is defined as an increase in CD4 count in the range of 50 to 150 cells/mm3 during the first year of therapy
Prophylaxis for pneumocystis pneumonia is started when CD4 < 200.
What is another surrogate marker for HIV?
Viral load. Patients should have viral suppression (undetectable HIV RNA level).
When do we start ART?
Recommended for all HIV infected individuals.
What are the recommended combinations for patients NAIVE to ART?
- 2 NRTI + 1 INSTI
Tenofovir + emtricitabine + bictegravir
Tenofovir + emtricitabine + dolutegravir
Abacavir + lamivudine + dolutegravir
Or
1 NRTI + 1 INSTI
Emtricitabine + dolutegravir
(NOT FOR individuals with v high viral load HIV RNA > 500,000 copies, HBV co infection or in whom ART is to be started before the results of HIV genotypic resistance testing or HBV testing are available.
What are some key adverse effects of NRTIs (nucleoside reverse transcriptase inhibitors)?
NRTIs include Tenofovir, emtricitabine, Abacavir, lamivudine, and zidovudine.
All of them cause lipoatrophy and N/V/D.
Abacavir can cause hypersensitivity reaction in patients with HLA-B*5701 allele. Can be fatal, do not Rechallenge. Testing for absence of this allele is required before initiating Abacavir. Concern for association with myocardial infarction, don’t use in high cardiovascular risk patients.
What are the INSTIs (integrase strand transfer inhibitor)?
Bictegravir, dolutegravir, raltegravir, elvitegravir.
Adverse effects of INSTIs?
Bictegravir - increase in serum creatinine
Raltegravir - fever, rhabdomyolysis
Dolutegravir - increase in serum creatinine
What are the NNRTIs (non nucleoside reverse transcriptase inhibitors)?
Efavirenz, rilpivirine
What are the key adverse effects of NNRTI?
Efavirenz - neuropsychiatric SE - depression, hallucination etc.
Rilpivirine - depression, headache
What are the protease inhibitors?
Ritonavir, lopinavir, atazanavir, darunavir,
