HIV Flashcards
Risk Factors of HIV
- Transmission about 4x higher in presence of active genital ulcer disease (eg HSV, chancroid, syphilis)
Frequency of common symptoms in Acute HIV infection
- fever
- adenopathy
- pharyngitis
- rash
- myalgia/arthralgia
- headach
- n/v
For determining a primary HIV infection what test do you order?
PCR viral load as well as routine HIV antibody/antigen test ELISA
→ VL becomes positive 5 to 20 days after infection onset and is always pos at high level when patient has symptoms.
→ ELISA takes about 3 to 7 weeks to turn positive
Diff Dx for HIV infection
- EBV mono (can be falsely positive in acute HIV)
- CMV, toxoplasmosis, rubella, syphilis, hepatitis
what are examples of conditions in early symptomatic HIV infection
- Thrush
- Vaginal Candidiasis
How to start tx for HIV infected pt?
-use at least three active drugs
-obtain genotype study
→ m184v causes resistance to 3TC and FTC
Tenofovir (TDF)
nRTI’s -Nuke
Generally well safe but has long tern renal effects and bone demineralization – use new form TALA (TAF) instead
Lamivudine (3TC) and Emtricitabine (FTC)
Nuke - very safe but low threshold to resistance
Abacavir
Nuke- Must check pt to make sure not HLA B*5701 pos → can lead to hypotension/high fever → death
Zidovudine (AZT)
rarely used- metabolically not friendly
Efavirenz (Sustiva)
non -nuke
very effective -terrific track record
• odd side effects - transient rash; vivid dreams
• co-formulated
Etravirine
non-nuke
Effective against many Efavirenz-resistant strains
Rilpivirine
non-nuke
-Fewer side side effects then EFV but not as effective when VL is more than 100,000 or CD4 less than 200; can induce wide non -nuke resistance
• co-forumalated
Doravirine
non nuke
new in 2018
co-formulated
Atazanavir
protease inhibitor
-safe well tolerated but causes asymptomatic rise in unconjugated bilirubin pts become jaundice
