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Summer FDTN Exam 6 > HIV > Flashcards

HIV Flashcards

1
Q

What are HIV trends

A

incidence has been declining for several years, but is now stable/inclining
Rates are higher in men
20-29 have highest rate of new infection
High risk pop: MSM, heterosexual sex, IVDU

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2
Q

When was AIDS first published

A

1981

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3
Q

What is HIV

A

a retrovirus; uses reverse transcriptase to turn RNS into DNA, integrate it’s genetic material into host DNA, and new virus is produced

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4
Q

What are the types of HIV

A

1: responsible for AIDS
2: isolated in west africa, less aggressive

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5
Q

What does HIV target

A 
T cells (esp CD4 helper cells) 
Also, B lymphocytes and macrophages
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6
Q

What do lymphocytes do

A

WBC that defend against VIRUSES, fungi, some bacteria, and protozoa

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7
Q

What are B and T cells

A

B cells make Abs to attack antigens
CD4 T cells enhance immune response and tell B cells to make Abs
CD8 killer cells destroy foreign agents

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8
Q

How does HIV replication occur

A

HIV particle fuses to CD4 component
HIV incorporated into host cell by reverse transcriptase
New copies of HIV released

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9
Q

How is HIV transmitted

A 
Sexually: exchange of body fluids 
IVDU 
Needlestick injuries (occupational) 
Blood products (extremely low risk now) 
HIV infected mom to infant 
-Basically, requires infectious body fluid and portal of entry! Not spread via casual contact!
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10
Q

What is the risk of transmission

A 
Insertive vaginal sex: 1/10K
Receptive vaginal sex: 1/1K
Needle stick: 1/300
Shared drug needle: 1/150
Receptive anal: 1/50
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11
Q

What is acute HIV

A

2-6 weeks after exposure, HIV initiates the attack and CD4 cells drop rapidly
You develop mono or flu-like Sx that ;ast about 2 weeks, then resolve (this indicates your body initially fighting back at the disease)
Patient is highly infectious

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12
Q

What do labs show in acute HIV

A

HIV antibody test is usually negative! it is too early for your body to have developed antibodies
HIV RNA (viral load) is measurable, and extremely high (>100K)
-Providers often only order the Ab test, which comes back negative, they tell the pt they are negative, and then they go infect others.
-Elevated LFT’s, Leukopenia, anemia, thrombocytopenia

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13
Q

What does catching acute HIV allow

A

To stop the spread of disease to others

But, once you have HIV, you can’t stop the disease progression

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14
Q

What are common manifestations of acute HIV

A 
Fever 
adenopathy 
sore throat
rash* upper trunk, neck, face 
Mucocutaneous ulcers 
myalgias 
arthralgias 
HA
diarrhea
N/V
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15
Q

What is clinical latency

A

It begins as immune system responds to infection (acute illness resolves)- lasts appx 10 years
Patient seroconverts (serum becomes HIV antibody +) around 3 months after infection
Viral load decreases to a set point and slowly rises over time (HIV is active in lymph nodes this whole time)
CD4 slowly declines
Patient is ASx usually

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16
Q

What happens during a symptomatic infection

A

Lymph nodes and tissue are damaged (burnt out)
Virus may mutate and be more pathogenic
Body fails to keep up with replacement of CD4 cells
Viral load (HIV RNA) increases
CD4 count decreases

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17
Q

What are HIV Sx

A 
fever, night sweats 
LAD 
fatigue, malaise 
arthralgias 
weight loss 
*Hairy leukoplakia 
prolonged diarrhea 
cervical dysplasia (HPV) 
Molluscum, dermatophyte infection, seborrheic dermatitis 
*Kaposi Sarcoma 
recurrent HZV 
ITP
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18
Q

What is a normal CD4 count

A

600-1200 (then she says 500-1400)

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19
Q

What is usually the first Sx of HIV

A

Tuberculosis! immune system fails revealing TB Sx

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20
Q

What is AIDS

A

CD4 count <200
OR
HIV + 1 of 27 AIDS defining conditions

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21
Q

What occurs at different CD4 counts

A

<200: P. jiroveci PNA,
<100: Toxoplasmosis
<50: MAC, CMV
Any: Kaposi, Candida

22
Q

What is pneumocystic jiroveci pneumonia

A

airborne fungus that reactivates when CD4 count is <200
Common opportunistic infx associated w/ AIDS
Presents w/ nonspecific Sx (fever, cough, SOB) =/- hypoxemia
CXR shows diffuse perihilar infiltrates

23
Q

How do you diagnose and treat P. jirovecii PNA

A

Sputum sample; can also get LDH (elevated)

Tx: Bactrim DS*** and supportive care

24
Q

What is Toxoplasmosis

A

Parasite (toxoplasma gondii) that reactivates when CD4 <100
Causes encephalitis, IC lesions
Acquired via cat feces, contaminated raw food or utensils
If immunocompetent, you rarely show Sx

