HIV

Question 1

What is the pathophys of HIV?

Answer 1

1. Spectrum of conditions caused by infection w/human immunodeficiency virus(HIV)
2. HIV infects components of the human immune system(CD4+T cells),macrophages&
   dendritic cells
3. Destroys CD4+T cells

Question 2

What are the 3 stages of HIV/AIDs?

Answer 2

1. 3 stages of HIV infection
   A. Acute infection
   B. Clinical latency
   C. AIDS

Question 3

How is HIV transmitted?

Answer 3

1. Unprotected intercourse
2. Blood
   A. (contaminated transfusions, hypodermic needles)
3. Vertical transmission
   A. (mother to childduringpregnancy, delivery, or breastfeeding)

Question 4

What is the average survival of HIV w/o treatment?

Answer 4

9-11yrs

Question 5

What is stage I of HIV infection?

Answer 5

1. Initial infection

A. Brief period offlu-like illness

Question 6

What is stage II of HIV infection?

Answer 6

Prolonged sx free period

Question 7

What is stage III of HIV infection?

Answer 7

1. Progresses & interferes w/immune system
2. ↑ susceptibility to common infections
   A. TB
   B. Opportunistic infections (Viral, fungal)
   C. Tumors

Question 8

What are the sxs of stage I? How long does it last?

Answer 8

1. lasts 1-2 wks
A. Fever
B. Tender lymphadenopathy
C. Pharyngitis
D. Rash (20–50% of cases)
-Maculopapular on trunk
E. Headache
F. Oral & genital sores
G. +/- opportunistic infections
H. +/- N/V/D
I. +/- peripheral neuropathyorGuillain-Barre syndrome

Question 9

What are the sxs of stage II? How long does it last?

Answer 9

1. lasts 3-20 yr w/o Tx, avg 8 yr
2. Few or no symptoms at 1st
3. Near end of stage
   A. Fever
   B. Weight loss
   C. GI problems
   D. Myalgias
   E. 50–70% w/generalized lymphadenopathy x 3-6 mo

Question 10

What are the sxs of stage III? How long does it last?

Answer 10

1. Acquired immunodeficiency syndrome (AIDS)
   A. CD4+T cell count less than 200cells/ul
   OR
2. Occurrence of specific diseases associated w/HIV infection (opportunistic infections)
   A. Pneumocystis pneumonia(40%)
   B. HIV wasting syndrome (20%)
   C. Esophageal candidiasis
   D. Recurringrespiratory tract infections
   E. Mycobacterium avium complex (MAC)
   F. NonTB mycobacterium species
   G. Toxoplasmosis
   H. Histoplasmosis

Question 11

What are common AIDS symptoms?

Answer 11

1. Fevers
2. Night sweats
3. Lymphadenopathy
4. Chills
5. Weakness
   6 .Diarrhea

Question 12

What cancers are more likely in AIDs pts?

Answer 12

1. ↑ Risk of viral induced cancers
A. Kaposi's sarcoma
B. Burkitt's lymphoma
C. CNS lymphoma
D. Cervical cancer (HPV)
E. Conjunctival cancer

Question 13

What are the dx studies for HIV/AIDs?

Answer 13

1. CD4 count
A. CD4 counts ≤250 cells/microL
B. IgG & IgM serologic screening for coccidiomycosis  @ Dx  annually if CD4 less than 250 cells/ul
2. PPD screen at Dx & annually
3. CBC
4. CMP
5. UA/UC

Question 14

What is a positive PPD test in an HIV pt? What comes next in management of the pt?

Answer 14

1. ≥ 5mm induration
2. CXR if (+)
3. Tx latent TB w/(+) PPD w/out active disease
   A. Isoniazid (INH) 300 mg qd x 9 mo
   B. Vit B6 (pyridoxine) 10-25 mg qd to prevent neuropathy

Question 15

How is HIV treated?

Answer 15

1. No cure orvaccine
2. Antiretroviral treatment (ART)slows course of disease & may lead to a near-normal life expectancy
   A. Restores cellular immunity
   B. Drug toxicity, drug resistance, adverse drug interactions, high cost & inconvenience of taking daily meds leads to non-compliance
3. Antibiotic prophylaxis

Question 16

What is included in antiretroviral therapy?

Answer 16

1. Combinations of 2 or more medications from 1 or more different classes:
2. Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
   A. “nukes”
3. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
   A. “Non-nukes”
4. Protease Inhibitors (PIs)
5. Entry/Fusion Inhibitors
6. Integrase Inhibitors

Question 17

What therapy is used when the CD4 count is less than 200 cells/ul?

Answer 17

1. Pneumocystis jiroveci pneumonia (PCP), toxoplasmosis, Mycobacterium avium complex (MAC) infection & TB
   A. TMP-SMX (Bactrim DS) QOD
   (Dapsone, atovaquone, inhaled pentamidine if TMP-SMX allergic)

Question 18

What therapy is used when the CD4 count is less than 100 cells per ul?

Answer 18

1. (+) Toxoplasmosis IgG serology

A. TMP-SMX (Bactrim DZ) bid until CD4 > 200 cells/microL

Question 19

What therapy is used when the CD4 count of less than 50 cells per ul?

Answer 19

1. MAC prophylaxis
   A. Azithromycin (Zithromax) or clarithromycin (Biaxin)
   B. Blood Cx for MAC prior to Tx
   C. D/C after CD4 >100 cells/microL > 3 months

Question 20

What is the HIV prophylaxis?

Answer 20

1. 4 interventions
   A. Immediate antiretroviral therapy (ART) for the infected partner in a serodiscordant couple

B. Pre-exposure prophylaxis (PrEP)

C. Prevention of mother-to-child transmission (PMTCT)

D. Post-exposure prophylaxis (PEP)

Question 21

What is the prognosis for HIV?

Answer 21

1. MostHIV-1infected people have detectable viral load & w/out Tx will eventually progress to AIDS
2. W/out treatment, ≈ ½ of people infected w/ HIV develop AIDS w/in 10 yrs

Question 22

How can HIV be prevented?

Answer 22

1. Encouragingsafe sex
2. NYS offers ALL pts ≥ HIV screen
3. Needle-exchange programs
4. Treating those who are infected
   5 .Tx w/antiretrovirals (ART) during pregnancy & delivery
5. ElectiveC-section
6. Avoiding breastfeeding
7. Administer antiretroviral (ART) drugs to newborn
8. Post-exposure prophylaxis for HIV
9. Avoid risk exposure & environmental precautions
   A. Avoid cat feces or eating undercooked meat to avoid Toxoplasmosis risk