HIV Flashcards
HIV is a ___ virus
meaning
retrovirus, uses cell RNA to replicate
origin HIV 1
chimpanzee
origin HPV 2
sooty mangaby
US most prevalent hiv type
B
Worldwide most prevalent hiv type
C
highest percentage of hiv is in_____
men vs women
south africa
more women than men
total estimated living with HIV
36.7 million
percentage women HIV vs men
60%
___ out of ___ are unaware of hiv infection
1 out of 8
number people infected us
1.2 million
population at greatest risk for HIV transmission
black MSM
HIV spread pattern
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
HIV flu like sx present at
2-4 weeks after infection lasting 3-14d
EIA (elisa) negative when?
between 3-4 weeks after incubation, will be negative during acute illness
HIV RNA PCR positive when?
10-15d
cd 4
decline
high infectivity during which phase?
acute
acute mono like illness presentation
fever rash swollen lymph nodes
immune response from high levels of ______ in acute retroviral syndrome
veremia
Rapid rise in HIV RNA by day __
Antibody doesn’t start increasing until ___days for EIA
HIV RNA rise by day 14
Antibody rise 28 d
Progression to aids
CD4 >500 (associated illnesses?)
CD4 200-500 (associated illnesses?)
500 TB, skin, pneumonia (occurring more frequently than those without HIV)
200-500 opportunist infx, ks, thrush, hsv
CD 4 at 200 develop _____ such as ___
opportunistic infections such as
mucocutaneous herpes, esophageal thrush, pneumocystitis carinii
percent of children that die if infected from birth and untreated
50% by age 2
ID early 3-6 months
viral set point is ____ in children than adults
viral set point is higher in children
when do most transmissions occur?
when patient is unaware
HIV screening recommendations
adult
high risk
pregnant
is written consent required?
adult- once
high risk- annually
pregnant- once and then may repeat in third trimester depending where
written consent should not be required
ELISA window period
p24 antigen test window period
3-4 weeks
one week less
test after ELISA
what test is actually used?
western blot
positive if 2 or 3 bands (p24, gp41, gp120/160)
repeated ELISA mostly used in labs
rapid HIV testing, is it equivalent to ELISA?
what to do if positive?
yes
confirmation test
HIV test for primary infection?
lab value?
HIV RNA at 10-15d
> 100,000 during acute infection
at what age should you test for antibody to HIV in infant born with HIV?
up to 18 months, usually by 10-12, confirm HIV antibody at this time
test for infant HIV infection
when to test?
when to retest for negative confirmation?
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**
OHL?
oral hairy leukoplakia
skin manifestations of HIV
herpes, recurrent staph infections (MRSA), seborrhea
plasma HIV viral load test
HIV RNA
screening for STIs and OIs
CMV
toxoplasmosis
Treponemal igg/rpr
varicella
prior to ART must do what test?
genotyping of HIV
pneumocystitis jirovecci tx
CD4
PJP formerly PCP
bactrim
if CD4 <200
toxoplasmosis tx
CD4
bactrim
if cdf <100
MAC tx
CD4
micobacterium avium complex- azithro weekly (clarithro)
if <50
routine vaccines for HIV patients
Pneumococcal vaccine (PCV13 then PPV23; CD4>200 preferred)
HAV, HBV
Influenza
HPV (13-26 years)
initiation of ART based on Cd4
initiate as soon as possible for any HIV patients regardless of lymph count
ART influence on HIV
prevents progression
Keeping HIV viral load low helps….
1)
2)
prevent transmission
prevent cancers, heart disease
WHO guidelines for ART
consider tx for asymptomatic and 350+ cd4, treat all that are <350
US DHHS initation ART for pedi recommendations vs WHP
DHHS- treat children regardless of cd4
WHO- treat all children <5 years old, if older than 5 prioritize those with cd4<350
example entry inhibitor
post-attachment inhibitor
when did HAART become standard of care?
when did it start?
1992
started around 1987
ART initial regime
integrase inhibitor + 2 NRTI
bictegravir
type
approved for?
contraindicated for?
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.
number of people worldwide on ART
% of people with HIV who are on ART worldwide
21 million as of 2017
50%
ART drugs increase or decrease metabolism of steroids?
decrease metabolism leading to increase in steroids in the body
Drug to drug interactions with ART
STEROIDS** STATIN*** methadone ocp rifampin ED drugs PPI St johns coumadin
statins interaction with art
contraindicated-
intermediate risk-
contraindicated- simvastatin and lovastatin
intermediate- fibrate + statin or atorvastatin
perinatal transmission risk hiv…which periods have highest risk?
delivery and breastfeeding
___% of mothers received ART in 2018
75%
PEP
regimen
drug for hcp
drug for others
3 drug regimen for 28 days
Dolutegravir**+ TDF/FTC (truvada)
But cant use in pregnant first trimester
others- dolutegravir or raltegravir
highest risk seroconverion of HIV
IM
risk of occupational viral transmission
0.2-0.5
labs PEP
initial
2 weeks
6 weeks
3 and 6 months
initial- CBC, Cr, LFT, HIV, HAV/HBV
2 weeks- CBC cr LFT
6 weeks- HIV, HCV (RPR)
3/6 months- HIV HCV
PrEP tx
risk decreased
2 drug therapy daily- TDF/FTC
(truvada)
risk decreased 92%
Guidelines PrEP
- negative HIV test
- NO S/S
- normal renal
- up to date vaccination, documented, including hep B
pregnancy PrEP?
discuss risks and benefits
prescribing Truvada, how much supply?
labs?
90 days max
test HIV every 2-3 months
treatment regime post exposure prophylaxis
dolutegravir OR raltegravir
+
TDF/FTC
new drug three in one
bictegravir (TAF/FTC)
