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Infectious Disease > HIV > Flashcards

HIV Flashcards

1
Q

What is Aids defined as ?

A

The outcome of chronic HIV infection and consequent depletion of CD4 cells.

Defined as CD4 count <200 cells/microL

or

the presence of any AIDS defining condition regardless of the CD4 count.

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2
Q

According to the WHO, name some populations that are most at risk for HIV

A

Men who have sex with men
Transgender people
People who inject drugs
Sex workers
Heterosexuals
Healthcare workers – needlesticks (3 per 1000)

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3
Q

How is HIV trasnmitted?

A

Blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk

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4
Q

____ type of T cell is most relevant to HIV/AIDs

A

CD4 helper T cells

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5
Q

Why is it HIV hard to treat?

A

reverse transcriptase is error prone so the virus is constantly mutating

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6
Q

_____ are increased in blood smear of patients with HIV

A

monocytes

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7
Q

What is the first stage of HIV known as?

A

acute retroviral syndrome

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8
Q

What are some s/s of acute retroviral syndrome?

A

Nonspecific viral syndrome (fever, chills, diaphoresis, pharyngitis, lymphadenopathy, myalgias/arthralgias, cephalgia, fatigue)

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9
Q

What PE should you do if you suspect HIV?

A

HEENT, lymph, abdomen, skin

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10
Q

What labs should you order if you suspect HIV?

A

HIV testing, CBC, CMP, UA, Screen for additional STDs

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11
Q

Who should be tested for HIV?

A

Known or suspected sexual or hematologic exposure

Those with promiscuous sexual history (heterosexual or homosexual)

Known drug abuse, especially IVDU

Accidental needlestick

Pregnancy

Recent sexually transmitted infection

CDC recommends routine screening ages 13 - 64 years at least once in their lifetime

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12
Q

Name some of the HIV tests?

A

Serum HIV enzyme-linked immunosorbent assay (ELISA)

HIV rapid antibody test - screening test; 10-20 min

Serum Western Blot

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13
Q

T/F: All patients positive for HIV should be offered ART, regardless of their CD4 count

A

TRUE

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14
Q

How often should you check the CD4 count and HIV viral load?

A

Monitor CD4 counts every 3 - 6 months in patients taking ART consistently

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14
Q

What is the PrEP drug?

A

Truvada

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14
Q

If an HIV positive women becomes pregnant, what things do you want to consider?

A

Initiation of ART if HIV positive

likely C-section delivery based on viral load

Avoidance of breastfeeding if HIV+

Start zidovudine (Retrovir)

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15
Q

What is the protocol if a healthcare worker is exposed to HIV?

A

HIV antibody testing and HIV viral load at baseline, 6 weeks, 3 months, and 6 months

ART ASAP and continued x 4 weeks
tenofovir 300mg plus emtricitabine 200mg (combo drug - Truvada) plus dolutegravir (Tivicay) or raltegravir (Isentress) = triple therapy*

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16
Q

_____ is found in 5% of all HIV positive patients

A

TB

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17
Q

80% of secondary syphilis rashes occur where?

A

on the palms and soles of the hands and feet

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18
Q

What are the recommended vaccines that need to be up to date on a patient with HIV?

A

Pneumococcal vaccine
Inactivated influenza vaccine annually in season
Hepatitis A vaccine
Hepatitis B vaccine
Tdap vaccine
HPV vaccine for patients <45 years of age
Haemophilus influenzae type b vaccine

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19
Q

Do not administer ____ vaccines to a HIV positive pt

A

LIVE vaccines

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20
Q

What is the primary goal of ART?

A

suppression of HIV replication

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21
Q

What is the recommended medication therapy schedule like?

A

Combination therapy with at least three medications from two different classes to avoid resistance → combination is termed HAART (highly-effective antiretroviral therapy)

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22
Q

What are some classes of ART therapy?

A

Entry inhibitors
Fusion inhibitors
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Nucleoside and nucleotide reverse transcriptase inhibitors (NRTI)
Integrase inhibitors
Protease inhibitors

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23
Q

_____ was the first approved antiretroviral medication for HIV; often not well tolerated due to anemia

A

zidovudine/ZDV/AZT (Retrovir)

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24
Q

Nucleoside/Nucleotide Reverse Transcriptase Inhibitor, what is a major complication?

A

peripheral neuropathy

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25
Q

What are some examples of Nucleoside/Nucleotide Reverse Transcriptase Inhibitor?

A

(Truvada, Atripla, Stribild)

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26
Q

efavirenz (Sustiva)
etravirine (Intelence)
nevirapine (Viramune)
rilpivirine (Edurant)
doravirine (Pifeltro)

A

Name some examples of NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs

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27
Q

How do NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs) work? Are they well tolerated?

