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Family Medicine > HIV > Flashcards

HIV Flashcards

1
Q

What is important in history taking of HIV?

A
  • Current symptoms: weight loss over 3 months, non-productive cough, night sweats and or sores in mouth
  • medical history and other STI
  • current medication and alternative therapies or OTC
  • allergies
  • family history
  • pregnancy and family planning
  • social:partner, substance and alcohol use
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2
Q

Which 3 drugs Treat both HIV and Hepatitis B?

A
  • Tenofovir (nrti)
  • lamivudine (3Tc) (nnrti) or FTC emtricibine (nrti)
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3
Q

Which Drug is used for PCP prophylaxis?

A

Cotrimoxazole (ctx) (trimethoprim- sulfamethoxazol)

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4
Q

Name 5 bloods that need to be taken in ARV workup

A
  • CD4: check crag if <100
  • (viral load)
  • eGFR ( TFR hepatotoxic)
  • hb
  • hbsag
  • cholesterol if on protease inhibitors (pancreatitis)
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5
Q

What routine monitoring should be done on art? (5)

A
  • Creatinine if on TDF (tenofovir) at initiation, 3 months post, 6 months post and 12 monthly
  • CD4 at initiation and at 1 year, 12 monthly if clinically indicated
  • viral load month 6 and 12 monthly
  • total cholesterol and triglycerides (if on LPV/r lopinavir ritonavir = protease inhibitors ) month 3
  • hb (hepatitis) and hb s Ag if switch from first to second line art
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6
Q

Define virological suppression

A

Viral load <50 c/ml

If more, medical emergency!

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7
Q

First line art regimen for adolescents and adults? (>35kg and ≥ 10 years age)

A
  • TDF tenofovir
  • 3Tc lamivudine
  • DTG dolutegravir
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8
Q

Name 4 contraindications to tenofovir TDF

A
  • age <10 or weight <35 kg
  • renal failure eGFR <50
  • osteoporosis
  • use of additional nephrotoxic drug eg aminoglycoside
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9
Q

Name 3 contraindications to 3Tc lamivudine

A
  • Pancreatitis
  • bone marrow suppression (complications)
  • renal failure
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10
Q

Name 2 contraindications to DTG dolutegravir

A
  • intolerance

* high dose metformin

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11
Q

Alternative to TDF tenafovir if contraindicated?

A

ABC (abacavir)

If ABC not available, consider azt (zidovudine) but many adverse effects

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12
Q

Alternative to 3Tc lamivadine if contraindicated?

A

Consider DTG dolutegravir, DRV /r (darunavir/ ritonavir) - discuss with specialist. If complication like pancreatitis, bone marrow suppression.
If renal failure, reduce dose according to eGFR

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13
Q

Alternative to DTG Dolutegravir if contraindicated?

A

EFV efavirenz (NNRTI) (RAL raltegravir [integrase inhib])/ DRV/r (darunavir/ritonavir) (PIs)

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14
Q

Name 5 drug interactions with dolutegravir

A
  • Rifampicin decrease dolutegravir
  • anticonvulsants (carbamazepine, phenobarbital, phenytoin, valproate) decrease dolutegravir
  • dolutegravir increase metformin dose (too high = lactic acidosis)
  • calcium and or iron supplements decrease dolutegravir levels if taken without food
  • antacids (magnesium or aliminium) decrease dolutegravir levels
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15
Q

How should dolutegravir be taken with rifampicin?

A

Double dolutegravir dose to 50 mg 12 hourly

If on TLD ( Tenofovir, lamivudine, dolutegravir) FDC, add dolutegravir 50 mg 12 hours after TLD dose

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16
Q

What is pathopneumonic of PCP?

A

Hypoxia especially after exercise

Also tachypnoea

17
Q

Define Iris

A

Immune reconstitution inflammatory syndrome
Excessive inflammatory response to preexisting antigen or pathogen and a paradoxical deterioration in clinical status after art initiation
Diagnosis of exclusion
2 types: unmasking and paradoxical Iris

18
Q

What is paradoxical Iris?

A

Worsening symptoms of known disease, either at new or original body site

19
Q

What is unmasking Iris?

