HIV Flashcards
What should you always test in HIV to confirm what type and what resistance the virus has?
HIV genotype
What are some risk factors for HIV?
sexual intercourse without protection, IV drug use, alcohol, and for severity = the viral load amount
How is HIV transmitted?
blood, semen, pre-seminal fluids, vaginal fluids, rectal fluids, breast milk
T/F: not everyone needs to be tested in the age 13-64
False. Everyone should be tested at least once
What’s one of the more important markers in determining ability to transmit and severity of infection?
viral load
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
?
at least once a year
What’s a technique to maximize testing for HIV in a respectful and responsible manner as a provider?
Opt out approach – less likelihood of parents refusing
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)?
PCR
How can you prevent HIV transmission?
condom use, never sharing needles/syringes, using PrEP and PEP!
T/F: when you get a positive HIV test, you should wait to start ART
false. Start immediately!
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
PREP, every 3 months
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
PrEP, every 6 months
When on ____, every __ months you need to:
* monitor eCrCl for ALL
* monitor triglycerides, cholesterol, and weight (F/TAF)
* screen heterosexuals for chlamydia
PrEP, 12 months
T/F: not all providers can prescribe PREP
false. Everyone can!
T/F: you should prescribe HIV to anyone who asks for it
true
When prescribing ____, you should test:
* HIV
* STI
* kidney function
* HBV serology
* lipid profile
PREP
When prescribing ____ you should test:
* HIV
* pregnancy
* liver
* urea nitrogen/creatinine
* STIs
* hep b
* hep C antibodies
PEP
What’s first line for ALL HIV-potential patients for PREP?
tenofovir disoproxil fumurate (TDF) and emtricitabine (F) (F/TDF) truvada
What’s some medications for either only IV drug users or only sexual intercourse PREP?
descovy (F/TAF) – IV drugs only
cobetegravir (CAB) – sexual intercourse only, NO needle sharing
Is PEP recommended > 72 hours after exposure?
No
If you cannot test a patient can you still administer PEP?
yes – if indicated
try to determine w/ antigen/antibodies or antibody blood tests
What is the treatment for HIV PEP?
F/TDF AND raltegravir OR dolutegravir
alternative: F/TDF AND darunavir AND ritonavir
What is the first line HIV test?
4th gen to test IgG, IgM, and p24 antigen is go-to and 1st step test (allows detection in window period!0
What are some signs of acute HIV infection?
fever, fatigue, myalgia, rash, headache, pharyngitis, lymphadenopathy, arthralgia, night sweats, diarrhea
What are some booster drugs?
cobisitat and ritonavir
T/F: not all pregnant women should be tested
FALSE! all pregnant women should be tested
How is AIDS defined?
signs of opportunistic infections or <200 CD4 count (when they usually occur)
What are some symptoms that may occur in a more severe HIV infection?
weight loss, fatigue, chronic diarrhea, seb derm, psoraisis, tinea, onchyomycosis, oral apthous ulcers, oral hairy leukoplakia, gingivitis, peripheral neuropathy, leukopenia, anemia, thrombocytopenia, nephropathy
T/F: opportunistic infections are a concerning sign and should make you ask why they are occuring
true!
Before starting HIV treatment, what do you need to do?
establish baseline organ function and retest with any modification, 2-8 weeks after starting, and every 3-6 months
Can you give measles-mumps-rubella and varicella live vaccines with an HIV vaccine?
yes, if >200 CD4 count. cannot give other live vaccines.
What is the confirmatory test of choice for chronic HIV infection?
ELISA and confirmatory Western blot
What’s the backbone of HIV treatment?
2 NRTIs , with a 3rd agent like protease inhibitors or integrase inhibitors
When should you consider prophylaxis for salmonella, C.diff, karopis sarcoma, TB, HSV?
<500 CD4
When should you consider prophylaxis for candida, AIDS dementia, pneumocystitis jirovecii pneumonia?
<200 CD4
When should you consider prophylaxis for B cell lymphoma, toxoplasmosis, histoplasmosis, cryptococcis, coccidiomycosis, cryptospordia?
<100 CD4
When should you consider prophylaxis for CMV, CNS lymphoma, MAC?
<50 CD4
