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Acute Care II > HIV > Flashcards

HIV Flashcards

1
Q

What type of body fluids can HIV be transmitted throught?

A

Blood
Human milk
Pre-seminal fluid (pre-cum)
Vaginal or rectal fluids
Semen (cum)

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2
Q

HIV-2 compared to HIV-1
which is more transmissible?
Which has a slower CD4 decline and disease progression
Which is susceptible to NNRTI (ART)
Which has a decreased response to protease inhibitors
Which has no commercial viral load assay to monitor suppression or resistance in the U.S.?

A

HIV-1
HIV-2
HIV-1
HIV-2
HIV-2

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3
Q

When do false negatives occur during HIV testing?
Most inidividuals seroconvert within what time frame of infection? Usually it occurs within what timeframe?
Rapid Testing is done via what body fluids?
Rapid test is followed up with 4th gen HIV test which detects what?

A

10-14 days
6 mo; weeks
saliva or blood
antibody, P24 antigen, and reflexes to HIV viral load

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4
Q

Symptoms of Primary HIV include?

A

Fever 96%
Adenopathy 74%
Pharyngitis 70%
Rash 70%
Myalgias 54%
Diarrhea32%
HA 32%
N/V 27%
Hepatosplenomegaly 14%
Weight loss 13%
Thrush 12%
Neurologic symptoms 12%

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5
Q

Management of HIV
Labs to Draw

A

CD4
Viral load
Genotypes (HIV and Integrase), HLA B5701, CCR5 Tropism
CBC, CMP, UA, Lipid, TSH, Phos
RPR, STD screening, pap (cervical and anal)
Hepatitis serology (HAV, HBV, HCV)
CMV IgG, Toxo IgG, G6PD
PPD, Tspot

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6
Q

Management of HIV
Patient Education topics for HIV

A

HIV
transmission
ART
safe sex
mental wellness
substance use
etc

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7
Q

Management of HIV
ART:
Assess what?
More frequent follow up is required at the start of what? How frequent?
Another reason for more frequent follow ups would be?

A

effectiveness, patient tolerance and side effects
HAART; every 4 weeks, then every 8, then 12 and then 16
adherence concerns

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8
Q

After initial follow ups how often should follow ups be?
These assessments should include assessments of what?

A

quarterly
Mental health; sexual behaviors; lifestyle behaviors; and primary care screenings

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9
Q

Goals of Treatment
Reduce what? prolong what?
Restore and/or preserve what?
Maximally and durably suppress what?
Prevent what?

A

HIV-related morbidity; duration and quality of survival
Immunologic function
HIV viral load
Transmission

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10
Q

Tools to achieve treatment goals include?

A

Selection of ART regimen (single vs multiple tablets)
Maximizing adherence
minimizing intolerance
pretreatment resistance testing (genotype)
Periodic resistance testing

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11
Q

Improving adherence strategies include

A

support and reinforcement
simplified dosing strategies
reminders, alarms, timers, texts, and pillboxes
ongoing pt education
trust in PCP
Health coaches/peer educators

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12
Q

CD4 counts are the major indicator of what?
The most recent CD4 count is the best predictor of what?
CD4 is a key factor in determining urgency of what?
CD4 counts are important in determining response to what?
What is an adequate response?

A

immune function
disease progression
ART or need for OI prophylaxis
ART
CD4 increase 50-150 cells/uL per year

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13
Q

CD4 monitoring
Check when?
Check how often during first 2 yrs of ART? or if CD4 is < what?
After 2 yrs on ART with HIV RNA consistently suppressed:
CD4 300-500 cell/uL check how often?
CD4 > 500 cells/uL check how often?
More frequent testing if on meds that do what? or if what happens?

A

Baseline and q3-6mo; immediately before initiating ART
q3-6 mo; 300
q12 mo
optional
meds that lower CD4 counts, or if clinical decline

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14
Q

What is the normal CD4 count?

A

500-1400 cells

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15
Q

With a CD4 count < 200 Start what?

A

PCP Prophylaxis

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16
Q

PCP prophylaxis is for what?

A

Pneumocystis carinii pneumonia caused by fungus called Pneumocystis Jiroveci

17
Q

What to give for PCP prophylaxis
First line?
If G6PD is wnl?
If sulfa allergic and G6PD deficient?

A

Bactrim first line
Dapsone
Mepron

18
Q

With a CD4 count < 50 start what?

A

MAI Prophylaxis

19
Q

MAI prophylaxis is for what?

A

Mycobacterium avium, mycobacterium intracellulare.

20
Q

What to give for MAI prophylaxis?
What to do before stoartin?

A

Azithromycin
Rule out disease

21
Q

Factors that cause moderate decrease in CD4 counts include

A

Acute infections
Major surgery
Corticosteroids

22
Q

Factors that have minimal effect on CD4 count include

A

gender
age
emotional stress
physical stress
pregnancy

23
Q

What is the Goal of ART?

A

To achieve HIV RNA below the limit of detection

24
Q

HIV viral load is the patients what?
The greater the viral burden, the more what?

A

HIV burden
Destruction to CD4 cells

25
Q

When to check RNA levels
Initiating ART
Start or change to ART how often/Until suppressed to what value?
Stable patients? May consider how often for patients who are stable, adherent and with VL suppression >2 yrs?

A

Immediately before initiating ART
2-4 wks (not more than 8 wks) after start or change of ART, then q 4-8wks until suppressed to < 200 copies/ml
q3-4mo; q6mo

Acute Care II (12 decks)

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