HIV Flashcards

1
Q

How is HIV transmitted?

A

Sexual activity

Blood product transfusions

IV drug use

Needle stick injury/exposure to body fluids

Transplacental viral spread from mother to fetus

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2
Q

What does HIV do?

A

impairs the immune system = <CD4 T lymphocytes –> allow opportunistic infections/malignancies to form

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3
Q

What are the markers of HIV progression/severity?

A

CD4 T lymphocyte and viral load

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4
Q

What is the relationship between CD4 T lymphocytes and viral load in HIV?

A

As HIV RNA copies (viral load) increases, the CD4 T lymphocyte decreases

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5
Q

What is the treatment strategy for HIV?

A

Treat with 3 drugs from two different classes

Usually = 2 (NRTs) reverse transcriptase inhibitors, 1 integrase (common)/protease inhibitors

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6
Q

What are the drug targets for HIV?

A

Entry/fusion inhibitors
Reverse transcriptase inhibitors
- Nucleoside (NRTI)
- Nucleotide (NtRTI)
- Non-nucleoside (NNRTI)
Integrase inhibitors
Protease inhibitors (maturation inhibitors)

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7
Q

What are the HIV goals of treatment?

A

Individual health benefits = reduce associated morbidity/mortality, improve QoL

Reduce transmission (population goal)

Prevention of HIV transmission from infected mother to child

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8
Q

When should HIV treatment be started?

A

Treatment-naïve patients w/ opportunistic infection = start once patient is stable (generally 2wks)

Those w/ TB = once treatment started, continue w/out interruption unless oral therapy C/I or in toxicity

When initiating treatment, patient should be willing/able to commit to lifelong therapy + understand benefits/risk

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9
Q

What should be done prior to starting HIV treatment?

A

Assess general health, assess prophylaxis/treatment for opportunistic infections

Assess hep B/c coinfection, screen STIs

Assess cardiovascular risk factors, diabetes

Test for resistant HIV strains

Ensure patient is ready to start treatment

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10
Q

What is HAART?

A

Highly active anti-retroviral treatment (start w/ 3 drugs, can drop to two later for maintenance treatment)

first line therapy for HIV = 2 NRTIs and 1 INSTI

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11
Q

What is cobicistat used for in HIV treatment?

A

Its not actually playing a tole in treatment

It (along w/ ritonavir) is a cytochrome P450 inhibitor used to inc plasma concertation of protease inhibitors and INSTI

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12
Q

What monitoring is required for HAART?

A

CD4 checked 4-6 wks after initiation then every 3 months, viral load fall below 50 copies after 3-6 months, CD4 inc 100-200

CV risk
- lifestyle factors, BP, weight, fasting blood lipids, blood glucose

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13
Q

How is HAART toxicity checked?

A

haematology, serum electrolytes, creatinine, liver function test

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14
Q

How is the risk of HIV exposure assessed?

A

The nature of exposure w/ its estimated risk/exposure

risk that the source is HIV positive, if status is unknown

Factors associated with the source and exposed individual

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15
Q

Describe when post exposure prophylaxis for HIV should occur

A

Effective only if commenced w/in 72 hrs of exposure, no conclusive evidence that it works

There is also re exposure prophylaxis = ongoing treatment that provides protection against HIV

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16
Q

What is the HIV PEP for low risk exposure?

A

2 drugs

Tenofovir disproxil fumarate w/ emtricitabine OR lamivudine

17
Q

What is the HIV PEP for high risk exposure?

A

3 drugs

comprised of 2 drug regimen PLUS dolutegravir OR raltegravir OR rilpivirine

18
Q

Why may resistance in HIV treatment occur?

A

Poor compliance

suboptimal drug concentration

inadequate regimen potency