HIV

Question 1

At which rate does the CD4 count fall? What is the normal CD4?

Answer 1

From normal 600-1000 falls at a rate of 50-100/year if untreated

Question 2

Transmitted by

Answer 2

IUD
sex (vaginal transmission is 1:3000-1:10000, anal 1:100)
Transfusion (before 1985)
Perinatal (25-30%) without prophylaxis
Needle stick injury(1:300)

Question 3

PCP appears under which CD4 count?

Question 4

Infections occurring under 200/uL are

Answer 4

PCP
varicella zoster
Herpes simplex
TB
Oral and vaginal candidiasis
Bacterial pneumo

Question 5

Best initial test to dx HIV, confirmed with

Answer 5

ELISA

Confirmed with western blot

Question 6

What dx test to use in infants?

Answer 6

PCR or viral culture (false positive ELISA cause maternal HIV antibodies are present for up to 6 mo aftr delivery)

Question 7

How to test response to tx?

Answer 7

PCR RNA viral load

Question 8

When is PCR RNA viral load relevant?

Answer 8

Infants
Measure response to tx
Detects treatment failure
Goal of tx is to drive it down to undetectable levels (

Question 9

Before starting medications which test should be done?

Answer 9

Viral resistance testing

Question 10

Viral resistance testing (genotyping) is done when? Why?

Answer 10

Before initiating tx
Decreases likelihood of starting meds to which pt’s virus is resistant
Guides choice of medication

Question 11

When is HIV treatment initiated?

Answer 11

CD4100000/uL or

Opportunistic infection occurs

Question 12

Initial drug regimen

Answer 12

Emtricitabine, tenofovir and efavirenz

Question 13

How to detect tx failure?

What to use then?

Answer 13

Rising viral load raises
CD4 count decreases or fails to raise

Alternative drug regimens: 3 drugs from 2 classes

Question 14

Nucleoside and nucleotide reverse transcriptase inhibitors

Answer 14

Zidovudine
Didanosine
Stavudine
Lamivudive
Emtricitabine
Abacavir
Tenofovir

Question 15

Side effects of zidovudine?

Answer 15

Macrocytic anemia

Question 16

Side effects of didanosine?

Answer 16

Neuropathy and pancreatitis

Question 17

Side effects of stavidine?

Answer 17

Neuropathy and pancreatitis

Question 18

Side effects of tenofovir

Answer 18

Renal toxicity

Question 19

Non nucleoside reverse transcriptase inhibitors

Answer 19

Efavirenz
Etravirine
Nevirapine

Question 20

Protease inhibitors

Answer 20

Ritonavir
Saquinavir
Nelfinavir
Amprenavir
Fosaprenavir
Lopinavir

Question 21

Side effects of protease inhibitors

Answer 21

Hyperlipidemia and hyperglycemia

Question 22

Side effect of indinavir

Answer 22

Kidney stones

Question 23

If the patient is resistant to multiple classes of first line agents, we use

Answer 23

Entry inhibitors: enfuvirtide, maraviroc

Integrase inhibitor: raltegravir

Question 24

When to do postexposure prophylaxis?

Answer 24

All significant needle stick injuries if hiv status is known
Sexual exposures
Bites
Give 4 weeks of combination tx (no need if exposure to urine and stool)

Question 25

Side effects of abacavir

Answer 25

Hypersensitivity, Steven Johnson reaction

Question 26

Side effects of tenofovir

Answer 26

Renal insufficiency

Question 27

If the patient is pregnant but the CD4 count is high, should you start/continue tx?
Which drug is teratogenic?

Answer 27

Yes

Efavirenz

Question 28

After delivery can you stop medications?

Answer 28

Yes, if the t cell count is >500

Question 29

If a baby is born from an hiv positive mom, what is the tx?

Answer 29

Zidovudine during delivery (intrapartum) and for 6 weeks after to prevent transmission.
If baby is hiv + (less than 1%) HAART

Question 30

At which viral load should you perform cesarian section?

Answer 30

> 1000uL

Question 31

How long does it take after infection to have clinical manifestations of HIV?

Answer 31

5-10years