HIV

Question 1

HIV is a ___ virus

meaning

Answer 1

retrovirus, uses cell RNA to replicate

Question 2

origin HIV 1

Answer 2

chimpanzee

Question 3

origin HPV 2

Answer 3

sooty mangaby

Question 4

US most prevalent hiv type

Answer 4

B

Question 5

Worldwide most prevalent hiv type

Answer 5

C

Question 6

highest percentage of hiv is in_____

men vs women

Answer 6

south africa

more women than men

Question 7

total estimated living with HIV

Answer 7

36.7 million

Question 8

percentage women HIV vs men

Answer 8

60%

Question 9

___ out of ___ are unaware of hiv infection

Answer 9

1 out of 8

Question 10

number people infected us

Answer 10

1.2 million

Question 11

population at greatest risk for HIV transmission

Answer 11

black MSM

Question 12

HIV spread pattern

Answer 12

Incubation (asymptomatic) 2-4 weeks

Infx dendritic cells 1 d

lymph nodes- within 24-48 hours

peripheral circulation- 5 d

acute retroviral syndrome at 10days- 10weeks

Question 13

HIV flu like sx present at

Answer 13

2-4 weeks after infection lasting 3-14d

Question 14

EIA (elisa) negative when?

Answer 14

between 3-4 weeks after incubation, will be negative during acute illness

Question 15

HIV RNA PCR positive when?

Answer 15

10-15d

Question 16

cd 4

Answer 16

decline

Question 17

high infectivity during which phase?

Answer 17

acute

Question 18

acute mono like illness presentation

Answer 18

fever rash swollen lymph nodes

Question 19

immune response from high levels of ______ in acute retroviral syndrome

Answer 19

veremia

Question 20

Rapid rise in HIV RNA by day __

Antibody doesn’t start increasing until ___days for EIA

Answer 20

HIV RNA rise by day 14

Antibody rise 28 d

Question 21

Progression to aids

CD4 >500 (associated illnesses?)

CD4 200-500 (associated illnesses?)

Answer 21

500 TB, skin, pneumonia (occurring more frequently than those without HIV)

200-500 opportunist infx, ks, thrush, hsv

Question 22

CD 4 at 200 develop _____ such as ___

Answer 22

opportunistic infections such as

mucocutaneous herpes, esophageal thrush, pneumocystitis carinii

Question 23

percent of children that die if infected from birth and untreated

Answer 23

50% by age 2

ID early 3-6 months

Question 24

viral set point is ____ in children than adults

Answer 24

viral set point is higher in children

Question 25

when do most transmissions occur?

Answer 25

when patient is unaware

Question 26

HIV screening recommendations adult high risk pregnant is written consent required?

Answer 26

adult- once high risk- annually pregnant- once and then may repeat in third trimester depending where written consent should not be required

Question 27

ELISA window period p24 antigen test window period

Answer 27

3-4 weeks one week less

Question 28

test after ELISA what test is actually used?

Answer 28

western blot positive if 2 or 3 bands (p24, gp41, gp120/160) repeated ELISA mostly used in labs

Question 29

rapid HIV testing, is it equivalent to ELISA? what to do if positive?

Answer 29

yes confirmation test

Question 30

HIV test for primary infection? lab value?

Answer 30

HIV RNA at 10-15d >100,000 during acute infection

Question 31

at what age should you test for antibody to HIV in infant born with HIV?

Answer 31

up to 18 months, usually by 10-12, confirm HIV antibody at this time

Question 32

test for infant HIV infection when to test? when to retest for negative confirmation?

Answer 32

HIV DNA PCR NOT HIV RNA PCR*** 2-3 weeks, 1-2 months, 4-6 months (HIV DNA PCR) confirmation at 12-18 months with HIV ANTIBODY**

Question 33

OHL?

Answer 33

oral hairy leukoplakia

Question 34

skin manifestations of HIV

Answer 34

herpes, recurrent staph infections (MRSA), seborrhea

Question 35

plasma HIV viral load test

Answer 35

HIV RNA

Question 36

screening for STIs and OIs

Answer 36

CMV toxoplasmosis Treponemal igg/rpr varicella

Question 37

prior to ART must do what test?

