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Exam > HIV > Flashcards

HIV Flashcards

1
Q

How is HIV transmitted?

A

• Sex (anal > vaginal > oral), blood, needles, breastfeeding

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2
Q

How does an acute HIV infection present? How long does it last?

A

Mono / Influenza-like illness that last weeks to months:
Fever > Fatigue > Malaise > Arthralgia > H/A > ↓Appetite > Rash > Night Sweats, Myalgias, N/V/D, pharyngitis, oral ulcers, stiff neck, weight loss

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3
Q

How does chronic symptomatic HIV infection present?

A
  • Fever, fatigue, general weakness, weight loss, LAD
  • Anemia
  • Some vision loss
  • Encephalopathy
  • Dyspnea / dry cough
  • Candidiasis / Dysphagia
  • Diarrhea
  • Increased infections?: Kaposi, Herpes Zoster, HSV
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4
Q

How does AIDS present?

A
  • Fever, fatigue, general weakness, Wasting Syndrome of HIV, LAD
  • CMV retinitis
  • Encephalopathy / HIV dementia / toxoplasmosis of the brain / progressive multifocal leukoencephalopathy
  • Candidiasis (mouth, esophagus, trachea, lungs)
  • Recurrent pneumonia / coccidiodomycosis / cryptococcosis / TB / pneumocystis jiroveci pneumonia
  • Cryptosporidiosis / isosporiasis / chronic intestinal
  • Kaposi sarcoma / lymphoma / invasive cervical cancer
  • Salmonella septicemia, mycobacterium
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5
Q

What are risk factors for contracting HIV?

A
  • Males 15-19
  • Sexual Hx: MSM, Sex Workers
  • SoHx: IVDU
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6
Q

What specific test is ordered to test of HIV? When are HIV antibodies detected?

A
  • ELISA

* HIV antigens or antibodies are detected in all by 6 wks – 3 mo

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7
Q

What needs to be discussed during pretest HIV counselling?

A 
Consent 
Confidentiality 
Counselling 
Correct Test Results (Test is for antibodies, Produce detectable antibodies within 3 months, Neg could mean too soon = false negative)
Connect to prevention / care / treatment
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8
Q

What post HIV test counselling must be done?

A

Assess the patient’s understanding of HIV
Treatment
Reporting

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9
Q

What post positive HIV basic investigations are needed?

A
  • CBC, Cr, eGFR, Pho, ACR, ALT, AST, T-bilirubin, INR, lipids, FPG / A1c
  • Baseline ECG
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10
Q

What post positive HIV-specific investigations are needed?

A
  • HIV resistance testing, HIV viral load, CD4

* HLA-B*5701

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11
Q

What co-morbid infections must be tested for after a positive HIV test?

A
  • HAV
  • HBV
  • HCV
  • Syphilis
  • G/C consider cervical + anal swabs
  • Toxoplasmosis IgG
  • TB skin test + CXR
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12
Q

What specific features of history must be taken after an HIV positive test?

A
  • HIV Exposure (date, place, route)
  • Symptoms
  • PMHx: Varicella, HZV, TB exposure
  • Sexual Hx: STI
  • GYNE: Abnormal PAP (include ana cytology)
  • Meds: Prior antiretroviral regimens
  • Immunization status
  • Mental health / Behaviour
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13
Q

What labs must be taken after initiating antiretroviral medication?

A

• q 1 mo CD4 and pVL until pVL < 40 copies per / ml

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14
Q

What labs must be taken every 3 months an HIV positive test? When can you switch to every 6 months?

A
  • HIV viral load, CD4
  • CBC, Cr, eGFR, Pho, ACR, ALT, AST, T-bilirubin, INR, lipids, FPG / A1C
  • Once pVL <40 x 2yr + CD4 is consistently >/350 switch to q 6 months
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15
Q

How often do you screen for CVD in HIV?

A

Every year

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16
Q

When do you screen for osteoporesis in HIV?

A

• BMD in postmenopausal females AND males >/50 yo

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17
Q

When do you perform anal cytology in HIV

A

• NOT STANDARD OF CARE

18
Q

When do you screen for hypogonadism, what do you test, and when do you consider treatment?