25
Q

How does toxoplasmosis present in HIV

A 
HA 
FND 
seizures 
AMS 
Retinitis
Pneumonitis
26
Q

How do you diagnose Toxoplasmosis

A

CT/MRI will show contrast enhancing lesions on brain

Seropositive for toxoplasmosis

27
Q

What is MAC

A

Mycobacterium avium/intracellulare, found in soil and dust, is inhaled or ingested
Can cause pulmonary infections in immunocompetent
In AIDS, can cause systemic disease, night sweats, weight loss, abdominal pain, diarrhea, anemia

28
Q

How do you diagnose MAC

A

Sputum acid fast bacillus (+)
Positive sputum sultures
Positive blood cultures

29
Q

What is CMV retinitis

A 
MC retinal infections in AIDS! 
herpes virus (CMV) transmitted by blood, sex, or perinatally, causes visual disturbances that may lead to blindness
30
Q

How do you diagnose CMV retinitis

A

Perivascular hemorrhages and white fluffy exudates on fundoscope (cotton wool spots, infiltrates, and hemorrhages)
Seropositive (+ Abs) for CMV

31
Q

How is CD count related to candidiasis

A

The more invasive the esophageal or vaginal candidiasis, the lower the CD4 count

32
Q

What is Kaposi’s sarcoma

A

Vascular neoplasm that can occur at any T cell count
MC in older eastern european and mediterranean males
MC in homosexual men
Lesions are multifocal and widespread, w/ associated LAD

33
Q

How do you treat Kaposi sarcoma

A

Many Tx available, like Thalidomide (teratogen that causes short limbs)

34
Q

HIV is…

A

a CHRONIC disease, not a terminal disease!

35
Q

Who should be screened for HIV at LEAST once

A 
everyone 13-64 (can opt out) 
anyone who is starting TB Tx 
At each STD presentation 
Annually for at risk patients (MSM) 
Pregnant women 
-Not providers, because we generally can not transmit HIV to our patients
36
Q

Who should get more frequnt HIV testing

A

Opportunistic infections
TB
Sx of established HIV: weight loss, fever, tiredness, LAD, diarrhea >1 week, sores of mouth, anus, genitals, PNA, unexplained neuro Sx
Sx associated w/ acute HIV

37
Q

What is the HIV antibody test

A

Detects the antibody our bodies make 4-12 weeks after infection, after patient seroconverts

38
Q

What is a rapid HIV test

A

another HIV antibody test done by saliva or blood
If positive, you need a confirmation test
Will not show positive if acute HIV

39
Q

What is preferred testing for HIV

A

Combination HIV antibody&antigen testing!

WILL detect acute HIV (viral load will be high)

40
Q

If a combination HIV Ab/Ag test comes back positive…

A

Must differentiate between HIV 1 & 2 thru the differentiation immunoassay
(In US, MC is: HIV1 +, HIV2 -)

41
Q

What is your pt has no insurance/is very young

A

Maricopa county STD clinic: $20
but, only the rapid test is available
Minors can get STD testing w/o parents, but HIV is not explicitly included. Send minors to county

42
Q

What treatment is recommended in ALL HIV patients (esp. acute/early infection)

A 
Antiretroviral Therapy (ART) 
The earlier you treat, the more immunologic and virologic benefits you experience
43
Q

If you diagnose someone with HIV, how do you proceed

A

Call the HIV clinic, set up an appointment for the NEXT DAY

Get them on Tx ASAP!

44
Q

How do you select ART

A

Based on genotypic drug resistance preformed at referral

45
Q

How long do you treat HIV

A

Lifelong! they must be willing to commit
They can postpone Tx if they will not be compliant and CD4 is higher, around 400ish, because being non-compliant is dangerous. it can lead to resistance

46
Q

What are Tx goals for HIV

A

Suppress plasma HIV RNA levels to undetectable

47
Q

Possible HIV exposures include

A 
Unprotected sex 
Condom broke or fell off 
Rape or sexual assault 
Work related injury 
Sharing needles for drugs
48
Q

What is post-exposure prophylaxis

A

Reduces risk of you acquiring HIV once you have been exposed!
MUST start within 72 hours of exposure

49
Q

What is pre-exposure prophylaxis

A

Daily medication (Truvada) that may be prescribed by HIV specialist or PCP

50
Q

What Sx do you see at different CD4 levels

A

Normal (500-1400): thrush, Kaposi sarcoma (people do well usually if 350+)
200: opportunistic infections
<200= AIDS (or any CD4 with a opportunistic AIDS infx)

51
Q

What meds do you give to patients based on CD4 counts

A

<200: Bactrim (prophylaxis for PJP)
<100: Bactrim (prophylaxis for toxoplasma)
CD4 <50: Azithromycin (prophylaxis for MAC)

Summer FDTN Exam 6 (7 decks)

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