A

Occult opportunistic infection not clinically apparent prior to art
Type of art associated illness

20
Q

HCT (HIV counselling and testing) should be voluntary and adhere to WHO 5 c’s of HCT. What are they?

A 
Consent 
confidentiality
Counselling pre and post test
Correct test results
Connections to care, treatment and prevention services.
21
Q

Which HIV test should be done for adults?

A

DNA rapid test or ELISA

22
Q

Describe WHO stage 1 HIV AIDS (2)

A
  • Asymptomatic
  • persistent generalised lymphadenopathy
23
Q

Describe WHO stage 2 HIV AIDS (8)

A
  • Unexplained moderate weight loss <10% presumed or measured body weight
  • recurrent respiratory infections - sinusitis, om, pharyngitis
  • herpes zoster shingles
  • angular stomatitis
  • Recurrent oral ulceration
  • papular pruritic eruption
  • seborrhoeic dermatitis
  • fungal nail infections
24
Q

Describe WHO stage 3 HIV AIDS (9)

A
  • Unexplained severe weight loss >10% presumed/measured body weight
  • unexplained chronic diarrhoea for >1 month
  • unexplained persistent fever > 37,5 intermittent or constant for > 1 month
  • persistent oral candidiasis (thrush)
  • oral hairy leukoplakia
  • pulmonary Tb
  • severe bacterial infections eg pneumonia, empyema, pyomyositis, bone or joint infec, meningitis, bacteraemia
  • acute necrotising ulcerative stomatitis, gingivitis, periodontitis
  • unexplained anaemia <8, neutropenia <0,5 and or chronic thrombocytopenia <50
25
Q

Describe WHO stage 4 HIV AIDS (20)

A
  • HIV wasting syndrome
  • extra pulmonary Tb
  • pneumocystis pneumonia
  • recurrent severe bacterial pneumonia
  • Chronic herpes simplex infec- orolabial, genital or anorectal of >1 month duration or visceral at any site
  • oesophageal candidiasis or of trachea, bronchi lungs
  • kaposi sarcoma
  • CMV - retinitis or infection other organs
  • CNS toxoplasmosis
  • HIV encephalopathy
  • extrapalmonary cryptococcosis including meningitis
  • disseminated non-tb mycobacterial infection
  • Progressive multifocal leukoencephalopathy
  • chronic cryptosporidiosis
  • chronic isosporiasis
  • disseminated mycosis- extrapulmonary histoplasmosis or coccidiomycosis
  • recurrent septicaemia- including non-typhoidal salmonella
  • lymphoma-cerebral or B cell non-hodgkin
  • invasive cervical carcinoma
  • atypical disseminated leishmaniasis
  • symptomatic HIV- associated nephropathy or cardiomyopathy
26
Q

Name 2 indications for deferring art initiation

A
  • Tb meningitis

* cryptococcal meningitis

27
Q

How should HIV patients with Tb co-infection be started on art?

A
  • In Tb patients with CD4 <50 (except Tb meningitis), start art within 2 weeks after starting tb.
  • if Tb meningitis, defer until 8 weeks
  • if Cd4 > 50, defer until 8 weeks.
28
Q

Which HIV regimen should be given to patients with Tb as first line?

A

• Tenofovir
• FTC emtricitabine
• EFV efavirenz
Also given to HIV positive pregnant women <6 weeks gestation or actively wanting to conceive
If EFV contraindicated, give TLD regimen and counsel pregnant patients on DTG NTDs

29
Q

Name 2 indications for primary prophylaxis for HIV with cotrimoxazole

A
  • WHO stage 2,3, or 4

* CD4 < 200

30
Q

Risk HIV transmission from pregnant woman to infant with and without treatment?

A

< 1% if on ARV
15 - 45% without

31
Q

How counsel negative HIV result (5)

A
  • Give result
  • explain window period: takes 2-3 weeks to make antibodies
  • recommend re -testing in 3 months if previous risky behaviour identified
  • advise on how to prevent transmission: condoms, no needle sharing
  • provide condoms and info on use

Family Medicine (20 decks)

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