A
  • In symptomatic men (libido, ED, BMD, hot flashes, wt, muscle strength, fatigue, MDD, sleep disturbance)
  • Serum testosterone
  • Consider treating if testosterone < 10 mmol/L
19
Q

When do you start PAP and how often do you screen for cervical cancer?

A
  • Start at age 21 OR 3yrs after 1st sexual contact whichever comes first
  • Repeat q6mo
  • If normal then q1yr
  • If CD4 < 200 do more frequently
20
Q

When do you give HBV vaccine in HIV?

A

• If susceptible OR with +anti-HBc w/ neg HBsAg & anti-HBs

21
Q

When do you give Tetanus / Diptheria vaccine in HIV?

A

• Q 10 yrs

22
Q

When you give the pneumococcal vaccine in HIV?

A
  • No previous immunization: Pneu-13 THEN Pneu-23 8 w later
  • Previous Pneu-23: >/1 yr later, Pneu-13
  • Repeat Pneu-23 5 yrs after initial Pneu-23
23
Q

When you give the HPV vaccine in HIV?

A

• 3 dose series between ages 9 – 26 regardless of CD4

24
Q

When you give the MMR and Varicella vaccine in HIV?

A

• Consider if non-immune and CD4 >/200

25
Q

What is the recommended antiretroviral treatment regimen in HIV?

A

2xNRTI + NNRTI OR PI or II

Otools suggests 2 NRTI and an II

26
Q

List 5 side effects of a NUCLEOSIDE REVERSE TRANSCRIPATES INHIBITORS (NRTI)

A 
mitochondrial toxicity:
peripheral neuropathy
pancreatitis
 lipoatrophy
hepatic steatosis
27
Q

List 5 side effects of a NON NUCLEOSIDE REVERSE TRANSCRIPATES INHIBITORS (NNRTI)

A

Neurologic
Psychiatric
QR prolongation

28
Q

List 5 side effects of a Protease Inhibitor (PI)

A 
insulin resistance 
hyperglycemia
diabetes
hyperlipidemia
lipodystrophy
hepatotoxicity
29
Q

List 5 side effects of an Integrase Inhibitor (II)

A
30
Q

At a CD4 count of 200, what organism do you give prophylaxis treatment for? What is the first line treatment? Name 3 second line treatments.

A

Pneumocystis Jiroveci Pneumonia
• First Line: Septra DS daily
• Second Line: Septra DS 3/week, Dapsone, Atovaquone, Aerosolized Pentamidine monthly

31
Q

At a CD4 count of 100, what organism do you give prophylaxis treatment for? What is the first line treatment? Name 2 second line treatments.

A

Toxoplasmosis Gondii Encephalitis
• First Line: Septra DS daily
• Second Line: Septra DS 3/week, Atovaquone

32
Q

At a CD4 count of 50, what organism do you give prophylaxis treatment for? What is the first line treatment?

A

disseminated mycobacterium avium complex (MAC)

• First Line: Azithromycin, Clarithromycin

33
Q

List five things to screen for in HIV

A 
Dyslipidemia
Hyperglycemia
Osteoporosis
CKD
Cervical cancer (yearly)
34
Q

List three NRTI

A

Tenofovir
Abacavir
Didanosine
Emticitabine

35
Q

List three NNRT

A

Delavirdine
Efavirenz
Etravirine

36
Q

List three Integrase Inhibitors

A

Raltegavir
Dolutregravir
Bictegravir

37
Q

Lis two Protease Inhibitors

A

Atazanavir

Darunavir

38
Q

What do you give for Pre exposure prophyalxis

A

Emtiricitabine Tenofovir (2 NRTIs)

Can give Truvada (combo pill) and can take daily or on demand around time of sex

need q 3 monthly labs
STI, CBC< creat, HCG, urinalysis

39
Q

What do you give for treatment in peripartum and neonates

A

Zidovudine (NRTI)

40
Q

What’s that thing where there is a purple type papule in an HIV patient

A

Karposi sarcoma

41
Q

Someone on prep needs:

A

Condoma
Hep vaccine
Baseline and q 3 montly sti screening, CBC, creat, HCG, urinalysis

Exam (100 decks)

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