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HIV Flashcards

1
Q

preferred INSTIs for use in pregnancy

A

RAL or DTG

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2
Q

K65R

A

tenofovir

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3
Q

Q148R and N155H

A

integrase inhibitor

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4
Q

Time window for PEP

A

72 hours

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5
Q

G140S and Q148R

A

Dolutegravir

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6
Q

Methods to acquire toxoplasmosis

A

feline feces (cats have to be outdoor eating rodents)
eating rare meat (lamb, beef, pork)
congenital transmission

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7
Q

Definitive diagnosis of CNS too

A

brain biopsy
CSF PCR
Serum PCR

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8
Q

Preferred therapy for CNS toxo

A

sulfadiazine, pyrimethamine, leucovorin
TMP-SMX

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9
Q

alternative therapies for CNS toxo

A

clindamycin plus pyrimethamine
atovaquone plus pyrimethamine

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10
Q

Toxo PPX IgG + and CD4 <100

A

TMP-SMX
Dapsone-pyrimethamine
Atovaquone pyrimethamine

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11
Q

m haemophilum culture

A

32C with iron enriched medium

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12
Q

positive PPD for HIV

A

5 mm

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13
Q

When to start ART after TB treatment started CD4 < 50

A

2 weeks

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14
Q

when to start ART after TB treatment started CD4 > 50

A

8 weeks

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15
Q

requirement for TB drug therapy in HIV

A

must be daily dosed drugs

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16
Q

when to start ART after Mac therapy

A

within 2 weeks

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17
Q

treatment for dMAC

A

clarithromycin/azithromycin plus EMB
rifabutin is optional third drug for severe disease

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18
Q

issue with CSF Crypto PCR

A

can have false negatives, always use CrAg

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19
Q

CSF PCR crypto utility

A

distinguish between IRIS (PCR negative) and relapse (PCR positive)T

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20
Q

treatment Course of Crypto meningitis

A

2 weeks induction (LAMB 5-FC)
8 weeks consolidation (Fluc 800 qd)
Maintenance Fluc 200 qd (52 weeks)

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21
Q

when to stop therapy for cryptococcal meningitis

A

stop after 12 months therapy if
CD4 is greater than 100-150 for more than 3 months
Asymptomatic
VL < 50 copies

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22
Q

utility of monitoring CSF Crag while on therapy

A

none

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23
Q

when to monitor 5-FC levels

A

after dose 3 or 5

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24
Q

when to start ART after cryptococcal meningitis

A

4-6 weeks

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25
Q

when to screen patients for crypto

A

if CD4 <100

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26
Q

management of positive CrAg

A

LP and blood cultures
If CSF positive or serum LFA > 640 treat like meningitis
If CSF negative treat with fluconazole 400 mg or 800 mg x 6 months

