HIV Flashcards
What prophylaxis should be given on an HIV patient with a CD4 count<200?
Cotrimoxazole for Pneumocystis jirovecii
At what CD4 count level should the cryptococcal antigen test be tested and what should be done if positive?
CD4 <200: If positive lumbar puncture should be done
List 7 investigations that should be done at diagnosis of HIV
Sputum: TB NAAT
Urine: Dipstix and pregnancy test
Bloods: CD4 count, creatinine and if CD4<200 Cryptococcal antigen
Cervical screening with a PAP smear
How frequently should cervical smear be done in HIV patients?
Every 3 years
Who should get routine TB NAAT while asymptomatic?(5)
HIV patients yearly
People who had TB in the last 2 years yearly for 2 years
Pregnant woman at first antenatal visits
Abnormal TB screening CXR even if there is no known exposure
When excluding TB disease during the TB preventative therapy work up
Which investigations should be done if a patient is on TLD?
Tenofovir: Creatinine at 1 month of regimen, 4 months of regimen and yearly
Lamivudine: Nothing as it has no side effects
Dolutegravir: Nothing as it only have self limiting side effects and no long term effects
What is the adverse effect of tenofovir?
Kidney failure
What is the adverse effect of lamivudine?
Uncommon
What is the adverse effect of dolutegravir?
Uncommon too
What is the adverse effect of zidovudine?
Symptomatic anemia and neutropenia
What is the most important adverse effect of abacavir?
Allergic hypersensitivity reaction
What is the long term effect of . zidovudine?
Lipoatrophy(fat loss)in the face, limbs and buttocks
When it happens switch to another drug
What is the long term effect of efavirenz?
Gynaecomastia
Switch to Dolutegravir
What are the short term side effects of dolutegravir?
Headaches, nausea and diarrhoea and insomnia
Why must a dolutegravir drug be taken in the morning?
To reduce the likelihood of having insomnia
What is the adverse effect of protease inhibitors?
Liver injury
Check ALT and review within 24 hours if symptoms occur
What is the long term complication of lopinavir/ritonavir?
Dyslipidemia ( Total chol>6 and trigs>5)
Name two HIV drugs that lead to diarrhoea.
Dolutegravir
Lopinavir/ritonavir(Switch drug if intolerable and last>6 weeks)
Name two HIV drugs that lead to sleep problems.
Efavirenz and dolutegravir
Contraindications of lopinavir ritonavir (3)
Chronic diarrhoea
CVD risk>20%
High total cholesterol and triglycerides
What is the contraindication of tenofovir?
Kidney disease with eGFR<=50 (creatinine>85 for pregnant patients)
Contraindications of zidovudine (3)
On linezolid
Anemia with Hb<8
Neutrophils<=1
Which investigation should be done routinely if on zidovudine?
FBC and differential count
Which investigation should be done routinely if on lopinavir ritonavir
Total cholesterol and triglycerides
What should be done if ALT>=200 on an HIV patient using TLD?
Stop all medications and refer
When to give HIV patients TB preventative therapy?(3)
If they never had one or if they were in contact with someone with TB.
Contraindications of TB preventative therapy(4)
Previous RR TB, liver disease and alcohol abuse/misuse and neuropathy
What is TB preventative therapy?
Isoniazid/rifapentine(3 HP) with pyridoxine(B6) for 3 months(used when VL<50)
Or
Isoniazid for 12 months with B6(used VL>50)
Can Prednisone be used for rifampicin resistant TB?
Nope only used in DS TB with improving symptoms and CD4<100
Stop at 4 weeks
When should ART be started on a patient with known TB meningitis or brain tuberculoma?
After 4-8 weeks of TB treatment
When should you start ART if the patient is known with pulmonary TB?
Start ART after 8 weeks of TB treatment
When should ART be started if a patient has TB and CD4<50?
DS-TB: Within 2 weeks of TB treatment
RR-TB: After 2 weeks of TB treatment
Pregnant/breastfeeding: within 2 weeks of starting TB treatment
When should ART be started in a patient known with Cryptococcal meningitis?
After 4-6 weeks of meningitis treatment
What is meant by virological failure?
When a patient is on TLD and adherent but the viral load is>=1000 for at least 2 times after starting TLD and has been using it for >2 years
What are two adverse side effects of tenofovir disoproxil fumarate
Bone demineralisation and hypochloremic metabolic acidosis(RTA)
