HIV Flashcards
what type of virus is it
retrovirus
how does it cause immunodeficiency
infecting and destroying cells of immune system, particularly the CD4 cells
When does AIDs occur
when number of CD4 cells falls below 200 cells/microlitre
why is AIDS dangerous
opportunistic infections and malignancies (AIDS defining illnesses) can develop
what is the greatest risk to excess mortality and morbidity
delayed HIV diagnosis and treatment
aims of treatment
- achieve undetectable viral load
- preserve immune funciton
- reduce motility and morbidity associated with chronic HIV infection
- reduce onward transmission of HIV Infection
- minimise drug toxicity
which patients with HIV need to be given immediate treatment?
ALL irrespective of CD4 cell counts
a patient has just been diagnosed as HIV positive. their CD4 cell count is relatively unaffected at the moment. when should you initiate treatment
straight away for all patients regardless of CD4 cell count
what does treatment naive mean
never taken ARV drugs
treatment of HIV Infection in treatment-naive pt
backbone is two nucleoside reverse transcriptase inhibitors (NRTIs) + one of the following as a third drug: integrase inhibitor (INI), non nucleoside reverse transcriptase inhibitor (NNRTI), or a boosted protease inhibitor (PI)
regimen of choice for treatment of HIV Infection in treament naive patients
(2 NRTIs + NNRTI/INI/bPI)
backbone: emtricitabine and tenofovir disoproxil/aladenamide
alternative backbone: abacavir and lamivudine
The third drug of choice is either atazanavir or darunavir both boosted with ritonavir, or dolutegravir, or elvitegravir boosted with cobicistat, or raltegravir, or rilpivirine.
Efavirenz may be used as an alternative third drug.
Patients who require treatment for both HIV and chronic hepatitis B should be treated with antivirals …
active against both diseases as part of fully suppressive combination ART
regimens of choice for pt who need treatment for both HIV and chronic Hep B (they ned to be active against both diseases)
tenofovir disoproxil + emtricitabine
tenofovir alafenamide + emtricitabine
when may you need a change in therapy in pt taking HIV treatment
e.g. CD4 cell count changes, clinical, virological changes
what is vertical transmission
mother to baby
management of HIV infection in pregnancy should focus on
- ell being of pt
- ensure ART regimen maximally suppresses viral replication ASAP, if possible before conception in order to minimise vertical transmission
does treatment need to be stopped or changes in women who are living with HIV who become pregnant whilst on effective ART
no continue this treatment throughout pregnancy
what to do if a woman gets HIV whilst pregnant
start ART treatment during pregnancy
recommended regimen for ART for HIV for a woman who gets HIV whilst pregnant
NRTI backbone: tenofovir disoproxil or abacavir with either emtricitabine or lamivurdine
3rd drug: efavirenz or atazanir boosted with ritovavir
all need to be assessed by specialist
do pregnancies in women with HIV and babies born to them need to be reported?
yes to National Study of HIV In pregnancy and childhood care AND to the ARV pregnancy register
can mothers with HIV positive mothers breast feed infant?
avoid because this can cause HIV Infection in the infant
risk of acquiring HIV is higher in these 3 sets of people
- MSM (unprotected anal intercourse)
- sexual partners of people who are HIV positive WITH a detectable viral load
- HIV negative heterosexual people who have unprotected intercourse with HIV positive pt and are likely to repeat this with the same person or another person with a similar status
a patient is a sexual partner of a person who is HIV positive with an undetectable viral load. do they have a high risk of acquiring HIV
no, sexual partners of people who are HIV-positive with a detectable viral load do
what treatment may be appropriate for pre exposure prophylaxis to reduce risk of sexually acquired HIV-1 infection in combination with safer sex practices in adults at high risk
emtricitabine with tenofovir disoproxil
TD alone is an alternative for HIV negative heterosexuals when E is contraindicated
post exposure prophylaxis of HIV - what to do and does it require treatment
prompt prophylaxis with ARV drugs (unlicensed indication)
seek immediate expert advice
may also be approbate following potential sexual exposure to HIV where there is a significant risk of viral transmission
recommended treatment for post exposure prophylaxis
emtricitabine + tenofovir disoproxil + raltegravir
28 days