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27
Q

flucytosine toxicity

A

marrow suppression
hepatitis
diarrhea

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28
Q

talaromyces treatment

A

amp or itraconazole

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29
Q

talaromyces seen in

A

asia

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30
Q

HIV–2 is naturally resistant to which drug classes

A

NNRTIs
fusion inhibitors

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31
Q

HIV-2 is commonly seen in

A

west africa
france
spain
india

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32
Q

flower cells

A

typical of HTLV-1

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33
Q

HTLV-1 commonly seen in

A

caribbean
australia

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34
Q

HTLV-2 clinical significance

A

none does not cause disease in humans

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35
Q

T/F HTLV-1 can be transmitted by breastfeeding

A

true

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36
Q

HTLV-1 CANCER association

A

Acute T cell leukemia

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37
Q

HTLV-1 infectious syndromes

A

TB
MAC
Leprosy
PCP
recurrent strongyloides
scabes/norwegian scabies

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38
Q

Associated neuro syndrome with HTLV-1

A

tropical spastic paraparesis

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39
Q

features of tropical spastic paraparesis

A

bladder disturbance
hyperreflexia
positive babinski

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40
Q

role of ART in HTLV-1

A

none

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41
Q

clinical features of CJD

A

myoclonus and dementia

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42
Q

most common CJD transmission route

A

spontaneous

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43
Q

which CSF marker is most consistent with CJD

A

RT-QuIC test

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44
Q

what is the second best marker for CJD

A

elevated 14-3-3 proteins in CSF

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45
Q

EEG in CJD

A

periodic sharp waves

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46
Q

EEG findings in variant CJD

A

none

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47
Q

MRI findings in spontaneous CJD

A

double hockey stick sign

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48
Q

MR findings in variant CJD

A

pulvinar sign
bilateral FLAIR hyper intensities seen in the thalamic nuclei

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49
Q

pathology in sCJD

A

abnormal prion accumulation

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50
Q

pathology in vCJD

A

florid plaques

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51
Q

dura mater graft association acquiring iatrogenic CJD seen in what country

A

Japan

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52
Q

ingestion of beef causing CJD seen in which two countries most frequently

A

UK and France

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53
Q

oral hairy leukoplakia associated with

A

EBV

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54
Q

When to start ART with TB CD4 <50 or pregnant

A

within 2 weeks of diagnosis

55
Q

when to start ART with TB CD4 > 50

A

within 8 weeks of diagnosis

56
Q

when to start ART with cryptococcal meningitis

A

4-6 weeks after initiation of treatment for crypto

57
Q

when to start ART after PML or cryptosporidiosis

A

immediately

58
Q

what vaccines are CI with CD4 <200

A

MMR, Varicella, oral typhoid, yellow fever

59
Q

side effect of pentamidine

A

hypoglycemia

60
Q

what drugs should only be given after screening for G6PD

A

primaquine
dapsone

61
Q

methmeglobinemia associated drugs

A

dapsone
primaquine

62
Q

pentamidine cardiac side effect

A

torsades de pointe

63
Q

rapid hiv test positive during woman in labor next step

A

start therapy while waiting for confirmatory testing

64
Q

HIV non Progressor testing

A

ELISA reactive
supplemental positive
HIV RNA may not be detectable

65
Q

DTG/3TC can be used for initial therapy with what level of viral load

A

500,000 or less

66
Q

rilpivirine should not be given with a viral load

67
Q

exception to using DTG/3TC as initial therapy

A

HBV s Ag positive or no resistance results

68
Q

options when you can’t use ABC, TAF or TDF

A

DTG/3TC
DRV/r + 3TC
DRV/r + RAL BID

69
Q

side effects of Efavirenz

A

CNS toxicity (abnormal dreams)
rash
suicidality

70
Q

Rilpivirine needs to be taken with

71
Q

RPV is not well absorbed with

72
Q

atazanavir side effect

A

increased indirect bilirubin (Gilbert’s like syndrome) jaundice

73
Q

BIC and DTG creatinine effect

A

inhibits absorption of creatinine so will see rise in creatinine

74
Q

NNRTIs that are p450 inducers except

75
Q

what class of drugs are p450 inhibitors

76
Q

rifampin cannot be used with what class of drugs

77
Q

SJS can be seen with what two ART drugs

A

nevirapine and etravirine

78
Q

zidovudine side effects

A

anemia and neutropenia, fatigue

79
Q

General side effect of NNRTIs

A

rash, can treat through unless they have constitutional symptoms

80
Q

ABC side effects

A

cardiovascular

81
Q

kidney stones

A

indinavir, atazanavir

82
Q

hyperlipidemia seen with

83
Q

peripheral neuropathy seen with what three ARTs

A

stavudine, zalcitabine, didanosine

84
Q

TAF studied in PrEP only in

85
Q

when is HIV RNA detectable after acquisition

A

10-11 days

86
Q

when is HIV antibody detectable after acquisition

A

20-25 days

87
Q

HIV screening in people on PrEP

A

HIV RNA before starting therapy and routine HIV RNA screening while on therapy

88
Q

what is the recommended regimen to start in new HIV diagnosis but recently on cabotegravir for PrEP

