HIV

Question 1

What should you always test in HIV to confirm what type and what resistance the virus has?

Answer 1

HIV genotype

Question 2

What are some risk factors for HIV?

Answer 2

sexual intercourse without protection, IV drug use, alcohol, and for severity = the viral load amount

Question 3

How is HIV transmitted?

Answer 3

blood, semen, pre-seminal fluids, vaginal fluids, rectal fluids, breast milk

Question 4

T/F: not everyone needs to be tested in the age 13-64

Answer 4

False. Everyone should be tested at least once

Question 5

What’s one of the more important markers in determining ability to transmit and severity of infection?

Answer 5

viral load

Question 6

How often should people be tested if:
* man who has sex with men
* anal/vaginal sex w HIV
* 1+ partners since last test
* shared needles
* exchanged sex for drugs/money
* diagnosed for another STI
* sex w/ someone who has any of the other things
?

Answer 6

at least once a year

Question 7

What’s a technique to maximize testing for HIV in a respectful and responsible manner as a provider?

Answer 7

Opt out approach – less likelihood of parents refusing

Question 8

What is the HIV test you need to detect it even earlier than first line (4th gen), like 3-5 days after acute infection (and is also used in checking response to ART)?

Answer 8

PCR

Question 9

How can you prevent HIV transmission?

Answer 9

condom use, never sharing needles/syringes, using PrEP and PEP!

Question 10

T/F: when you get a positive HIV test, you should wait to start ART

Answer 10

false. Start immediately!

Question 11

When on _____, every ___ months you need to:
* repeat HIV test
* provide prescription of prEP
* assess and provide support for medication adherence
* test sexually active for STIs
* provide access to sterile needles + substance use services
* answer questions

Answer 11

PREP, every 3 months

Question 12

When on ___, every __ months you need to:
* monitor kidney function eCrCl >50y with <90ml/min when starting or other kidney threats
* screen for STIs - syphilis & gonorrhea for ALL, chlamydia for MSM and trans women if symptomatic
* assess interest in continuing or stopping

Answer 12

PrEP, every 6 months

Question 13

When on ____, every __ months you need to:
* monitor eCrCl for ALL
* monitor triglycerides, cholesterol, and weight (F/TAF)
* screen heterosexuals for chlamydia

Answer 13

PrEP, 12 months

Question 14

T/F: not all providers can prescribe PREP

Answer 14

false. Everyone can!

Question 15

T/F: you should prescribe HIV to anyone who asks for it

Answer 15

true

Question 16

When prescribing ____, you should test:
* HIV
* STI
* kidney function
* HBV serology
* lipid profile

Answer 16

PREP

Question 17

When prescribing ____ you should test:
* HIV
* pregnancy
* liver
* urea nitrogen/creatinine
* STIs
* hep b
* hep C antibodies

Answer 17

PEP

Question 18

What’s first line for ALL HIV-potential patients for PREP?

Answer 18

tenofovir disoproxil fumurate (TDF) and emtricitabine (F) (F/TDF) truvada

Question 19

What’s some medications for either only IV drug users or only sexual intercourse PREP?

Answer 19

descovy (F/TAF) – IV drugs only

cobetegravir (CAB) – sexual intercourse only, NO needle sharing

Question 20

Is PEP recommended > 72 hours after exposure?

Answer 20

No

Question 21

If you cannot test a patient can you still administer PEP?

Answer 21

yes – if indicated

try to determine w/ antigen/antibodies or antibody blood tests

Question 22

What is the treatment for HIV PEP?

Answer 22

F/TDF AND raltegravir OR dolutegravir

alternative: F/TDF AND darunavir AND ritonavir

Question 23

What is the first line HIV test?

Answer 23

4th gen to test IgG, IgM, and p24 antigen is go-to and 1st step test (allows detection in window period!0

Question 24

What are some signs of acute HIV infection?

Answer 24

fever, fatigue, myalgia, rash, headache, pharyngitis, lymphadenopathy, arthralgia, night sweats, diarrhea

Question 25

What are some booster drugs?

Answer 25

cobisitat and ritonavir

Question 26

T/F: not all pregnant women should be tested

Answer 26

FALSE! all pregnant women should be tested

Question 27

How is AIDS defined?

Answer 27

signs of opportunistic infections or <200 CD4 count (when they usually occur)

Question 28

What are some symptoms that may occur in a more severe HIV infection?

Answer 28

weight loss, fatigue, chronic diarrhea, seb derm, psoraisis, tinea, onchyomycosis, oral apthous ulcers, oral hairy leukoplakia, gingivitis, peripheral neuropathy, leukopenia, anemia, thrombocytopenia, nephropathy

Question 29

T/F: opportunistic infections are a concerning sign and should make you ask why they are occuring

Answer 29

true!

Question 30

Before starting HIV treatment, what do you need to do?

Answer 30

establish baseline organ function and retest with any modification, 2-8 weeks after starting, and every 3-6 months

Question 31

Can you give measles-mumps-rubella and varicella live vaccines with an HIV vaccine?

Answer 31

yes, if >200 CD4 count. cannot give other live vaccines.

Question 32

What is the confirmatory test of choice for chronic HIV infection?

Answer 32

ELISA and confirmatory Western blot

Question 33

What’s the backbone of HIV treatment?

Answer 33

2 NRTIs , with a 3rd agent like protease inhibitors or integrase inhibitors

Question 34

When should you consider prophylaxis for salmonella, C.diff, karopis sarcoma, TB, HSV?

Answer 34

<500 CD4

Question 35

When should you consider prophylaxis for candida, AIDS dementia, pneumocystitis jirovecii pneumonia?

Answer 35

<200 CD4

Question 36

When should you consider prophylaxis for B cell lymphoma, toxoplasmosis, histoplasmosis, cryptococcis, coccidiomycosis, cryptospordia?

Answer 36

<100 CD4

Question 37

When should you consider prophylaxis for CMV, CNS lymphoma, MAC?

Answer 37

<50 CD4