A

inhibit reverse transcriptase

well tolerated

28
Q

What class?

A

Protease inhibitors

29
Q

What are some key points to know about protease inhibitors?

A

Suppress HIV replication

Administered as combination therapy

Metabolized by cytochrome P450 system → high potential for drug interaction

Used to “boost” other regimens

30
Q

____ function to block the entry of HIV into cells by blocking fusion to cell membrane or blocking receptors, Used as add-on therapy for patients with multidrug resistance

A

ENTRY/FUSION INHIBITORS

31
Q

maraviroc (Selzentry)
- CCR5 antagonist
and
enfuvirtide (Fuzeon)
– Fusion Inhibitor
Are both included in what class?

A

ENTRY/FUSION INHIBITORS

32
Q

raltegravir (Isentress HD)
cabotegravir (Vocabria)
dolutegravir (Tivicay, Tivicay PD

All fall in what category?

A

INTEGRASE STRAND TRANSFER INHIBITORS (INSTIs)

33
Q

Slow HIV replication by blocking the HIV integrase enzyme needed for viral multiplication.
Allow for more rapid decrease in viral load versus other regimens

A

Integrase Inhibitors

34
Q

fostemsavir (Rukobia)
What class?

A

Attachment Inhibitor

35
Q

ibalizumab-uiyk (Trogarzo)
What class?

A

Post-attachment Inhibitor:

36
Q

lenacapavir (Sunlenca)
What class?

A

Capsid Inhibitor

37
Q

cobicistat (Tybost)
What class?

A

Pharmacokinetic Enhancer

38
Q

When do CD4 count and HIV viral load need to be monitored?

A

checked every 1-2 months after regimen initiation/change

Every 3-6 months once stable

39
Q

What is advanced HIV infection defined as ?

A

defined as CD4 count <50 cells/microL

40
Q

What is AIDS defined as?

A

Defined as CD4 count <200 cells/microL

or

the presence of any AIDS defining condition regardless of the CD4 count.

41
Q

Complaint of unpleasant taste or mouth dryness

Pseudomembranous (removable white plaques) or erythematous (red friable plaques) in the mouth

What am I?

A

MUCOCUTANEOUS CANDIDIASIS (oral thrush)

42
Q

What is the treatment for MUCOCUTANEOUS CANDIDIASIS (oral thrush)?

A

clotrimazole 10 mg troches one PO 5 times a day x 14 days

fluconazole 100 mg po daily x 3 - 7 days

43
Q

What is a MUCOCUTANEOUS CANDIDIASIS - fungal rash caused by? What is the treatment?

A

Tinea cruris

ketoconazole 2% cream bid
clotrimazole 1% cream bid

44
Q

ORAL HAIRY LEUKOPLAKIA is caused by _____

A

Epstein-Barr virus

45
Q

White lesion on lateral aspect of the tongue that cannot be rubbed off
Has corrugated appearance with fine or thick “hairy” projections

What am I?
What is the treatment?

A

ORAL HAIRY LEUKOPLAKIA

No specific treatment - resolves with ART

46
Q

What is the treatment for genital herpes?

A

Treated for 5 - 10 days with:

acyclovir 400 mg po TID
famciclovir 500 mg po BID
valacyclovir 1000 mg po BID

47
Q

Painful, vesicular lesions occurring along dermatome
What am I?
What is the treatment?

A

Herpes Zoster/Shingles
Treated for 7 - 10 days with:
famciclovir 500mg po tid
valacyclovir 500mg po tid

48
Q

What is a way to prevent HERPES ZOSTER / SHINGLES?

A

Consider live attenuated zoster vaccine - Zostavax (ZVL) or inactivated Shingrix (RZV) for patients >50 years old with CD4 count >200 mcL

49
Q

Caused by a pox virus
Seen in children, but common in HIV - infected adults
Umbilicated fleshy papules
Treated topically with liquid nitrogen
What am I?
What is the treatment?

A

MOLLUSCUM CONTAGIOSUM

imiquimod (Aldara) topical - off label

50
Q

_____ is the most common cause of pulmonary disease in HIV infected patients

A

COMMUNITY ACQUIRED PNEUMONIA (CAP)

51
Q

COMMUNITY ACQUIRED PNEUMONIA (CAP) is caused by what 3 bacteria?

A

Pneumococcal pneumonia
Haemophilus influenzae
Pseudomonas aeruginosa

52
Q

Fever, cough, dyspnea, hypoxemia
Classic CXR findings - diffuse or perihilar infiltrates
Most common opportunistic infection with AIDS
Fungal in origin
AIDS-defining condition
What am I?