A

Boosted DRV with TAF/TDF plus FTC or 3TC
don’t use INSTI unless you have genotype results without INSTI resistance

89
Q

treatment of bacillary angiomatosis in HIV

A

Doxyxyline, Erythromycin, Azithromycin, Clarithromycin x 3 months

90
Q

what method is the highest risk for HIV transmission from HIV positive source

A

blood transfusion

91
Q

cabotegravir exclusions

A

no history of virologic failure, drug resistance or chronic HBV infection

92
Q

M184V

A

FTC and 3TC

93
Q

K65R

A

TDF
also ABC and DDI

94
Q

K103N

95
Q

K65R mutation, which drug can be used to salvage

A

Zidovudine

96
Q

If present K103N which NNRTI will still work

A

Doravirine

97
Q

Y181C

A

Nevirapine

98
Q

Rilpivirine failure is associated with

A

E183K, K101E and Y181C –> resistant to all NNRTIs

99
Q

I50L

A

Atazanavir ATV

100
Q

Elvitegravir resistance mutation

101
Q

Q148R resistance can be overcome by prescribing

A

BID dosing of DTG

102
Q

which type of virus would indicate the highest likelihood of maraviroc activity

A

pure R5 virus

103
Q

K103N retains susceptibility to

A

Etravirine

104
Q

N155H

A

RAL and EVG

105
Q

Y143C

106
Q

R263K

107
Q

when to start ART after OI (non CNS Crypto or TB)

108
Q

can’t use rifampin with what class of ART

A

Protease inhibitors

109
Q

RIF with DTG adjustment

A

double the dose of DTG 50 BID

110
Q

which ART is effective against HBV

A

3TC, FTC and TDF/TAF

111
Q

What HBV drug has activity against HIV

112
Q

regimen for HBV and HIV confection

A

2 active drugs against HBV and 3rd drug for HIV (preferred BIC and DTG)

113
Q

what regimen is not recommended in pregnancy

A

two drug regimen

114
Q

management of ART near delivery

A

if HIV RNA > 1000 or unknown use IV ZDV and C/section at 38 weeks

115
Q

preferred regimen in pregnancy

A

2 NRTIs and 3rd drug (PI, INSTI or NNRTI)

116
Q

NRTIs ok in pregnancy

A

ABC, 3TC, TDF/TAF, FTC

117
Q

NNRTIs ok in pregnancy

A

EFV or RPV

118
Q

which INSTI has insufficient data to use in pregnancy

119
Q

INSTIs safe to use in pregnancy

A

DTG or RAL

120
Q

Fanconi syndrome is what type of RTA

121
Q

FAnconi syndrome affects what part of nephron

A

proximal tubule

122
Q

electrolyte abnormalities in Fanconi

A

Hypophosphatemia
Renal Glucosuria
Hypouricemia
aminoaciduria
LOW proteinuria if any

123
Q

complication of Fanconi syndrome

A

osteomalacia

124
Q

dapsone risk

A

methmeglobinemia

125
Q

HIVAN features

A

high grade proteinuria
NO EDEMA
rapid progression to ESRD

126
Q

most effective method to prevent progression to ESRD in HIVAN

127
Q

treatment of HIV associated ITP

128
Q

effect of COBI and INSTI on Creatinine

A

decreases secretion of creatinine at the proximal tubule, see .1 to .2 increase in SCr

129
Q

what class of drugs has no effect against HIV-2 infection

130
Q

what classes of drugs are effective against HIV-2

A

PIs, NRTIs, INSTIs

131
Q

mycobacterium haemophilum requires what in media to grow

132
Q

leishmania media

133
Q

marinum should be grown at

IDBR (23 decks)

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