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Internal Medicine > HIV > Flashcards

HIV Flashcards

1
Q

Name 6 respiratory opportunistic infections in HIV positive

A
  • Tb
  • pneumocystis pneumonia (pjp)
  • CMV pneumonia
  • mycobacterium avium complex (MAC)
  • fungal pneumonia: aspergillosis, histoplasma capsulatum
  • parasitic pneumonia: toxoplasma gondii
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2
Q

Treatment cryptococcal meningitis with HIV? (4)

A
  • induction phase: Amphotericin B and flucytosine for 1 week
  • continuation phase: then fluconazole for 1 week
  • maintenance phase: Continue maintenance treatment for at least 12 months until CD4 > 200 and vl suppressed
  • defer ARTs 4-6 weeks
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3
Q

Treatment for HIV with CD4 < 200

A

Prophylactic bactrim for PCP

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4
Q

Name 2 types IRIS

A
  • Paradoxical
  • unmasking
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5
Q

Name 5 causes high viral load in HIV

A

ABCDE

  • adherence
  • bugs / Iris
  • inCorrect dose
  • drug interactions
  • rEsistance
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6
Q

WHO HIV clinical stage 1? (2)

A
  • Asymptomatic
  • persistent generalised lymphadenopathy
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7
Q

WHO HIV clinical stage 2? (8)

A
  • Unexplained moderate weight loss (<10% body weight)
  • recurrent URTI
  • hzv
  • angular cheilitis
  • recurrent oral ulcers
  • papular pruritic eruptions
  • seborrheic dermatitis
  • fungal nail infections
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8
Q

WHO HIV clinical stage 3? (9)

A
  • Unexplained severe weight loss (>10%)
  • unexplained chronic diarrhoea > 1 month
  • unexplained persistent fever > 37,5 for > 1 month
  • persistent oral candida
  • oral hairy leukoplakia
  • pulmonary tb!
  • severe bacterial infections
  • acute necrotising ulcerative stomatitis/ gingivitis/periodontitis
  • unexplained anaemia (<8), neutropenia (<0,5), chronic thrombocytopenia (<50)
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9
Q

WHO HIV clinical stage 4? (10)
= AIDS

A
  • Invasive Cervical carcinoma
  • extrapulmonary cryptococcosis
  • HIV encephalopathy
  • HIV wasting syndrome
  • Kaposi sarcoma
  • lymphoma
  • non-tb / extrapulmonary disseminated mycobacterium infection
  • pneumocystis pneumonia; recurrent bacterial pneumonia
  • recurrent sepsis
  • symptomatic HIV associated nephropathy
  • symptomatic HIV associated cardiomyopathy
  • candidiasis of oesophagus/ trachea/ bronchi / lungs; cryptosporidiosis > 1 month; cystoisosporiasiS > 1 month; disseminated endemic mycosis eg histoplasmosis; cerebral toxoplasmosis; atypical disseminated leishmaniasis
  • CMV outside liver, spleen, nodes; HSv > 1 month
  • progressive multi focal leucoencephalopathy
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10
Q

Treatment PJp?

A

Trimethoprim / sulfamethoxazole (cotrimoxazole/ bactrim) 20/100 mg/kg/day in 4 divided doses for 21 days

(Alternative = clindamycin 900mg 3x daily iv, switch to 600mg Tds oral once improving, + primaquine 30mg daily for 21 days)

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11
Q

Prophylaxis pjp?

A

When CD4 < 200

Cotrimoxazole (bactrim) (trimethoprim sulfamethoxazole) 160/800 mg daily

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12
Q

Treatment cerebral toxoplasmosis in HIV?

A
  • Sulfadiazine +
  • pyrimethamine +
  • folinic acid

( alt=bactrim)

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13
Q

What does Bactrim prevent when given for HIV CD4 < 200? (3)

A
  • Pneumocystis jirovecii pneumonia
  • cerebral toxoplasmosis
  • cystoisospora belli diarrhoea

Also: bacterial pneumonia, bacteraemia, malaria

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14
Q

Prevention therapy for cryptococcosis in HIV when CD4 < 200?

A

Fluconazole 200 mg daily for minimum 1 year

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15
Q

Treatment oesophageal candidiasis in HIV?

A

Fluconazole 200mg daily for 14 days

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16
Q

Treatment disseminated mycobacterium avium complex in HIV?

A
  • Clarithromycin 500mg bd +
  • ethambutol 15mg / kg daily

For minimum 1 year

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17
Q

What prophylaxis should HIV with CD4 < 200 be on

A
  • Bactrim 160 / 800 mg daily
  • fluconazole 200 mg daily
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18
Q

What causes oral hairy leukoplakia

A

EBV

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19
Q

Bacterial pneumonia vs PCP vs tb? (5) (duration, dyspnoea, wcc, CXR, CRP)

A
  • Duration acute vs subacute vs variable
  • dyspnoea common vs prominent! Vs occasional
  • wCC increased us normal us variable
  • CXR: consolidation vs interstitial bilateral infiltrate vs variable bilateral infiltrate + effusion + nodes
  • CRP markedly increased vs variable vs increased
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20
Q

Diagnosis PCP?

A

Induced Sputum or bronco - alveolar lavage:

  • Silver stains
  • pcr
  • immunofluorescence
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21
Q

How does Tb present in HIV with CD4 < 200? (4)

A
  • Subacute/acute presentation with rapid progression
  • CXR different: rarely cavities, pulmonary infiltrates not predominantly inapical areas. Pleural effusions + hilar lymphadenopathy common. Can be normal.
  • sputum smears negative in > 50% patients due to absence of pulmonary cavities
  • many have disseminated tb, sometimes military pattern on CXR - usually pleura or LNS.
22
Q

What is progressive multifocal leucoencephalopathy (pml)

A

HIV related neurological disorder

Presents with stroke-like episodes with cognitive impairment.
Usually visual impairment caused by involvement of occipital cortex
Caused by JC virus
No rx.

