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Primary care II > HIV > Flashcards

HIV Flashcards

1
Q

HIV is a ___ virus

meaning

A

retrovirus, uses cell RNA to replicate

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2
Q

origin HIV 1

A

chimpanzee

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3
Q

origin HPV 2

A

sooty mangaby

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4
Q

US most prevalent hiv type

A

B

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5
Q

Worldwide most prevalent hiv type

A

C

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6
Q

highest percentage of hiv is in_____

men vs women

A

south africa

more women than men

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7
Q

total estimated living with HIV

A

36.7 million

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8
Q

percentage women HIV vs men

A

60%

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9
Q

___ out of ___ are unaware of hiv infection

A

1 out of 8

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10
Q

number people infected us

A

1.2 million

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11
Q

population at greatest risk for HIV transmission

A

black MSM

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12
Q

HIV spread pattern

A

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

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13
Q

HIV flu like sx present at

A

2-4 weeks after infection lasting 3-14d

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14
Q

EIA (elisa) negative when?

A

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

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15
Q

HIV RNA PCR positive when?

A

10-15d

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16
Q

cd 4

A

decline

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17
Q

high infectivity during which phase?

A

acute

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18
Q

acute mono like illness presentation

A

fever rash swollen lymph nodes

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19
Q

immune response from high levels of ______ in acute retroviral syndrome

A

veremia

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20
Q

Rapid rise in HIV RNA by day __

Antibody doesn’t start increasing until ___days for EIA

A

HIV RNA rise by day 14

Antibody rise 28 d

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21
Q

Progression to aids

CD4 >500 (associated illnesses?)

CD4 200-500 (associated illnesses?)

A

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

200-500 opportunist infx, ks, thrush, hsv

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22
Q

CD 4 at 200 develop _____ such as ___

A

opportunistic infections such as

mucocutaneous herpes, esophageal thrush, pneumocystitis carinii

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23
Q

percent of children that die if infected from birth and untreated

A

50% by age 2

ID early 3-6 months

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24
Q

viral set point is ____ in children than adults

A

viral set point is higher in children

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25
Q

when do most transmissions occur?

A

when patient is unaware

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26
Q

HIV screening recommendations

adult
high risk
pregnant

is written consent required?

A

adult- once

high risk- annually

pregnant- once and then may repeat in third trimester depending where

written consent should not be required

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27
Q

ELISA window period

p24 antigen test window period

A

3-4 weeks

one week less

28
Q

test after ELISA

what test is actually used?

A

western blot

positive if 2 or 3 bands (p24, gp41, gp120/160)

repeated ELISA mostly used in labs

29
Q

rapid HIV testing, is it equivalent to ELISA?

what to do if positive?

A

yes

confirmation test

30
Q

HIV test for primary infection?

lab value?

A

HIV RNA at 10-15d

> 100,000 during acute infection

31
Q

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

A

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

32
Q

test for infant HIV infection

when to test?
when to retest for negative confirmation?

A

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**

33
Q

OHL?

A

oral hairy leukoplakia

34
Q

skin manifestations of HIV

A

herpes, recurrent staph infections (MRSA), seborrhea

35
Q

plasma HIV viral load test

A

HIV RNA

36
Q

screening for STIs and OIs

A

CMV
toxoplasmosis
Treponemal igg/rpr
varicella

37
Q

prior to ART must do what test?

A

genotyping of HIV

38
Q

pneumocystitis jirovecci tx

CD4

A

PJP formerly PCP

bactrim

if CD4 <200

39
Q

toxoplasmosis tx

CD4

A

bactrim

if cdf <100

40
Q

MAC tx

CD4

A

micobacterium avium complex- azithro weekly (clarithro)

if <50

41
Q

routine vaccines for HIV patients

A

Pneumococcal vaccine (PCV13 then PPV23; CD4>200 preferred)

HAV, HBV

Influenza

HPV (13-26 years)

42
Q

initiation of ART based on Cd4

A

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

43
Q

ART influence on HIV

A

prevents progression

44
Q

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

A

prevent transmission

prevent cancers, heart disease

45
Q

WHO guidelines for ART

A

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

46
Q

US DHHS initation ART for pedi recommendations vs WHP

A

DHHS- treat children regardless of cd4

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

47
Q

example entry inhibitor

A

post-attachment inhibitor

48
Q

when did HAART become standard of care?

when did it start?

A

1992

started around 1987

49
Q

ART initial regime

A

integrase inhibitor + 2 NRTI

50
Q

bictegravir
type
approved for?
contraindicated for?

A

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.

51
Q

number of people worldwide on ART

% of people with HIV who are on ART worldwide

A

21 million as of 2017

50%

52
Q

ART drugs increase or decrease metabolism of steroids?

A

decrease metabolism leading to increase in steroids in the body

53
Q

Drug to drug interactions with ART

A 
STEROIDS**
STATIN***
methadone
ocp 
rifampin
ED drugs
PPI 
St johns 
coumadin
54
Q

statins interaction with art

contraindicated-
intermediate risk-

A

contraindicated- simvastatin and lovastatin

intermediate- fibrate + statin or atorvastatin

55
Q

perinatal transmission risk hiv…which periods have highest risk?

A

delivery and breastfeeding

56
Q

___% of mothers received ART in 2018

A

75%

57
Q

PEP
regimen
drug for hcp

drug for others

A

3 drug regimen for 28 days

Dolutegravir**+ TDF/FTC (truvada)
But cant use in pregnant first trimester

others- dolutegravir or raltegravir

58
Q

highest risk seroconverion of HIV

A

IM

59
Q

risk of occupational viral transmission

A

0.2-0.5

60
Q

labs PEP

initial
2 weeks
6 weeks
3 and 6 months

A

initial- CBC, Cr, LFT, HIV, HAV/HBV

2 weeks- CBC cr LFT

6 weeks- HIV, HCV (RPR)

3/6 months- HIV HCV

61
Q

PrEP tx

risk decreased

A

2 drug therapy daily- TDF/FTC
(truvada)

risk decreased 92%

62
Q

Guidelines PrEP

A
  • negative HIV test
  • NO S/S
  • normal renal
  • up to date vaccination, documented, including hep B
63
Q

pregnancy PrEP?

A

discuss risks and benefits

64
Q

prescribing Truvada, how much supply?

labs?

A

90 days max

test HIV every 2-3 months

65
Q

treatment regime post exposure prophylaxis

A

dolutegravir OR raltegravir

+
TDF/FTC

66
Q

new drug three in one

A

bictegravir (TAF/FTC)

Primary care II (13 decks)

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