HIV

Question 1

Two Types of HIV

Answer 1

HIV-1
Accounts for the majority of cases worldwide, including in the United States

HIV-2
Primarily found in West Africa
Less efficiently transmitted and results in a slower disease progression than HIV-1

Question 2

AIDS Defining Conditions

Answer 2

Candidiasis, pulmonary or esophageal
Cervical cancer
Coccidioidomycosis
Cryptococcosis
Cryptosporidiosis
Cytomegalovirus
Toxoplasmosis
Histoplasmosis HIV-associated dementia
HIV-associated wasting
Isosporiasis
Kaposi sarcoma
Lymphoma
Herpes simplex virus
TB

Question 3

Signs and symptoms

Answer 3

2-3 weeks after exposure CD4 T-cells decline while HIV RNA particles in the plasma (viral load) increase
diagnosing HIV-1 infection with combination immunoassay, which detects circulating antibodies to the virus and p24 antigen.
It takes about 6 months after infection to develop antibodies

Question 4

CD4+ T-Cell Count

Answer 4

<200 is bad
The CD4+ T-cell count- indicates the
extent HIV has damaged the immune system.
Usually, CD4+ T-cell count is between 500 and 1,600/mm3

Question 5

Plasma HIV RNA (Viral Load) indicates what

Answer 5

Viral loads that are undetectable (e.g., <20 to 75 copies/mL) are associated with longer duration of suppression of viral replication as compared with detectable levels

Question 6

Before ART Therapy Begins

Answer 6

Perform HX and PE
CBC
Basic chem (CMP)
Liver Fx
Fasting lipids & glucose
Urinalysis
CD4 T cell count
Viral Load
Genotype resistance testing
Other serologies (Hep B and C)

Question 7

Five Main Goals of Antiretroviral Therapy (SERRP)

Answer 7

Suppression of viral load (maximal and sustained). Can be achieved in 12-24 weeks.
Enhancement of quality and duration of life
Restoration and preservation of immune system function
Reduction in morbidity and mortality from HIV-related complications
Prevention of HIV transmission

Question 8

Nucleoside Reverse Transcriptase Inhibitors (NRTI)and Nonnucleoside reverse transcriptase inhibitors (NNRTI)

Answer 8

Interferes with transcription of RNA to DNA
Based on renal elimination
S/E: hypersensitivity with fever, rash, GI, lactic acidosis, hepatic steatosis, CYP450 metabolism

Question 9

Protease inhibitor (PI)

Answer 9

Act at final stage of HIV viral replication by inhibiting protease-mediated cleavage of the polyproteins
Causes GI disturbances, elevated liver enzymes

Question 10

Integrase strand transfer inhibitor (INSTI)

Answer 10

Prevent integration of viral DNA into host cell’s genome
most common adverse effects of elvitegravir include nausea, headache, and diarrhea.

Question 11

CDC Recommended multiple drug treatment regimen

Answer 11

2 NRTIs plus PI or INSTI

Question 12

Nucleoside reverse transcriptase inhibitors (NRTI) (lots of “dines”)

Answer 12

Abacavir (Ziagen)
Didanosine (Videx)
Emtricitabine (Emtriva)
Lamivudine (Epivir)
Stavudine (Zerit)
Tenofovir disoproxil fumarate (Viread)
Zidovudine (Retrovir)

Question 13

Protease inhibitors (PI) (all “navir”)

Answer 13

Darunavir (Prezista)
Fosamprenavir (Lexiva)
Indinavir (Crixivan)
Lopinavir/ritonavir (Kaletra)
Nelfinavir (Viracept)
Ritonavir (Norvir)
Saquinavir (Invirase)
Tipranavir (Aptivus)

Question 14

Integrase Strand Transfer Inhibitors (ISTI) (all “gravir”)

Answer 14

Dolutegravir (Tivicay)
Elvitegravir (Vitekta)
Raltegravir (Isentress)

Question 15

Monitoring Patient Response

Answer 15

CD4 counts should be checked at baseline and at 3 months after starting medications
check CD4 count every 3-6 months to assess response to therapy for 1st 2 years
Viral load checks every 4-8 weeks until it becomes undetectable