23
Q

Most common space-occupying lesions in hiV?

A

Cerebral toxoplasmosis

24
Q

Name 3 AIDS defining cancers

A
  • Kaposi sarcoma
  • cervical cancer
  • non Hodgkin lymphoma (ebv related)
25
Q

Alternative prophylaxis PCP when cotrimoxazole poorly tolerated?

A

Dapsone ( sulfone - usually used for leprosy) 100 mg

= efficacy for PCP, but doesn’t prevent the other opportunistic infections like bacterium does

26
Q

MAC prevention in HIV?

A

Azithromycin or clarithromycin if CD4 <50 until >100

Same to treat

27
Q

Which vaccines should be given to HIV patients (3)

A

Nb to wait until CD4 > 200!

  • conjugate pneumococcal vaccine
  • annual influenza
  • hep B if not immune

BCG and other live vaccines contraindicated!

28
Q

Name 5 nrti

A
  • Lamivudine!
  • tenofovir!
  • abacaVir
  • emtricitabine
  • zidovudine
29
Q

Name nnrti

A

Efavirenz
Rilpivirine

30
Q

Name protease inhibitors

A
  • Lopinavir
  • ritonavir
  • atazanavir
31
Q

Name integrate inhibitors

A
  • Dolutegravir
  • raltegravir
  • elvitegravir
32
Q

How and when should ART be deferred (3)

A
  • Major opportunistic infections: start within 2 weeks
  • cryptococcal meningitis: defer for 5 weeks
  • tb meningitis: defer for 8 weeks unless CD4 < 50.
33
Q

Which 3 drugs Treat both HIV and Hepatitis B?

A

• Tenofovir (nrti) (most effective)
• lamivudine (3Tc) (nnrti) or FTC emtricibine (nrti)

LET

34
Q

Name 4 contraindications to tenofovir TDF

A

•age <10 or weight <35 kg
• renal failure eGFR <50
• Osteoporosis
• use of additional nephrotoxic drug es aminoglycoside

35
Q

Name 3 contraindications to 3Tc lamivudine

A

• Pancreatitis
• bone marrow suppression (complications)
• renal failure

36
Q

Name 2 contraindications to DTG dolutegravir

A

• intolerance
• high dose metformin

37
Q

Name 5 drug interactions with dolutegravir

A

• Rifampicin decrease dolutegravir
• anticonvulsants (carbamazepine, phenobarbital, phenytoin, valproate) decrease dolutegravir
• dolutegravir increase metformin dose (too high = lactic acidosis)
• calcium and or iron supplements decrease dolutegravir levels if taken without food
• antacids (magnesium or aliminium) decrease dolutegravir levels

38
Q

How should dolutegravir be taken with rifampicin?

A

Double dolutegravir dose to 50 mg 12 hourly

If on TLD (Tenofovir, lamivudine, dolutegravir) FDC, add dolutegravir 50 mg 12 hours
after TLD dose

39
Q

What is pathopneumonic of PCP?

A

Hypoxia especially after exercise
Also tachypnoea

40
Q

Define Iris

A

Immune reconstitution inflammatory syndrome
Excessive inflammatory response to preexisting antigen or pathogen and a paradoxical deterioration in clinical status after art initiation
Diagnosis ot exclusion
2 types: unmasking and paradoxical Iris

41
Q

What is paradoxical Iris?

A

Worsening symptoms of known disease, either at new or original body site

42
Q

What is unmasking Iris?

A

Occult opportunistic infection not clinically apparent prior to art
Type of art associated illness

43
Q

Name 5 side effects dolutegravir

A

Usually mild and self limiting.

• insomnia
• headache
• CNS effects: depression
• gastrointestinal: increase serum creatinine
• weight gain
• neural tube defects: avoid preconception and first 6 weeks pregnancy

44
Q

Benefits using DTG instead of EFV? (3)

A

• High genetic barrier to resistance
• no interaction with hormonal contraceptives
• side effects mild and uncommon (efavirenz neuropsychiatric,)

45
Q

Benefits using efavirenz instead of dolutegravir? (3)

A

• safe in pregnancy
• no significant interaction with Tb treatment (at interact with rifampin)
• better for obese patients (dolutegravir: weight gain)

46
Q

How should polyvalent cations be taken with dolutegravir
(4)

A

• Take calcium and DTG together with food (only decrease DTG on empty stomach)
• take iron with DTG with food
• calcium and Iron must be taken at least 4 hours apart
• magnesium/aliminium containing antacids should be taken minimum 2 hours after or 6 hours before DTG

47
Q

Name side effect lamivudine

A

Generally well tolerated. Rarely pure red cell aplasia causing anaemia

48
Q

Define art treatment failure

A

Unsuppressed viral load >1000 for >3 months

49
Q

Tb preventative therapy in HIV?

A

Isoniazid for 6 months.

If positive tuberculin skin test: 36 months
Rifampicin + isoniazid for 12 weeks equally effective as Isoniazid for 6 months

50
Q

Name regimen used for HIV pre-exposure prophylaxis

A

Tenofovir + embricitabine

(both nrti)

51
Q

How is hepatitis D spread

A

Need HBV
Close contact, blood, vertical transmission

52
Q

How is hepatitis D spread

A

Blood
Saliva

Internal Medicine (20 decks)

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