A

PNEUMOCYSTIS JIROVECI PNEUMONIA

53
Q

How do you diagnose PNEUMOCYSTIS JIROVECI PNEUMONIA?

A

Dx through Wright-Giemsa stain of sputum, or direct fluorescence antibody testing of sputum
Serum lactate dehydrogenase elevated in 95%; positive serum beta-glucan test

54
Q

What is the treatment for PNEUMOCYSTIS JIROVECI PNEUMONIA?

A

Rx: trimethoprim-sulfamethoxazole DS (Bactrim DS) po TID x 21 days + prednisone 80 mg taper x 21 days
Prophylaxis started for CD4 count <200 cells/mcL

55
Q

Common AIDS complication / AIDS-defining condition
Typically caused by C. albicans
Dysphagia, or difficulty swallowing
Commonly diagnosed via EGD
What am I?
What is the treatment?

A

ESOPHAGEAL CANDIDIASIS
fluconazole 100 - 200 mg po qd x 14 - 21 days

56
Q

Name some aids defining conditions?

A

PNEUMOCYSTIS JIROVECI PNEUMONIA
ESOPHAGEAL CANDIDIASIS
KAPOSI’S SARCOMA

57
Q

Purplish, non-blanching lesions, either papular or nodular
Caused by _____ sarcoma associated herpesvirus, also known as HHV8
Lesions appear anywhere - inspect for occult lesions
May flare as part of Immune Reconstitution Inflammatory Syndrome
What am I?
What is the treatment?

A

KAPOSI’S SARCOMA
Resolve with effective ART

58
Q

What are some treatments for wasting syndrome?

A

proper ART
megestrol acetate (Megace – appetite stimulant) 80mg po QID,
dronabinol (appetite stimulant / antiemetic) 2.5 - 5mg po BID,?
medical cannabis
anabolic steroids (testosterone)

59
Q

What is the treatment for MYCOBACTERIUM AVIUM INFECTION? When should you treat a pt?

A

clarithromycin 500mg po bid plus ethambutol (EMB) 15mg/kg/day

Treated for at least 12 months after which may be discontinued if CD4 counts have exceeded 100 cells/mcL for 6 months while on antiretroviral therapy

Prophylaxis offered for all patients with CD4 count <50 cells/mcL (clarithromycin or azithromycin)

60
Q

Encapsulated budding yeast found in soil and pigeon dung
Spread by inhalation
Starts as pulmonary nodules and/or infiltrates that spread to CNS
Gram stain of CNS fluid with budding, encapsulated fungi
What am I?
What is the treatment?

A

CRYPTOCOCCAL MENINGITIS

Treated with IV liposomal amphotericin B with PO flucytosine (Ancobon - antifungal), followed by PO fluconazole to complete one year of therapy

61
Q

Most common retinal infection in AIDS patients

Retinal perivascular hemorrhages and white fluffy exudates

Rapidly progressive visual loss with involvement of optic nerve or retinal detachment

What am I?
What is the treatment?

A

CYTOMEGALOVIRUS RETINITIS

IV ganciclovir x 7 - 10 days plus valganciclovir 900 mg po BID x 21 days, then 900 mg/day maintenance

62
Q

Causes CNS disease
Most common space-occupying lesion in HIV affected patients
Headache, focal neurologic deficits, altered mental status, seizures
Multiple contrast-enhancing lesions on CT scan
What am I?
What is another way to diagnose?
What is the treatment?

A

TOXOPLASMOSIS

Most have positive Toxoplasma serologic testing (may not mean active disease)

Treated with pyrimethamine (anti-parasitic) combined with sulfadiazine (antibiotic) and leucovorin (folic acid)

63
Q

You should test for ______ at all CD4 counts

A

Tuberculosis

64
Q

Need to test for _____ at a CD4 count at or below 250

A

Coccidiomycosis: Annual IgG and IgM serologic screening

Prophylactic fluconazole if positive until CD4 > 250 for > 6 months

65
Q

Need to test for _____ at a CD4 count at or below 200

A

Pneumocystis
TMP-SMX in all patients for prophylaxis
Discontinue when CD4 > 200

66
Q

Need to test for _____ at a CD4 count at or below 150

A

Histoplasmosis

67
Q

Need to test for _____ at a CD4 count at or below 100

A

Toxoplasmosis: Bactrim
Cryptococcus

68
Q

Need to test for _____ at a CD4 count at or below 50

A

Mycobacterium avium complex (MAC): check blood cultures

treat with azithromycin

Infectious Disease (16 decks)

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