HIV Flashcards
How is HIV transmitted?
• Sex (anal > vaginal > oral), blood, needles, breastfeeding
How does an acute HIV infection present? How long does it last?
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
How does chronic symptomatic HIV infection present?
• Fever, fatigue, general weakness, weight loss, LAD
• Anemia
• Some vision loss
• Encephalopathy
• Dyspnea / dry cough
• Candidiasis / Dysphagia
• Diarrhea
• Increased infections?: Kaposi, Herpes Zoster, HSV
How does AIDS present?
• 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
What are risk factors for contracting HIV?
• Males 15-19
• Sexual Hx: MSM, Sex Workers
• SoHx: IVDU
What specific test is ordered to test of HIV? When are HIV antibodies detected?
• ELISA
• HIV antigens or antibodies are detected in all by 6 wks – 3 mo
What needs to be discussed during pretest HIV counselling?
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
What post HIV test counselling must be done?
Assess the patient’s understanding of HIV
Treatment
Reporting
What post positive HIV basic investigations are needed?
• CBC, Cr, eGFR, Pho, ACR, ALT, AST, T-bilirubin, INR, lipids, FPG / A1c
• Baseline ECG
What post positive HIV-specific investigations are needed?
• HIV resistance testing, HIV viral load, CD4
• HLA-B*5701
What co-morbid infections must be tested for after a positive HIV test?
• HAV
• HBV
• HCV
• Syphilis
• G/C consider cervical + anal swabs
• Toxoplasmosis IgG
• TB skin test + CXR
What specific features of history must be taken after an HIV positive test?
• 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
What labs must be taken after initiating antiretroviral medication?
• q 1 mo CD4 and pVL until pVL < 40 copies per / ml
What labs must be taken every 3 months an HIV positive test? When can you switch to every 6 months?
• 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
How often do you screen for CVD in HIV?
Every year
When do you screen for osteoporesis in HIV?
• BMD in postmenopausal females AND males >/50 yo
When do you perform anal cytology in HIV
• NOT STANDARD OF CARE
When do you screen for hypogonadism, what do you test, and when do you consider treatment?
• In symptomatic men (libido, ED, BMD, hot flashes, wt, muscle strength, fatigue, MDD, sleep disturbance)
• Serum testosterone
• Consider treating if testosterone < 10 mmol/L
When do you start PAP and how often do you screen for cervical cancer?
• 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
When do you give HBV vaccine in HIV?
• If susceptible OR with +anti-HBc w/ neg HBsAg & anti-HBs
When do you give Tetanus / Diptheria vaccine in HIV?
• Q 10 yrs
When you give the pneumococcal vaccine in HIV?
• 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
When you give the HPV vaccine in HIV?
• 3 dose series between ages 9 – 26 regardless of CD4
When you give the MMR and Varicella vaccine in HIV?
• Consider if non-immune and CD4 >/200
What is the recommended antiretroviral treatment regimen in HIV?
2xNRTI + NNRTI OR PI or II
Otools suggests 2 NRTI and an II
List 5 side effects of a NUCLEOSIDE REVERSE TRANSCRIPATES INHIBITORS (NRTI)
mitochondrial toxicity:
peripheral neuropathy
pancreatitis
lipoatrophy
hepatic steatosis
List 5 side effects of a NON NUCLEOSIDE REVERSE TRANSCRIPATES INHIBITORS (NNRTI)
Neurologic
Psychiatric
QR prolongation
List 5 side effects of a Protease Inhibitor (PI)
insulin resistance
hyperglycemia
diabetes
hyperlipidemia
lipodystrophy
hepatotoxicity
List 5 side effects of an Integrase Inhibitor (II)
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.
Pneumocystis Jiroveci Pneumonia
• First Line: Septra DS daily
• Second Line: Septra DS 3/week, Dapsone, Atovaquone, Aerosolized Pentamidine monthly
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.
Toxoplasmosis Gondii Encephalitis
• First Line: Septra DS daily
• Second Line: Septra DS 3/week, Atovaquone
At a CD4 count of 50, what organism do you give prophylaxis treatment for? What is the first line treatment?
disseminated mycobacterium avium complex (MAC)
• First Line: Azithromycin, Clarithromycin
List five things to screen for in HIV
Dyslipidemia
Hyperglycemia
Osteoporosis
CKD
Cervical cancer (yearly)
List three NRTI
Tenofovir
Abacavir
Didanosine
Emticitabine
List three NNRT
Delavirdine
Efavirenz
Etravirine
List three Integrase Inhibitors
Raltegavir
Dolutregravir
Bictegravir
Lis two Protease Inhibitors
Atazanavir
Darunavir
What do you give for Pre exposure prophyalxis
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
What do you give for treatment in peripartum and neonates
Zidovudine (NRTI)
What’s that thing where there is a purple type papule in an HIV patient
Karposi sarcoma
Someone on prep needs:
Condoma
Hep vaccine
Baseline and q 3 montly sti screening, CBC, creat, HCG, urinalysis
