HIV Flashcards
What is important in history taking of HIV?
- 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
Which 3 drugs Treat both HIV and Hepatitis B?
- Tenofovir (nrti)
- lamivudine (3Tc) (nnrti) or FTC emtricibine (nrti)
Which Drug is used for PCP prophylaxis?
Cotrimoxazole (ctx) (trimethoprim- sulfamethoxazol)
Name 5 bloods that need to be taken in ARV workup
- CD4: check crag if <100
- (viral load)
- eGFR ( TFR hepatotoxic)
- hb
- hbsag
- cholesterol if on protease inhibitors (pancreatitis)
What routine monitoring should be done on art? (5)
- 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
Define virological suppression
Viral load <50 c/ml
If more, medical emergency!
First line art regimen for adolescents and adults? (>35kg and ≥ 10 years age)
- TDF tenofovir
- 3Tc lamivudine
- DTG dolutegravir
Name 4 contraindications to tenofovir TDF
- age <10 or weight <35 kg
- renal failure eGFR <50
- osteoporosis
- use of additional nephrotoxic drug eg aminoglycoside
Name 3 contraindications to 3Tc lamivudine
- Pancreatitis
- bone marrow suppression (complications)
- renal failure
Name 2 contraindications to DTG dolutegravir
- intolerance
* high dose metformin
Alternative to TDF tenafovir if contraindicated?
ABC (abacavir)
If ABC not available, consider azt (zidovudine) but many adverse effects
Alternative to 3Tc lamivadine if contraindicated?
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
Alternative to DTG Dolutegravir if contraindicated?
EFV efavirenz (NNRTI) (RAL raltegravir [integrase inhib])/ DRV/r (darunavir/ritonavir) (PIs)
Name 5 drug interactions with dolutegravir
- 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
How should dolutegravir be taken with rifampicin?
Double dolutegravir dose to 50 mg 12 hourly
If on TLD ( Tenofovir, lamivudine, dolutegravir) FDC, add dolutegravir 50 mg 12 hours after TLD dose
What is pathopneumonic of PCP?
Hypoxia especially after exercise
Also tachypnoea
Define Iris
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
What is paradoxical Iris?
Worsening symptoms of known disease, either at new or original body site
What is unmasking Iris?
Occult opportunistic infection not clinically apparent prior to art
Type of art associated illness
HCT (HIV counselling and testing) should be voluntary and adhere to WHO 5 c’s of HCT. What are they?
Consent confidentiality Counselling pre and post test Correct test results Connections to care, treatment and prevention services.
Which HIV test should be done for adults?
DNA rapid test or ELISA
Describe WHO stage 1 HIV AIDS (2)
- Asymptomatic
- persistent generalised lymphadenopathy
Describe WHO stage 2 HIV AIDS (8)
- 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
Describe WHO stage 3 HIV AIDS (9)
- 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
Describe WHO stage 4 HIV AIDS (20)
- 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
Name 2 indications for deferring art initiation
- Tb meningitis
* cryptococcal meningitis
How should HIV patients with Tb co-infection be started on art?
- 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.
Which HIV regimen should be given to patients with Tb as first line?
• 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
Name 2 indications for primary prophylaxis for HIV with cotrimoxazole
- WHO stage 2,3, or 4
* CD4 < 200
Risk HIV transmission from pregnant woman to infant with and without treatment?
< 1% if on ARV
15 - 45% without
How counsel negative HIV result (5)
- 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
