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ICM - Infectious Disease > HIV > Flashcards

HIV Flashcards

1
Q

What are all boring

A

Diabetic Feet

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2
Q

What are E Europe and Central Asia still on the rise

A

Heroin/IV drug use

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3
Q

Why did N America do so much better starting in 96

A

First release of Protease Inhibitors

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4
Q

HIV History.

A

Read the slide a time or two.

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5
Q

First good protease inhibitor

A

Indenovir

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6
Q

Dr. Myer made an anal joke.

A

lolz

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7
Q

Significance of the Release of HAART (the Protease Inhibitors) in 1996

A

60-80% reduction in mortality from AIDS in US

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8
Q

First signs of HIV showing up in the US population

A

1981 – Penumocystis pneumonia and Kaposi’s sarcoma show up in NYC and SF homosexuals

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9
Q

THe four H’s at risk groups

A

Homosexual
Heroin
Hemophiliac
Haitian

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10
Q

Transfusion related HIV began to diminish in 1985. Why?

A

Serologic Testing Developed

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11
Q

Where does HIV come from?

A

The Congo – ID’d as early as 1959

Most common strain from Africa to Haiti (66) to the US (69)

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12
Q

Why did HIV increase so much in the 70s?

A 
Increased Travel
Gay Sexual Revolution
Increased Blood Transfusions
Transfusing Factor VIII to hemophiliacs
Increased IVDA
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13
Q 
Estimated Transmission Rate. 
Transfusion with Contaminated Blood?
Needle Sharing?
Receptive Anal Intercourse?
Occupational Needle Stick?
A

90%

  1. 7%
  2. 5%
  3. 3%
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14
Q

CDC Testing Guidelines for HIV

A

Screen all healthy patients after notification unless they decline
Specific Informed consent unnecessary
High risk patients should be scheduled annually
Prevention counseling should not be required, but encouraged

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15
Q

Main Clinical Indications for Testing

A 
TB
Syphilis
Recurrent Shingles
Unexplained chronic constitutional symptoms
Unexplained Adenopathy
Unexplained Chronic Diarrhea/Wasting
Thrush
Opportunistic Diseases
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16
Q

Common opportunistic diseases

A 
TB
Pneumo
Kaposi
Peri-anal warts
Thrush/Candidiasis
etc.
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17
Q

Testing for HIV. Who shows up first in blood?

A

HIV RNA in plasma (approx. 10 days)

Used for viral detection

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18
Q

Testing for HIV. Second blood level to rise.

A

HIV p24 Ag

Previously used viral detection method

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19
Q

Testing for HIV. Last level to rise

A

HIV Ab

Takes 20-30 days to become measurable

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20
Q

Common symptoms of Primary HIV

A 
Fever, Fatigue
Rash/Petechiae
Myalgia*
Pharyngitis
Night Sweats*
Weight Loss*
Oral/Genital ulcers
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21
Q

Primary HIV Clinical Clues

A

Mucocutaneous ulcerations
Rash
** Abrupt onset
GI symptoms

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22
Q

Primary HIV Clinical Clues. What makes it less likely

A

Cough/URI

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23
Q

How do you test for HIV?

A

ELISA
Usually works within a month
99% accurate at 3 months

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24
Q

What do you do when you see a positive HIV response.

A

Repeat the test

Still positive, WB to confirm

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25
Q

What are you looking for on the western blot?

A

Three characteristic bands (positive with 2/3)

1/3 indeterminate – check the viral loads

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26
Q

Can a low CD4 be used as a confirmation of HIV?

A

No

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27
Q

Are rapid HIV tests available?

A

yes

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28
Q

What do you need to find in an HIV patient history? (8)

A 
High Risk Behaviors
Knowledge of HIV
Emotional Response to Diagnosis
Family/Social Situation
Employment and Insurance Status
Travel History
Exposure to TB, STDs, Hepatitis
Immunization Status
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29
Q

Labs you need to run on a newly diagnosed patient.

A 
Complete Blood and Differential Count
Liver Function Labs + Fasting Glucose
CD4 count + Viral Load
HIV Genotype Test 
Other disease checks
30
Q

Labs you need to run on a newly diagnosed patient. Other diseases.

A 
Syphilis Testing
Toxo serology
Anti- Hepatitis 
PPD
Pap Smear +/- Anal pap smear
Chlamydia+GC test
G6PD quantitative testing
31
Q

Why do the HIV genotype test?

A

By testing the genotype, you can assess specific genetic indication for which drugs may be most effective in killing off the virus

32
Q

What is the main surrogate marker for HIV disease progression?

A

CD4 levels

33
Q

Normal range for CD4

A

350-110 mm3

34
Q

Normal decline in CD4/year without treatment?