Answer 37

genotyping of HIV

Question 38

pneumocystitis jirovecci tx CD4

Answer 38

PJP formerly PCP bactrim if CD4 <200

Question 39

toxoplasmosis tx CD4

Answer 39

bactrim if cdf <100

Question 40

MAC tx CD4

Answer 40

micobacterium avium complex- azithro weekly (clarithro) if <50

Question 41

routine vaccines for HIV patients

Answer 41

Pneumococcal vaccine (PCV13 then PPV23; CD4>200 preferred) HAV, HBV Influenza HPV (13-26 years)

Question 42

initiation of ART based on Cd4

Answer 42

initiate as soon as possible for any HIV patients regardless of lymph count

Question 43

ART influence on HIV

Answer 43

prevents progression

Question 44

Keeping HIV viral load low helps.... 1) 2)

Answer 44

prevent transmission prevent cancers, heart disease

Question 45

WHO guidelines for ART

Answer 45

*consider tx* for asymptomatic and 350+ cd4, treat all that are <350

Question 46

US DHHS initation ART for pedi recommendations vs WHP

Answer 46

DHHS- treat children regardless of cd4 WHO- treat all children <5 years old, if older than 5 prioritize those with cd4<350

Question 47

example entry inhibitor

Answer 47

post-attachment inhibitor

Question 48

when did HAART become standard of care? when did it start?

Answer 48

1992 started around 1987

Question 49

ART initial regime

Answer 49

integrase inhibitor + 2 NRTI

Question 50

bictegravir type approved for? contraindicated for?

Answer 50

Bictegravir (BIC) HIV-1 integrase strand transfer inhibitor (INSTI) that has been approved by the U.S. Food and Drug Administration for initial therapy in adults with HIV as part of a single-tablet, once-daily regimen that includes tenofovir alafenamide and emtricitabine (BIC/TAF/FTC) creatinine clearance <30 or liver not recommended not approved <18.

Question 51

number of people worldwide on ART % of people with HIV who are on ART worldwide

Answer 51

21 million as of 2017 50%

Question 52

ART drugs increase or decrease metabolism of steroids?

Answer 52

decrease metabolism leading to increase in steroids in the body

Question 53

Drug to drug interactions with ART

Answer 53

``` STEROIDS** STATIN*** methadone ocp rifampin ED drugs PPI St johns coumadin ```

Question 54

statins interaction with art contraindicated- intermediate risk-

Answer 54

contraindicated- simvastatin and lovastatin intermediate- fibrate + statin or atorvastatin

Question 55

perinatal transmission risk hiv...which periods have highest risk?

Answer 55

delivery and breastfeeding

Question 56

___% of mothers received ART in 2018

Answer 56

75%

Question 57

PEP regimen drug for hcp drug for others

Answer 57

3 drug regimen for 28 days Dolutegravir**+ TDF/FTC (truvada) But cant use in pregnant first trimester others- dolutegravir or raltegravir

Question 58

highest risk seroconverion of HIV

Answer 58

IM

Question 59

risk of occupational viral transmission

Answer 59

0.2-0.5

Question 60

labs PEP initial 2 weeks 6 weeks 3 and 6 months

Answer 60

initial- CBC, Cr, LFT, HIV, HAV/HBV 2 weeks- CBC cr LFT 6 weeks- HIV, HCV (RPR) 3/6 months- HIV HCV

Question 61

PrEP tx risk decreased

Answer 61

2 drug therapy daily- TDF/FTC (truvada) risk decreased 92%

Question 62

Guidelines PrEP

Answer 62

- negative HIV test - NO S/S - normal renal - up to date vaccination, documented, including hep B

Question 63

pregnancy PrEP?

Answer 63

discuss risks and benefits

Question 64

prescribing Truvada, how much supply? labs?

Answer 64

90 days max test HIV every 2-3 months

Question 65

treatment regime post exposure prophylaxis

Answer 65

dolutegravir OR raltegravir + TDF/FTC

Question 66

new drug three in one

Answer 66

bictegravir (TAF/FTC)