HIV Flashcards
What is the viral structure of HIV?
An enveloped virus
What is the advantage of a non-enveloped virus?
More stable to UV, heat, desiccation and disinfection
The HIV virus in enveloped, what is the advantage of this?
The envelope helps the virus attach and invade our cells
What cells does HIV infect?
T-lymphocytes, specifically CD4 cells (T-helper’s)
What stage does the HIV virus become infectious?
Protease stage
What is acute HIV syndrome often misdiagnosed as?
Flu
What age group has the highest rate of new diagnoses of HIV?
25-34
Who is at risk of contracting HIV?
Concomitant STDs
Alcohol and drug use
Sexual intercourse
Needles
How is HIV transmitted?
Via blood and bloody fluids
(semen, vaginal fluid), breast milk, etc)
When does acute retroviral syndrome occur?
Develops 3-6 weeks after infection (window period), lasts 1-2 weeks
What are the symptoms of mild acute retroviral syndrome?
Vague flu like illness
What are the symptoms of severe mild acute retroviral syndrome?
Meningitis, encephalitis, thrombocytopenia, etc. (usually requires hospitalization)
How is screening conducted for HIV?
Completed by “opt-out” testing with routine bloodwork
What are the different screening tests available for HIV?
Nucleic acid tests (NATs)
Antigen/antibody testing
Antibody testing only
When is nucleic acid testing (NATs) completed?
Mostly for acute HIV or intermediate test (no HIV antibodies yet), detectable 10 days post-exposure
Who gets treatment for HIV?
Initiate immediate treatment at time of diagnosis in anyone under 18 (< 18 shared decision making)
Includes pregnant patients, patients with opportunistic infections
What is the only exception for not starting immediate treatment?
Patients who won’t commit to compliance due to risk for medication resistance
What screening for co-infections should be done at time of HIV diagnosis?
STI’s
Latent TB
Hepatitis A, B, and C
Coccidioidomycosis
What is the first line treatment for HIV?
Anti-retroviral therapy - generally a 3 drug combination (1 InSTI + 2 NRTI’s)
How often should a CD4 count be checked?
Every 6 months for first 2-years, then annually > 500 is optimal
When does Immune reconstitution inflammatory syndrome (IRIS) occur?
After initiation of ART (higher risk if worse disease)
What is the treatment for IRIS?
Supportive, steroids if severe
What are some reasons for adjusting ART?
Side effects
Toxicity
Simplify regimen for compliance
Virology failure
What are some prevention strategies for HIV?
Cessation of IV drug use/needle sharing
Safe sex practices
Sex education
ART as prevention
What is PrEP?
Pre-exposure prophylaxis for the prevention of HIV infection in HIV negative patients
What are the two oral PrEP’s available?
Truvada
Descovy (not indicated for receptive vaginal sex)
What is the intramuscular injection available for PrEP and when is it given?
Cabotegravir, given every 2 months
How often do you need to screen a patient on PrEP?
Every 3-months
What is PEP?
Post-exposure prophylaxis (PEP), for prevention of HIV in negative patients after exposure to HIV
When does PEP need to be started after exposure?
Within 72 hours of exposure (sooner the better)
What is the regimen of PEP?
Tenofovir DF + emtracitibine (Truvada) orally for 28 days
After treatment with PEP, when should HIV screening be conducted?
30 and 60 days after
How is late-stage (AIDS) defined by lab values?
CD4 counts less than 200 or presence of an ‘AIDS defining’ infection/malignancy
When CD4 counts drop below 100 what are the Opportunistic Infections that the patient is at risk for?
Toxoplasmosis
Candidal, HSV, or CMV esophagitis
What are the clinical findings on CXR in Pneumocystis jirovecii (PCP)?
Diffuse or perihilar (middle of chest) infiltrates
What is the treatment for Pneumocystis jirovecii (PCP)?
Bactrim for 21 days
What is the finding on CT for toxoplasmosis?
Ring-enhancing (contrast-enhacing) lesion
What is the treatment for toxoplasmosis?
Primethamine + sulfadiazine for 6 weeks
What is the alternative treatment for toxopasmosis?
TMP-sulfa (Bactrim)
How is Cryptococcal Meningitis diagnosed?
Serum cyptococcal antigen (CRAG)
India ink stain CSF
How long is the treatment for Cryptococcal Meningitis?
1-year
What is the presentation of Kaposi’s Sarcoma?
Purplish macules, papules, or nodules