A

75-100 mm3/year

35
Q

Describe the natural history of untreated HIV

A

CD4 levels drop quite a bit while the virus levels shoot up.
Clinical Latency at 10,000-20,000
Slow increase of Virus until the CD4 count drops below 200
Much more symptomatic below this level – here you have worst symptoms and death

36
Q

Prognostic indication of a high early viral load

A

Symptoms are worse for patients with early high levels of the virus. Knocks down the CD4s faster and indicates clinically that the meds will have a rough time.

37
Q

Why is it important to track CD4 levels

A

Determines need for antiretroviral therapy
Need for antimicrobial prophylaxis
Assess Prognosis

38
Q

How are viral loads measures?

39
Q

Normal variability of HIV?

A

0.3 log (3-5 fold)

40
Q

Why monitor viral load?

A

Monitor antiretroviral terhapy

Assess prognosis

41
Q

Average HIV patient with a CD4 above 500

A 
Asymptomatic
Bacterial infections (pneumo, staph), TB, Shingles
42
Q

Average HIV patient with CD4 200-500

A

Many still asymptomatic

Generalized adenopathy, thrush, Kaposi’s

43
Q

Average HIV patient with CD4 below 200

A

PCP, Toxoplasmosis, Cryptococcus

44
Q

Average HIV patient with a CD4 below 50

A

CMV, Mycobacterium avium complex
Increased risk of Lymphoma
Highest Mortality

45
Q

When do you start treating for HIV?

A 
AIDS Defining Condition
CD4 count below 500
Pregnancy if keeping baby
Chronic co-infection with Hep B
HIV-associated nephropathy
46
Q

Targets of HIV drugs. NRTIs

A 
Abacavir
Didanosine
*Emtricitabine
*Lamivudine
Stavudine
*Tenofovir
Zidovudine
47
Q

How do you get resisitant HIV?

A

Failure to adhere to medications that can cause

48
Q

How do integrase inhibitors work?

A

They prevent the incorporation of viral dsDNA from integrating into you DNA

49
Q

What do protease inhibitors?

A

Prevent new RNA protegy from being able to assemble correctly in affected cells

50
Q

What do infusion inhibitors do?

A

Exactly what it sounds like

Blocks virus from coming in

51
Q

Name the fusion innhibitor

A

Enfuvirtide

52
Q

Name the CCR5 Antagonist

53
Q

How do meds usually work

A

Usually 3 drugs at a time, Virus can’t make resistance to 3 at a time
Often two NRTIs with an integrase inhibitor

54
Q

Significance of SMART trial, ART-CC, NA-ACCORD

A

Shows lower risk for people who start above 350

Even better above 500

55
Q

Common NNRTI drugs

A

Delavirdine
Efavirenz
Etravine
Nevirapine

56
Q

What other non-infectious disease state should be watched for in HIV treatment?

A

HIV is an inflammatory disease

57
Q

Preferred Initial Treatment for HIV. NNRTI based.

A

Not Recommended

58
Q

Preferred Initial Treatment for HIV. PI based.

A

DRV/r + TCF/FTC

59
Q

Preferred Initial Treatment for HIV. II based.

A

DTG or EVG/Cobi or Ral + TDF/FTC

60
Q

Preferred Initial Treatment for HIB. Pregnant women.

A

LPV/r + ZDV/3TC

61
Q

When should you initiate ART?

A 
History of AIDS-defining Illness
CD4 below 350 (sometime just blow 500)
Pregnant Women
HIV-associated nephropathy
Hep B coinfection + HBV
62
Q

Complications of HIV treatment

A 
Lipodystrophy syndrome
Lactic acidemia
Premature osteopenia/porosis
Avascular necrosis of hips
Peripheral neuropathy
63
Q

What is Lipodystrophy syndrome

A

Body morphologyy changes and metabolic complications (the big body little arms)

64
Q

Symptoms of Lactic acidosis

A 
Peripheral neuropathy
pancreatitis
Myopathy
Steatosis
Liver Failure
65
Q

Who tends to get occupational exposures

A

Nurses and ancillary staff
24% say it happened this year
Only 106 seroconversions worldwide reported

66
Q

Which stick is most likely to infect. HBV? HCV? HIV?

A

HBV – 30%
HCV – 3%
HIV – 0.3%

67
Q

Why expose someone to ZDV immediately after a needle stick?

A

in this case, AZT was 81% protective against HIV

now they’d get blasted with 2-3 antiretrovirals

68
Q

Examples of non-occupational HIV PEP scenarios

A

Sex/Sexual Assault

IDU

69
Q

Who might you give PrEP to?

A

Patients uninfected with a high risk of infection

70
Q

What is PrEP

A

you should really look that up Bryan

ICM - Infectious Disease (11 decks)

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