HIV

Question 1

Which cells does HIV attack?

Answer 1

CD4 T cells

WBC

Question 2

How can vertical transmission of HIV be decreased?

Answer 2

Antiretroviral treatment (ZDV) during pregnancy

Question 3

Blood transfusion or contaminated needles would be an example horizontal or vertical transmission.

Answer 3

horizontal transmission

Question 4

• What is pneumocystis jiroveci pneumonia (PJP)?

Answer 4

• funal infection of the lungs

Acquired perinatally

Question 5

What is length of treatment of pneumocystis jiroveci pneumonia (PJP) prophylaxis?

Answer 5

Begins by 4 weeks of age and continues until 1 year for HIV(+) or D/C for confirmed HIV(-)

Question 6

What is the difference in infection time and AIDS diagnosis b/w children and adults?

Answer 6

1 year in children vs 10 years in adults.

Question 7

Name 4 out 7

What are the clinical manifestations HIV/AIDS

Answer 7

1. Lymphadenopathy (swollen lymph nodes)
2. Hepatosplenomegaly (liver and spleen enlargement)
3. Oral candidiasis (thrush)
4. Parotitis (inflammation of parotid gland)
5. Chronic or recurrent diarrhea
6. Failure to thrive
7. Developmental delays

Question 8

Which test is not accurate in diagnosing HIV in children under 18 months of age?

Why?

Answer 8

ELISA or Western Blot

False positive may result from detecting maternal antibodies

Question 9

How often is an infant tested for HIV if they are exposed?

Answer 9

First PCR test, repeat at 1 to 2 month, and again at 4 to 6 months.

May confirm absence with HIV antibody assay at 12-18 months of age

Question 10

What is the treatment course for a baby born to an HIV+ mother?

Answer 10

• Whether the initial PCR test confirms/denies infancy HIV status, they are put on ZDV.
• If there PCR comes back positive at 4 to 6 months other medications would be added w/ ZDV. If negative ZDV is removed.

Question 11

What are the four clinical stages of HIV?

Answer 11

• Stage N (infected but asymptomatic)
• Stage A (mild symptoms)
• Stage B (moderate symptoms)
• Stage C (severe symptoms)

Can only progress in stages, can’t go back a stage

Question 12

What are the three immunological stages of HIV?

Answer 12

• Stage 1 = no evidence of suppression
• Stage 2 = moderate suppression
• Stage 3 = severe supression

suppression of immune system

Question 13

What are the immunological stages of HIV based on?

Answer 13

CD4 count or percentage

CD4 = CD4 T lymphocyte

Question 14

What are the immunological stages of HIV affected by? Why?

Answer 14

age, CD4 counts and % are higher in younger children.

Question 15

Why is it important to assess for CD4+ counts/percentages?

Answer 15

1. Infected immune system’s response to therapy
2. Risk for disease progression
3. Need for PJP prophylaxis beyond 1 yr. of age

Question 16

When is an elective cesarean indicated for HIV+ pregnant woman?

Answer 16

women with an HIV viral load of > 1000 copies/ml.

Question 17

What the management of HIV+ women for vaginal delivary?

Answer 17

Administration of antiretroviral prophylaxis (ZDV) during pregnancy **and labor **and to the infant for 6 weeks after birth.

IV ZDV, if ZDV was not administered during pregnancy.

Question 18

Which tanner stage does the dosing change from pediatric to adult dose?

Answer 18

• Tanner 1 and 2 – Pediatric dosing
• Tanner 3 to 5 – Adult dosing

Question 19

Which antiretroviral should be avoided during pregnancy?

Answer 19

efavirenz

Question 20

What does the regimen for ART consist of?

Answer 20

Two NRTI’s and one of the following:
* Protease Inhibitors (PI)
* Non-Nucleoside Reverse Inhibitors (NNRI)
* Integrase Strand Transfer Inhibitors (ISTI)

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Question 21

What is the rationale for NOT using several drugs from 1 category of Antiretroviral for treatment?

Answer 21

Minimize viral resistance to the drugs

Question 22

Which vaccines need a CD4 % of ≥ 15 in order to be administered to children with HIV+?

All other vaccines do not need this requirement

Answer 22

MMR and Varicella

Measles, mumps, rubella and chickenpox